On 12 April 2016, the Wilson Center Maternal Health Initiative convened this dialogue, in partnership with the Maternal Health Task Force (MHTF) and the United Nations Population Fund (UNFPA).
“The Zika outbreak is a result of something; it is the result of the lost attention to sexual and reproductive health issues as a human right and women as subjects of rights,” said Jaime Nadal Roig, the United Nations Population Fund representative to Brazil, at the Wilson Center on April 12.
Given the growing evidence of Zika’s connection to birth defects, it is imperative to address inequities to provide all women – pregnant or not – the health care they need, said a panel of women’s health advocates and experts. “Zika has made a longstanding public health crisis impossible to ignore,” said Chloë Cooney, director of global advocacy at the Planned Parenthood Federation of America. They recommended governments and the global health community combat the disease by supporting vector control efforts, universal access to sexual and reproductive health care, and targeted outreach to marginalized communities and youth before it spreads further afield.
A Moving Target
Though the current outbreak is not the first, little is known about Zika. There is no vaccine or treatment, and scientists discover more about the virus daily. Urban legends permeate the zeitgeist, making the task of dispelling myths and dispersing accurate information easier said than done.
The Zika flavivirus, commonly found in mosquitoes, is most closely related to dengue. It is primarily spread by the Aedes aegypti mosquito, which also transmits dengue and chikungunya. Transmission through sexual contact and from mother to child is also possible.
Since the first confirmed case of the outbreak in Brazil in May 2015, Zika has spread to all parts of Brazil and 34 states and territories in the Americas, according to Marcia Castro, associate professor of demography at the Harvard T.H. Chan School of Public Health.
Most adults with Zika do not show any symptoms, but some develop Guillain-Barré Syndrome: a nervous system disorder that can cause paralysis. A fetus infected through its mother can develop birth defects such as microcephaly, which causes babies to have smaller heads and brains than babies of the same sex and age. While the link between Zika and microcephaly was once a suspicion, it has been all but confirmed in recent months. Two studies released in March reveal that when Zika is introduced to neural stem cells, it reduces cell growth and even increases cell death.
New Headlines, Old Problems
Zika is most prevalent in the north and northeast regions of Brazil, which have high levels of poverty, poor infrastructure, scant health services, and a substantial Afro-Brazilian population. Subpar sanitation, limited or no access to piped water, and irregular waste collection have all contributed to the spread and penetration of the Aedes aegypti mosquito into the poorest communities, said Nadal Roig. Inadequate health services have made it especially difficult to reach young black women.
“An urgent contemporary example of the inseparability of health and human rights”
A 2006 study found that only 10 percent of Brazilian adolescents received information on family planning in health services in the last six months. In combination with strict abortion laws, lack of family planning services contributed to an adolescent fertility rate of 67 births per 1,000 women in 2014, compared to 24 births per 1,000 women in the United States. High risk of sexual violence also impedes the ability of women to plan their families.
With centuries of racism and sexism working against them, it is perhaps sadly unsurprising that “the gap between wanted and actual fertility is highest among black women,” said Nadal Roig. And if an Afro-Brazilian women living in the northeast or north does become pregnant, she will be hard-pressed to find Zika diagnostic tests, maternity health care, and social welfare to support her if she gives birth to a baby with microcephaly, Nadal Roig said.
The link between Zika vulnerability and inequality is not unique to Brazil. The Centers for Disease Control and Prevention has warned there is high potential for local mosquito-borne Zika cases to spread into the continental United States and beyond, wheremarginalized communities also struggle with access to basic health care.
Alaka Basu, a senior fellow at the United Nations Foundation, pointed out that some countries in South Asia and Africa have even less piped water, worse sanitation, and more overcrowding than Central and South American countries. In Malawi, only 23 percent of households have access to piped water, and that number is even lower in Bangladesh at 12 percent, she said. Similarly, contraceptive prevalence is also lower in many South Asian and African countries.
