Zika: A Chance to Expand Reproductive Rights?
Recently, medical detectives from the CDC arrived in Brazil to investigate the suspected, but as yet unproven, link between the Zika virus and serious birth defects like microcephaly Guillain-Barré syndrome.
As scientists look for definitive proof, governments in countries like Brazil and Colombia have offered this piece of advice to their citizens: Don't get pregnant. That guidance, says Wendy Chavkin, special lecturer and professor emerita in Population and Family Health, is as about as helpful as Marie Antoinette's infamous "Let them eat cake."
In Latin America, the center of the Zika outbreak, access to contraception is limited and, in many countries, safe abortions are nearly impossible. In El Salvador, for example, abortion is illegal with no exceptions, even if the health of the mother is at stake. Without access to a full range of reproductive health services, telling women to avoid pregnancy in the wake of Zika is "somewhere between callous and cynical," says Chavkin. "It's appalling, meaningless, and not pragmatic at all."
Zika is not a new virus — the first human case dates back to 1952 — but its latest appearance is the first time the mosquito-borne virus has been linked to microcephaly. Prior to the current outbreak, Zika symptoms were thought to be fairly mild for everyone: a fever, a rash, joint pain. But now, when a pregnant woman contracts Zika, the suspected consequences for her unborn child are believed to be serious and life-long.
Chavkin, a co-founder of an international coalition of doctors who work to advance reproductive rights called Global Doctors for Choice (GDC), was first alerted to the Zika outbreak and its possible effect on pregnancy by a former student of hers. Brazilian Mailman alumna Brena Sena, MPH ’14, now works as a researcher in Santiago, Chile, and keeps a close eye on the news in her home country. Last year, she read with increasing frequency about cases of a "weaker dengue" virus that was eventually identified as Zika. After Brazil's government linked Zika to a microcephaly cluster in Recife, Sena knew the outbreak would have implications for reproductive health — and that she had to share the news with Chavkin and her organization. Since then, Sena has worked with the Brazilian chapter of GDC to better understand the outbreak and to advocate for clearer communications from the Brazilian Ministry of Health, in addition to doing freelance reporting about Zika.
When Zika moved from Brazilian local news to global front pages, Sena noticed a discrepancy between advice from international health agencies and reality in Brazil: "The CDC and WHO talk about the rights of women — to get an ultrasound, to understand what's going on, to make educated decisions," she says. "Where we are, women facing Zika, especially poor women, don't have access to choice."
Zika has been called a "disease of the poor" and an "epidemic that mirrors the social inequality of Brazilian society." Like so many other mosquito-borne illnesses, it thrives in areas with poor sanitation, standing water, and inadequate infrastructure. At an increased risk of contracting the virus, women living in poverty have fewer resources to access information about preventing pregnancy, contraception methods, and abortion services. And the high costs for being poor continue after their baby is born: poor families are also less able to adequately support and raise a child with developmental problems resulting from the birth defects believed to be caused by Zika.
Many advocates, including GDC, see Zika as an opportunity to expand access to contraception, broaden abortion laws, and invest in women’s health services in Latin America. GDC has action centers in several countries where Zika is hitting the hardest, and is currently working to "ensure that women in Latin America and the Caribbean have the information, sex education, support, and services, including full access to contraception and abortion." (Learn more about GDC's work on Zika at GlobalDoctorsforChoice.org.)
There is reason to hope for change in the heavily Catholic region, says Chavkin — though that change may only be incremental. In the past, Brazil has shown itself open to making small health-related exceptions to its highly restrictive abortion laws. Just a few years ago, the country expanded its exceptions beyond cases of rape and endangerment of the health of the mother to include evidence of anencephaly, a fatal birth defect. And in terms of access to pregnancy prevention methods, even Pope Francis has shown himself to be amenable to loosening the Church's absolute ban on contraception, saying during a recent trip to Mexico that "avoiding pregnancy is not an absolute evil."
The World Health Organization has declared Zika an international public health emergency, and the global response should involve efforts to tackle several public health issues at once. "If people are really serious about fighting Zika," says Chavkin, "The general approach needs to focus on improving sanitation, controlling mosquitoes, mitigating the effects of climate change, and guaranteeing the right to full and adequate reproductive healthcare for all women."
Mailman School of Public Health, Columbia School of Public Health
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