We asked Dr Mark Pietroni of LAMB hospital about the situation of women in Bangladesh, and how their TB work affects women particularly:

Maternal mortality is high in Bangladesh, female participation in civil society is very limited and education of women, though actively encouraged for girls by government subsidies, still lags behind males at the higher levels.  Women have a literacy rate 20% than average in a community where average literacy is only 40% – and this judged by the most minimum of criteria. 

Crimes against women are widely reported, and domestic abuse is commonplace – a report by the Center for Health and Gender Equality in the USA in 1999 noted that 47% of women in Bangladesh have been physically assaulted by their husband or partner.  The Dowry and a patrilineal marriage system are common causes of abuse, discord, divorce, and increased poverty, as well as being a primary reason for a preference for male children and the neglect of girls. 

LAMB’s work is providing a vital service for women and their families – if the rural population of Bangladesh have access to health care facilities and can work, they are much less likely to feel the need to move into the cities such as Dhaka, leading to family break-up, loss of community, increased pressure on urban services and even greater poverty.

With regards to TB, case finding among women is much lower than men.  This may be due to exclusion from wider society and hence decreased exposure to the disease, or this exclusion may inhibit access to TB services.  It is not uncommon for a man to leave his wife if she develops TB, and if she is not already married the stigma attached to TB may prevent a woman from finding a husband.  TB can lead to isolation and abandonment by the woman’s family members too.  This may hinder women’s presentation for diagnosis and treatment because of (rightly) perceived increased stigmatisation resulting from the diagnosis of TB. 

These intangible burdens result in depression, anxiety and lower life satisfaction, further adding to the burden of TB.  Involving women in the strategy to reach women, especially as volunteers, and as trained community health educators (especially those who have been cured of the disease) has proved effective in the field of leprosy locally, and LAMB aims to use these methods in regard to TB.   LAMB’s awareness-raising work not only improves self-referrals and early case-detection, but also aims to change attitudes to the disease, breaking down the barriers of discrimination and stigma.