Zika Virus and Reproductive Health Access in Latin America

In response to the rapid spread of the Zika virus and the increasing number of cases linking the virus to microcephaly—a birth defect frequently characterized by a small head and incomplete brain development—some Latin American and Caribbean governments are urging women to delay having children. In El Salvador, for example, the deputy health minister made headlines when he urged women to refrain from becoming pregnant until 2018. Yet throughout the region, women’s reproductive rights and access to health care  are limited, and in 2014, more than half of the region’s pregnancies were unplanned. For instance, in El Salvador—which has one of the highest teen pregnancy rates in Latin America—one in three babies are born to girls between the ages of ten and nineteen, often as a result of unplanned pregnancies. These factors make calling for women to hold off on getting pregnant an impractical solution at best.

Last week, the World Health Organization (WHO) declared the virus an international public health emergency, citing the virus’ possible connection to microcephaly as its primary concern. Governmental health organizations, including the Center for Disease Control and Prevention (CDC), have warned pregnant women and women trying to become pregnant to consider not traveling to countries with Zika. Spread by the Aedes aegypti mosquito, the Zika virus has so far hit Brazil the hardest. As the Council on Foreign Relations’ global health expert Laurie Garrett notes, Brazil’s health minister has already warned that Zika has gone from being an epidemic to endemic disease in his country, which means that Zika may be taking hold permanently, potentially threatening thousands of babies per year.

For Brazil, the virus and recommendations against traveling couldn’t come at a worse time. Brazil is stepping up eradication efforts in advance of the 2016 Olympic Games, which it is hosting in Rio de Janeiro this August. But fears about the virus have continued to grow and could threaten the upcoming games. Moreover, travel warnings could have a negative economic impact on the region, given the dependence many countries have on tourism as well as business travel.

Authorities in Dallas, Texas, recently reported a case of the Zika virus transmitted by sex, rather than a mosquito bite, in a case involving an individual who returned recently from Venezuela.  In response last week, the CDC issued interim guidelines for preventing sexual transmission of Zika virus.  Noting the Texas case, the CDC guidance recommends that men “who reside in or have traveled to an area of active Zika virus transmission and their pregnant sex partners should consistently and correctly use condoms during sex...or abstain from sexual activity for the duration of the pregnancy.” In prior cases, evidence suggested that the Zika virus had been sexually transmitted or found in semen.

However, in addition to confronting restrictions on reproductive rights and limited access to reproductive health services, women who are less-educated or live in remote areas throughout the Americas typically lack sex education. Not only do they frequently have insufficient information about and access to contraception and family planning, these women (and men) may not be well-informed about the importance of safe sex to prevent sexually transmitted diseases (STDs). Additionally, women often face cultural barriers or lack power in relationships, which may undercut their ability to insist on contraception and safe sex.  While years of HIV/AIDs prevention campaigns have driven home the point on STD-prevention for the better-educated, cosmopolitan, urban elites, such campaigns are less likely to have reached women who live in poor or remote communities with less access to news and information.

A further problem women face is sexual violence, which can cause unplanned pregnancies and the spread of STDs. Citing El Salvador’s high rates of sexual violence, Human Rights Watch’s Amanda Klasing notes, “Calling on women to delay their pregnancy might be prudent[,] [b]ut many women and girls in the region don’t have control over when they get pregnant.” Other rights groups say that El Salvador’s high teen pregnancy rate is in part because of rape by stepfathers, relatives, and gang members, and that brutal sexual violence is a particular problem in light of street gangs that use rape to control women and girls as well as to terrorize local communities, extort money, and silence opposition. Monica Roa, vice president of strategy for Women’s Link Worldwide, calls it “incredibly naive for a government to ask women to postpone getting pregnant in a context such as Colombia where more than 50 percent of pregnancies are unplanned and across the region where sexual violence is prevalent." Tackling the Zika crisis will require addressing the region’s broader challenges concerning women’s equality and public health, including high rates of sexual violence, limited access to women’s health care services, and lack of family planning information.