Every day, we learn more about Zika: its epidemiology, transmission, and myriad complications. As of last week, the Centers for Disease Control and Prevention (CDC) confirmed the highly suspected link between Zika and microcephaly and other potential brain defects. While agencies work feverishly to develop and test a Zika vaccine for future prevention efforts, we must confront the current outbreak’s ongoing repercussions.
On April 12, the Maternal Health Task Force co-hosted a dialogue on Zika and its implications for sexual and reproductive health. The event, How Zika is Shaping the Sexual and Reproductive Health and Rights Agenda, was part of the Maternal Health Task Force’s Advancing Dialogue on Maternal Health Series, in partnership with UNFPA and the Wilson Center.
Experts in global, sexual, reproductive, and maternal health convened for an engaging and timely dialogue focused on Zika through the lens of sexual and reproductive health. Due to its effects on pregnant women and infants as well as the risk of sexual transmission, Zika has created an opportunity to set the conversation on access, quality, and equity of sexual and reproductive health care in affected regions. It has caused us to grapple with hard questions: What is the impact for women in these areas who do not have a full range of health services including contraception and abortion? How will we mitigate potential implications caused by this outbreak, such as higher rates of unsafe abortion and maternal mortality? How can we facilitate maternal and newborn health for women in affected areas who want to become pregnant?
Panelists and speakers agreed that we must ensure that all women have substantial information to make informed decisions regarding their reproductive health. We can support all women in Zika-affected areas, regardless of their pregnancy decisions, by providing access to high quality sexual and reproductive health care. We must keep the setting of this outbreak, where access to contraceptive methods and abortion is highly restricted or illegal, at the forefront of our response.
We must also consider our target population. Unfortunately, the most disadvantaged women are also the most vulnerable for contracting Zika. Panelist Alaka Basu, Senior Fellow, United Nations Foundation, outlined some of the factors that contribute to the spread of the virus: poor water supply and sanitation conditions, overcrowding, and lack of access to contraception. According to Anne Burke, Associate Professor of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, “Among the women most affected are those with the least resources, and these [women] really must be the focus of the majority of our efforts.”
With roughly 23 million women of reproductive age in Latin America and the Caribbean facing unmet contraceptive needs, lack of access to sexual and reproductive health care is not a new issue, but an ominous problem exacerbated by Zika. Chloë Cooney, Director of Global Advocacy, Planned Parenthood Federation of America, provided insight on how disparities in Zika-affected countries likely foreshadow what the United States could expect from an outbreak, “Women who have the least access to reproductive health services, including family planning, will bear the greatest burden in this epidemic…the same is going to be true in the contiguous United States as it becomes more prevalent here.”
Given this trajectory, we must focus on what we can do to allay Zika’s far-reaching consequences. As Burke said, “At the very least, we do need to focus preventive efforts, particularly on educating women who may have low literacy levels and educating women who may not have had good access to health care.” In addition, we must mobilize providers and expand access to sexual and reproductive health services, which will be especially important for at-risk women who wish to become pregnant.
Collaboration is crucial in our fight against Zika. As Congressman Eliot Engel advised, “We can’t put our heads in the sand and pretend that this is somebody else’s problem, another country’s problem, another hemisphere’s problem…What’s one problem becomes a global problem.”
As the virus, expected to impact areas in North America, such as Puerto Rico, draws global attention, we must make every effort to confront this issue from a rights-based perspective.
As Congressman Engel emphasized,
“Every person everywhere should be able to make free and informed decisions on reproductive health and family planning. People should be able to protect themselves and their babies if they choose to become pregnant… If we fail to act as Zika spreads, we will see the price of that inaction in unwanted pregnancies and potentially poor pregnancy outcomes.”
The current landscape of Zika-affected areas, rife with inadequate access to sexual and reproductive health care and barriers to preventing pregnancy, underscores the importance of addressing women’s unmet needs for family planning. As Burke articulated, “Avoiding pregnancy until 2018 should not be considered an effective public health intervention.” Advising women not to become pregnant in the indefinite time of Zika is an unsustainable solution and violation of human rights. Instead, we must support women in their reproductive desires now (and always).
Furthermore, the devastating effects of the Zika virus extend beyond women’s ability to access high quality health care. The outbreak has both significant social and economic impacts, such as the disintegration of families and increased care giving demands for babies born with microcephaly or other birth complications in families affected by Zika. Panelists and presenters called for social support systems to protect these vulnerable populations.
While we learn more about the Zika virus every day, there are still many questions to answer. As the Zika-affected cohort of women and babies ages, we will become familiar with the developmental needs of babies born with microcephaly. Health leaders must be well-positioned to respond to other potential Zika-related health complications that are not apparent at birth. As the panelists and presenters discussed, the global health community must have a plan in place to closely monitor all Zika-affected babies for developmental and health sequelae, even those without microcephaly. We must reach women in disadvantaged areas, not only to provide adequate sexual and reproductive health care, but to ensure that they and their children receive high-quality follow-up care and are counted in our efforts to overcome Zika.
Photo Credit: Zika and SRHR Agenda, courtesy of the Wilson Center Maternal Health Initiative