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on women and girls. Because they are over-represented among caregivers, nurses and cross-bordertraders, women have an increased risk of exposure, and more women than men have contracted thevirus in Guinea and Sierra Leone. 140 Some reports also claim that women are dying from Ebola in muchgreater numbers than are men. 141 In addition, observations from the field point to a series of indirectconsequences for women. Because medical staff are focused on Ebola and because many peopleare afraid of getting infected if they visit health facilities, women are not receiving treatment for otherconditions; and childbirth has become more risky because maternal health clinics have had to close orpregnant women choose to stay home to give birth. 142Affordability and accessibility are major issues,particularly for women who are less able to payuser fees or travel costs to reach facilities. Poorservice quality as well as discriminatory social norms,stigmatization and fear of violence may also deterwomen and girls from using education, health, wateror sanitation facilities. Addressing these barriers isessential to ensure their equal enjoyment of rights.Women have organized to improve their accessto and delivery of social services through theirinvolvement in water or school managementcommittees, local health councils and patientforums. 143 Ensuring the transformation of socialservices in the long term requires governmentaction to hold service providers to account ongender equality outcomes. Such action must bebolstered by making information freely available tocitizens, regularly monitoring the performance ofproviders as well as rewarding responsiveness andsanctioning neglect of women’s needs. Vigilant usersand civil society organizations are also crucial tocounter strategies by conservative lobbies or vestedinterests to subvert gender equality mandates duringimplementation. This is particularly important whereservice provision is contested, as is the case for sexualand reproductive health. 144The remainder of the chapter focuses on threetypes of social services: health, care and water andsanitation. It reviews the extent to which current policyand provision in each of these areas supports genderequality and the realization of women’s economicand social rights.HEALTH SERVICESBiological differences between women andmen—as well as socially determined differencesin their rights, roles and responsibilities—havean impact on their health risks and status. 145For example, although women across theglobe tend to live longer than men, for bothbiological and behavioural reasons, their livesare not necessarily healthier. Lack of controlover resources, the burden of unpaid care anddomestic work and gender-based violence allundermine well-being among women. In somecountries, gender-based discrimination dampensthe general pattern of greater female longevity,such that female life expectancy at birth is similarto that of males. 146The right to health is enshrined in a number ofhuman rights treaties and instruments (see Box3.8). It goes beyond access to health servicesto encompass a range of factors influencingwhether people can lead healthy lives. It isintimately connected to other economic andsocial rights, including rights to food, socialprotection, housing, water and sanitation aswell as rights at work. For example, women’sgreater morbidity in old age may be magnifiedby their lesser access to pensions, while women’shealth risks during pregnancy are affectedby the availability of paid maternity provisionand health and safety conditions at work(see Chapter 2), as well as by their access toantenatal care.