Ugandan Mothers Caught Between Ebola and Hunger

By Timothy Okwir

Uganda has battled Ebola outbreaks for decades, but amid the chaos of containment efforts, one group remains overlooked—breastfeeding mothers and their babies. When the virus strikes, these women are forced into impossible decisions. Should they continue nursing, risking potential transmission? Or should they stop, depriving their infants of life-saving nutrition? Without clear, research-backed answers, mothers and healthcare providers in Uganda are left to navigate a terrifying unknown.

In Uganda, where access to clean water and medical care is limited, breastfeeding is essential for infant survival. The World Health Organization (WHO) and UNICEF stress the importance of exclusive breastfeeding for the first six months, followed by continued nursing for two years or more. Breastmilk not only nourishes babies but also strengthens their immune systems, offering protection against infections that thrive in unhygienic conditions. However, during an Ebola outbreak, the very act of breastfeeding becomes a source of fear. The virus spreads through bodily fluids, and though transmission through breastmilk has not been conclusively proven, the uncertainty has led to drastic and often harmful decisions.

Ebola is a ruthless disease, and its toll on pregnant women and infants is devastating. The symptoms—fever, exhaustion, vomiting, diarrhea, and internal bleeding—can be fatal, with mortality rates soaring among expectant and nursing mothers. Uganda’s healthcare system, already stretched thin, struggles to provide safe alternatives to breastfeeding, such as formula feeding with clean water. This leaves many mothers with an agonizing choice: risk Ebola transmission or expose their babies to malnutrition and deadly infections. In past outbreaks, confusion and fear have led to dangerous practices, including unnecessary separation of mothers and babies, abrupt breastfeeding cessation, and vaccine hesitancy due to misinformation.

Alarmingly, there is more research on Ebola’s presence in semen than in breastmilk. WHO guidelines for breastfeeding during an outbreak are based on what they themselves call “very low-quality” evidence—more speculation than science. This lack of knowledge has dire consequences in Uganda. Some mothers refuse Ebola vaccinations, fearing potential harm to their nursing infants. Others stop breastfeeding out of caution, unintentionally making their babies more vulnerable to diseases like pneumonia and diarrhea—both of which can be just as deadly as Ebola. In some cases, infected mothers and infants have been forcibly separated, despite no definitive proof that breastmilk itself is infectious. These misguided interventions, driven by fear rather than data, may be causing more harm than good.

For years, experts have urged the global health community to prioritize research on Ebola and breastfeeding, yet little has been done. Uganda, with its history of repeated Ebola outbreaks, should be at the forefront of these studies. A recent paper in The Lancet Global Health outlines a roadmap for closing this deadly knowledge gap. Key questions remain unanswered: Can Ebola be transmitted through breastmilk, and if so, for how long? Can infected milk be treated to make it safe? Should breastfeeding continue if both mother and baby have the virus? Could vaccinating mothers help protect their nursing infants? These are not theoretical concerns—they are urgent, life-or-death questions for Ugandan families.

Uganda has the expertise and experience to lead this research. With top virologists and public health specialists working on the frontlines, the country is well-positioned to conduct studies that could provide much-needed answers. While researching Ebola during an active outbreak is challenging, many of these studies—particularly on vaccine safety—can be conducted in advance. If Uganda spearheads this effort, it could save countless lives, not only within its borders but across Africa and beyond. Governments, health organizations, and pharmaceutical companies must step up to fund and support these critical studies.

The issue extends beyond Ebola. It is part of a larger, systemic problem known as the “female data gap,” where women’s health concerns are historically under-researched. The Universal Declaration of Human Rights states that “motherhood and childhood are entitled to special care and assistance.” But without the necessary research, these words are meaningless for Ugandan mothers. Breastfeeding women deserve clear, evidence-based guidance—guidance that could mean the difference between life and death for their children. Uganda has the opportunity to lead the way in closing this gap. The time for hesitation is over. The world must act now.