What we really need to combat the Zika virus
By Christina Wegs, CARE’s Senior Advisor for Global Policy, Sexual, Reproductive and Maternal Health and Rights; and Stephanie Ogden, CARE’s Senior Water Policy Advisor
As concerns about the Zika virus spread worldwide, one thing is clear: the world’s poorest women will bear the brunt of the mosquito-borne disease and its consequences, and will have the fewest resources to fight it.
On Feb. 1 the World Health Organization declared the Zika virus a “public health emergency of international concern.” The virus has been linked to congenital microcephaly, a rare birth defect that causes brain damage and lifelong disability.
Zika has been steadily spreading across Latin America and the Caribbean. More than 20 countries are currently battling outbreaks of the virus, which has no cure or vaccine. The WHO warns that as many as 4 million people can be infected by the end of the year.
Unfortunately, it is the poorest who are at greatest risk of infection. They live in communities with limited access to safe and accessible water sources or sanitation, where the mosquito that transmits the disease breeds in the many vessels of water collected and stored for domestic use, in standing water caused by wash-water disposal or dispersed trash that collects rainwater to form long-standing pools and puddles. The same mosquito is responsible for transmitting dengue fever and yellow fever, diseases that have been shown to be most prevalent among the poorest.
Within the poorest communities, it is women that have the least access to information on disease prevention, least access to health care services that facilitate treatment and help to identify risk to pregnancy. Women and girls in the poorest communities of Latin America are less likely than their male peers to be taken to health clinics for treatment.
These same poor women have the least access to information on birth control and to contraceptives themselves. In Latin America, an estimated 30% of pregnancies are unplanned. Over the past few years, access to contraceptives has increased, but the region faces persistent inequities with poor, rural and indigenous women having the least access to health services. Girls are particularly vulnerable; according to the United Nations Population Fund, the region has the 2nd highest rate of teenage pregnancy in the world, and is the only region in the world where births to girls under age 15 are increasing.
What’s more, restrictive government policies as well as society’s expectations of women and girls constrain many women and girls’ ability to make their own decisions, not only about if and when to have children, but also even to make decisions if and when to have sex. In Latin America, an estimated 4 out of every 10 women experience sexual violence inside and outside their intimate relationships. And many women and adolescent girls simply don’t have decision-making power to insist on using contraception.
Given all this, recommendations from some Latin American government officials that women should simply “avoid getting pregnant”- in some cases recommending they avoid pregnancy until 2018 – are missing the point.
We need to change the conversation, and focus on long-term policy solutions. We must recognize the essential role of basic services such as water and sanitation in combatting this and other diseases, and urge increased investment in universal water, sanitation, and basic services. Until we do, the poorest will see the highest rates of children born with birth defects, with the fewest resources to care for them.
We need to work to ensure that all women – wherever they live, and whoever they are – have access to the comprehensive reproductive health services they need, and that they are empowered to make free and informed choices about planning and spacing their pregnancies. We must change the narrative about the Zika virus and shift the burden of responsibility from the shoulders of women alone, to the shoulders of men and women together- any recommendations to avoid pregnancy need to target both men and women. And most critical of all, we must work to truly increase women’s autonomy to make decisions about whether, when, and under what conditions they have sex.
Until we change the conversation, our responses to Zika will give women a false choice, and a responsibility they cannot fulfill- and efforts against Zika virus are short-sighted.