A gender sensitive approach to trachoma

Trachoma affects more women than men. This article explains why it is important for trachoma elimination programmes to adopt a woman-orientated approach and what can be done in practice.

What is the evidence that women are more affected by trachoma?

Trachoma-related blindness is up to four times more common in women than in men. A systematic review of published research reported that women are 1.8 times more likely to have trichiasis compared to men. This is most likely due to their role as the primary caregiver to children within the household and their close contact with infected children, resulting in more frequent exposure to ocular Chlamydia trachomatis infection.

Why are gender, health and trachoma associated?

In most societies, women and girls are responsible for caring for children. In trachoma-endemic populations this increases their risk of acquiring ocular Chlamydia trachomatis infection from children with active trachoma, and may be the cause of their elevated risk of developing trachoma-related blindness.

• Women and girls are often the ones responsible for household work including cooking, collecting water, cleaning the house. Collecting water places a significant burden on women and girls when they have to walk long distances. This can result in girls missing school and not receiving key education messages about health.

• Women are disproportionately affected by lack of adequate water and sanitation services. Women and girls who do not have a toilet at home often wait until nightfall to defecate. This results in discomfort and potential health issues. Walking long distances to shared toilets or open defecations fields at night also increases the risk of harassment and assault. Lack of separate toilet facilities at schools can deter girls from attending, especially during menstruation.

• Women may have less freedom to travel outside their community if they have to stay at home to care for children and do household chores. This often means that women have less access to health care services.

• Women do not always have the authority to make financial decisions. They may have to seek permission from their husband to spend money. When resources are limited, they may decide to prioritise the family’s needs over their own.

• Women who suffer from visual impairment from trachoma may downplay or conceal their disability for fear that exclusion or stigmatisation may affect their family situation or marriage prospects.

What should programmes do to reach women?

As primary caregivers, women play a central role in improving the health of their families and communities. Programmes need to ensure that they are reaching and meeting the needs of women. This includes:

• Encouraging women to bring their children for treatment

• Promoting safe hygiene practices such as facial cleanliness

• Promoting the provision of adequate water, hygiene and sanitation (WASH) services

• Counselling women on the need for trichiasis surgery.

Reaching women: Practical examples

• Understand local culture and behaviour for WASH: Employ women health workers in health promotion activities. Women may feel more comfortable talking about problems with other women.

• Develop specific information messages: Design health promotion campaigns that include messages and communication channels that will reach women e.g. posters, plays, radio messages

• Empower behaviour change: Involve women’s groups, self-help groups and village committees in trachoma control activities, hygiene promotion and in the planning and management of water supply and sanitation programmes.

• Seek support: Talk with and advocate to men and other family members about the importance of treatment and surgery for women.

• Reach the most vulnerable groups: Identify households headed by women and ensure they receive adequate support.

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