Outbreak preparedness for women and girls in low- and middle-income countries: a qualitative study

Abstract Background Infectious disease outbreaks (“outbreaks”) pose heightened gender-based violence (GBV) risk for women and girls. However, little is known about the integration of GBV and gender-informed programming within outbreak preparedness and response in low- and middle-income countries (LMICs). Methods This qualitative study draws on in-depth interviews with ten public health practitioners with experience supporting infectious disease outbreak preparedness and response in LMICs. Participants represented intergovernmental organizations and worked across multiple outbreak contexts, including Ebola, COVID-19, Mpox, Zika, and Cholera, in diverse geographic settings. Interviews examined barriers, gaps, successes, and opportunities for integrating gender-informed programming and GBV considerations into outbreak preparedness and response. Authors employed thematic content analysis with a mixed inductive and deductive coding approach to analyze data. Results Four major themes emerged. First, participants described the persistent normalization of excluding gender and GBV considerations from outbreak response, driven by competing priorities and inadequate funding. Second, they identified insufficient community engagement and localization, emphasizing that responses often fail to account for existing gender norms, community priorities, and local expertise. Third, participants highlighted fragmented coordination across sectors and organizations, advocating for stronger partnerships with women-led organizations (WLOs), improved collaboration, and more gender-balanced leadership. Finally, they emphasized the need to better institutionalize lessons learned and operationalize existing evidence to strengthen preparedness and support more effective, gender-informed responses during future outbreaks. Conclusions To strengthen gender integration in global outbreak response, we recommend embedding GBV risk mitigation throughout response planning, improving cross-sector coordination and gender-balanced leadership, strengthening partnerships with local WLOs, and adopting flexible long-term funding mechanisms. Integrating gender-informed approaches into outbreak preparedness is essential to protecting women and girls, strengthening community resilience, and improving the effectiveness and sustainability of public health responses in LMICs.