Female Genital Schistosomiasis: A Silent Threat to Women's Health and Gender Equality

14 Oct 2024

Female Genital Schistosomiasis (FGS), is a serious but often overlooked public health issue, disproportionately affecting women in rural Africa. Caused by the parasitic worm Schistosoma haematobium, FGS leads to severe gynecological complications such as lesions, vaginal bleeding, pain, and infertility. Despite millions of women in endemic regions being at risk, FGS remains underdiagnosed and undertreated, exposing a larger issue of gender inequality in healthcare access and diagnosis.

FGS primarily affects women in communities where freshwater sources—often contaminated with Schistosoma larvae—are used for daily activities like bathing, washing, and farming. The infection occurs when the larvae penetrate the skin, often during contact with infected water, and migrate through the body, affecting the urogenital system. Unfortunately, the symptoms of FGS, such as vaginal discharge, bleeding, pelvic pain, and lesions closely resemble those of sexually transmitted infections. As a result, women are frequently misdiagnosed and wrongly treated for these infections or other gynecological conditions including cervical cancer, without the root cause—FGS—being addressed. This results in women, particularly those in rural and underserved areas, suffering in silence without access to the proper care they desperately need.

The consequences of FGS extend beyond the immediate symptoms. Women affected by the disease are at higher risk of contracting life-threatening infections, such as HIV and human papillomavirus, which is a risk factor for cervical cancer. Despite being one of the most prevalent gynecological conditions in schistosomiasis-endemic regions, FGS is rarely diagnosed due to a severe lack of awareness among healthcare providers. This lack of recognition is particularly dangerous in rural areas, where resources are scarce and access to health services is limited.

Preventive treatment with praziquantel—a safe and effective medication that kills adult worms and prevents the development of new FGS lesions—is critical to protecting women’s health. However, rural communities face difficulties in accessing this medication due to limited resources, poor awareness among community members, and healthcare infrastructure challenges.

In response to this urgent issue, the Expanded Special Project for the Elimination of Neglected Tropical Diseases (ESPEN) works through gender-sensitive and transformative strategies to support countries in establishing National Multisectoral FGS Committees, which coordinate the planning and implementation of tailor-made interventions including programs for community health workers and clinicians, community engagement and WASH. These efforts have proven successful in countries like Ghana and Mozambique, where high-level Ministry of Health involvement has been instrumental in securing the advocacy necessary for sustainable action.

The Path Forward: A Call for Action

At the 2024 World Health Summit, FGS took center stage during a special event titled "Investing in Women's Health: Driving Global Development." This session commemorated 30 years of the International Conference on Population and Development agenda, underscoring that while significant progress has been made, many women have been left behind—particularly those suffering from conditions like FGS. A new initiative was announced to end the neglect of FGS, calling for investment in women-centered health services, cross-sectoral collaboration, and targeted interventions to improve health outcomes for women and girls. ESPEN joins the global community in celebrating this milestone and committing to scaling up efforts in the Africa region.

The WHO’s Neglected Tropical Diseases (NTD) Roadmap 2021-2030 emphasizes the integration of disease interventions to strengthen health systems and improve outcomes for affected populations. For FGS, this means incorporating its prevention and treatment into broader healthcare frameworks, particularly those addressing sexual and reproductive health, HIV, and maternal health.

By addressing gender-based disparities in healthcare and promoting equitable access to services, global health leaders can reduce the impact of FGS and empower women and girls in endemic regions to lead healthier lives.

Female Genital Schistosomiasis remains a silent but devastating disease for millions of women in Africa. With increased awareness, investment, and a commitment to gender-sensitive health strategies, we can turn the tide on this neglected disease, ensuring that no woman is left behind.