A Rights-Centered Approach
With no vaccine to prevent Zika, no medicine to treat it, and any hopes of sophisticated interventions (e.g., genetically modified mosquitoes) several months or years down the line, Zika will continue to be a threat to pregnant women and their newborns, especially the most socioeconomically disadvantaged. Improving sanitation, waste management, and piped water will do the most to prevent the spread of Zika. But in terms of reducing cases of microcephaly, increasing access to basic reproductive and maternal health services is the most fundamental solution, said Dr. Anne Burke, associate professor at Johns Hopkins University.
“The Zika virus presents an urgent contemporary example of the inseparability of health and human rights,” said Burke. Some women in Zika-affected areas want to avoid pregnancy; others may want to become pregnant; and others may already be pregnant. If governments and health care providers are serious about taking a human rights approach to Zika, they need to meet women where they are and support their reproductive decisions at every stage.
“We can’t put our head in the sand and pretend that this is somebody else’s problem”
Government advisories to avoid pregnancy for several months or years – as in the case of El Salvador – without accompanying efforts to increase access to contraception, family planning counseling, and services to prevent and respond to sexual violence are not only impractical, they fly in the face of human rights, said Burke.
Instead of advisories, Cooney recommended increasing support for sex education and youth-friendly health centers. By creating safe spaces for young people to get answers to their sexual health questions, health providers promote safe and consensual sex, thereby reducing the risks of sexual violence, unwanted teenage pregnancy, and the possibility of Zika spreading via sexual contact. Dr. Pablo Duran from the Pan American Health Organization emphasized the need to target male sexual partners with this safe sex messaging to avoid placing the onus solely on women.
While governments, aid organizations, and researchers determine how to implement solutions, Brazilian women’s groups are responding with strategic litigation. Françoise Girard, president of the International Women’s Health Coalition, highlighted one group’s call for an expansion of abortion rights in cases of confirmed Zika diagnosis, provision of social welfare for women with babies that have neurological disorders, and vector control interventions in slums. The group is developing a case built on affidavits by Brazilian women who have been affected by Zika to bring to the Supreme Federal Court.
An Emergency Appeal
Turning talk into action requires political will and funding. U.S. Congressman Eliot Engel (NY-D) called on Congress to allocate resources to the United Nations Population Fund. UNFPA, he pointed out, currently does more work on reproductive health issues in the Americas than the U.S. Agency for International Development, and may be the best way to blunt the disease before it further penetrates the United States and spreads elsewhere. “We can’t put our head in the sand and pretend that this is somebody else’s problem,” he said.
Thus far, only the government of Japan has responded to UNFPA’s emergency appeal for $10 million dollars with a contribution of $250,000, which will help pay for contraceptives and other reproductive health supplies.
For its part, UNFPA is working with multiple community stakeholders to empower women to protect themselves from Zika, said Nadal Roig. UNFPA is partnering with grassroots organizations to disseminate information; with field crews to develop a national strategy for risk communication and community engagement; and with the Ministry of Health to facilitate public health research.
Whether it’s Zika or the next big outbreak of a communicable disease that affects the health of mothers and newborns, the international community can be proactive about transforming crisis into opportunity through an elegantly simple philosophy, said Cooney: put women and girls at the center.
Written by Francesca Cameron, edited by Schuyler Null.
See event resources and documents>>
- Alaka Basu
Senior Fellow, Women and Population, United Nations Foundation; Professor, Cornell University
- Dr. Anne Burke
Associate Professor, Department of Gynecology and Obstetrics, and Department of Population, Family and Reproductive Health, Johns Hopkins University
- Marcia Castro
Associate Professor of Demography, Department of Global Health and Population, Harvard T.H. Chan School of Public Health
- Chloë Cooney
Director of Global Advocacy, Planned Parenthood Federation of America (Invited)
- Roger-Mark De Souza
Global Fellow and Advisor
Former Director of Population, Environmental Security, and Resilience
- Dr. Pablo Duran
Regional Advisor on Perinatal Health, Latin American Center for Perinatology (CLAP / SMR), Pan American Health Organization
- Congressman Eliot Engel
U.S. Member of the House of Representatives, New York 16th Congressional District
- Françoise Girard
President, International Women’s Health Coalition
- Dr. Laura Laski
Chief, Sexual and Reproductive Health, United Nations Population Fund
- Jaime Nadal Roig
Representative to Brazil, United Nations Population Fund