Sexual and Reproductive Health and Rights in the Time of Zika in Latin America and the Caribbean

This article has been published originally in "Studies in Family Planning" . By Ana Langer and Jacquelyn M. Cagliaand (director and associate director of Women and Health Initiative, Harvard T. H. Chan School of Public Health, Boston, MA) and Clara Menéndez, Director of the Maternal, Child and Reproductive Health Initiative and Research Professor at ISGlobal.

The Latin America and Caribbean (LAC) region moves to a unique beat, a blend of rapid urbanization and economic development coupled with large socioeconomic disparities among and within countries.

The current zika epidemic in Latin America and the Caribe began in late 2015 and is now affecting more than a million people in over 20 countries

The region overall is undergoing a pro-tracted epidemiologic transition seeking to lower the incidence of a number of chronic non- communicable diseases while addressing the persistence of vector-borne diseases such as malaria, Chagas disease (American trypanosomiasis), and dengue and the emergence of new vector-borne challenges such as Chikungunya and now Zika virus (ZIKV).

Rapid urbanization and lax urban planning in the LAC region perpetuate poor infrastructure for water and sanitation, creating conditions conducive to mosquito breeding, which, coupled with climate change, increases the rate of transmission of vector-borne illnesses.

Zika, a avivirus transmitted by mosquitoes of the Aedes family, was first identifed in humans in Uganda in 1952 with subsequent outbreaks recorded in Africa, Asia, the Paci c, and the Americas. The current ZIKV epidemic in LAC began in late 2015 and is now afecting more than a million people in over 20 countries. 

The recommendations made by several governments in LAC do not address the root causes of ZIKV and issue a devastating blow to women’s reproductive rights

While the infection shares a vector and social determinants with other viruses, it has some unique characteristics. The virus produces symptoms similar to those of dengue including fever and muscle and joint pain, which can be debilitating in their own right. More alarming is the simultaneous increase in reported cases of microcephaly among newborn babies, particularly in Brazil, and now in Colombia, as well as increased reports of other congenital neurological anomalies and Guillain-Barre syndrome. While we do not have absolute proof of a causal link between ZIKV and microcephaly, the current evidence is sufficient to strongly infer ZIKV’s teratogenic effects.

WHO has launched a global emergency response, and many countries in LAC are taking action to control the spread of ZIKV and limit the potentially devastating consequences, es- pecially for perinatal health. Governments, such as those in Colombia and El Salvador, have issued recommendations that women abstain from sex and delay pregnancy for the immediate future, but policies like these are unrealistic, make women chiefly responsible for avoiding infection, and are difficult to translate into concrete action in a region where sexual assault, intimate partner violence, and non-consensual sex are common occurrences.

The most impoverished women are the most likely to be exposed to vector-borne illnesses like ZIKV

In the poorest quintile of the population, coverage of reproductive health services like family planning and antenatal care remains low,10 and unmet need for family planning is twice as high as in the wealthiest quintile. The most impoverished women are at increased risk of unplanned pregnancy and are also the most likely to be exposed to vector-borne illnesses like ZIKV, the least likely to be diagnosed early in pregnancy during antenatal care, and the least likely to be offered the options to which their better-off counterparts may have access in case of fetal abnormalities.

Latin America and the Caribbean, a predominantly Catholic region, has some of the most restrictive policies affecting sexual and reproductive health and rights

Furthermore, the recommendations made by several governments in LAC do not address the root causes of ZIKV and issue a devastating blow to women’s reproductive rights. Latin America and the Caribbean, a predominantly Catholic region, has some of the most restrictive policies affecting sexual and reproductive health and rights, especially access to safe and legal abortion. In several countries affected by the ZIKV outbreak, such as El Salvador, Honduras, and Nicaragua, abortion is illegal under any circumstance. Of the 4.4 million abortions estimated to have occurred in LAC in 2008, 95 percent were unsafe according to WHO standards.

The policies and actions that are needed on several fronts to control the spread of ZIKV and mitigate the impact of the current outbreak are radically different from those offered so far. Within countries in LAC, the population needs access to accurate information about transmission of the virus and prevention of infection, and affected communities need widespread efforts to promote vector control including long-term solutions for improved water and sanitation systems. Most urgently, all sexual and reproductive health and rights for women (and men) should be guaranteed, including access to a full range of contraceptive methods, sound counseling on reproductive options, and safe abortion services.

Full and effective coordination is needed between all organizations involved in the regional and global response

Throughout LAC, full and effective coordination is needed between all organizations involved in the regional and global response, including WHO, PAHO, and CDC. Efforts should be directed at strengthening partnerships with governments, research institutions, the private sector, and civil society groups, including faith-based organizations. Moreover, at a global level, the necessary financial resources need to be made available to fully understand causal links between ZIKV and congenital neurological abnormalities, rapidly develop and deploy diagnostic tests and vaccines, and address the social factors that underlie the Zika outbreak. We must harness this moment of heightened attention in the region to support LAC in a response that simultaneously responds to ZIKV; improves health systems so they are able to offer quality integrated care to girls, women, and children; and strengthens sexual and reproductive health policies, programs, and services and guarantees rights for all.

Zika infection could add a huge burden to the most vulnerable women or be channeled into an opportunity to change restrictive sexual and reproductive health policies

The current ZIKV outbreak is a wake-up call for LAC and the world at large, providing a magnifying glass through which to look at sexual and reproductive health and rights and highlight unjust disparities throughout the region. Zika infection could add a huge burden to the most vulnerable women, families, and countries or be channeled into an opportunity to change restrictive sexual and reproductive health policies and strengthen health and social support systems overall.

The cost of inaction could be devastating: a generation of severely handicapped children, and women unable to full their reproductive wishes or reach their human development potential because of the heavy time and economic burden of long-term caregiving. Controlling Zika will only be possible if multiple constituencies, including the research community, act rapidly, decisively, and in a coordinated fashion, based on evidence.