As Zika continues to spread through the western hemisphere, the women’s health aspect of the virus has not entered the public conversation. Perhaps more than the failure to control mosquito populations, lack of access to widespread, effective contraception is the root cause of microcephaly in most of Latin America and the Caribbean, and yet remains the least talked about aspect of the epidemic.
Ebola, like HIV before it, offered an impetus to improve general healthcare infrastructure in west Africa, as international money and political will joined the fight against the epidemic. For all its negatives, the Zika outbreak similarly provides an opportunity to press strongly for universal access to contraception and reproductive services for women in all Zika-affected countries, but this opportunity is being largely overlooked.
To prevent babies being born with microcephaly, the Centers for Disease Control and Prevention (CDC) and the World Health Organisation are choosing to encourage “delaying pregnancy”, as well as to recommend mosquito nets and protective spray to those who are already pregnant. Without putting any resources behind widespread contraception, this is merely lip service and fails to deal effectively with the problem. Only 62.5% of Latin American women use some form of contraception [pdf], and in Haiti, only 34% of women have access to contraception. In the US, 45% of pregnancies are unintended, and 65% in Puerto Rico are as well [pdf]. Health authorities in El Salvador estimate that as many as 90% of pregnancies may be unintended, and Haiti, without an effective public health system or quotable statistics, is likely not far off from this figure.
The choice to focus on expectant mothers rather than considering women as a whole will be costly, most of all for vulnerable women who are most likely to have an unintended pregnancy. In Haiti, where we work in women’s health, the cost – both social and economic – could be catastrophically high as the scale of the epidemic is probably drastically under-reported to date. In most low- and middle-income countries in Latin America, marginalised women’s chances of resuming their schooling and work will be decimated when they have to look after a severely disabled child.
The CDC’s efforts in Puerto Rico have been limited to handing out Zika-prevention kits, including insect repellent, mosquito nets, brochures and a condom as a reminder of the possibility of sexual transmission of Zika, and not as a form of contraception where no pregnancy is desired. Local authorities have also collected 1.2 million discarded tyres, dropped larvicide into abandoned pools, educated residents and trained local brigades in fumigation.
Efforts in Puerto Rico have been confounded because the US Congress has been unable to pass a Zika funding bill. None of the $ 250m (£200m) planned for Zika in Puerto Rico or the $ 376m for the Caribbean was earmarked for reproductive health services, sending signals to other governments and non-profits where to steer their efforts.
Widespread contraception would be one of the cheaper options for dealing with the Zika crisis, at only $ 31 per woman per year, including all the personnel costs of healthcare workers. Some have estimated that the cost of one child with Zika birth defects in the US is $ 4m, including extra ultrasounds, hospitalisations, surgeries and critical care. The CDC estimates that 138,000 women of reproductive age in Puerto Rico (19%) do not currently desire pregnancy and are not using contraception. At $ 31 per woman per year, the $ 4.3m additional cost for achieving universal access to contraception is dwarfed by the $ 250m in the US Senate bill allocated for the prevention of Zika infections in pregnant women and associated medical costs.
Widespread contraception would be one of the cheaper options for dealing with the Zika crisis
Our work in Haiti strives towards empowering women through delivering healthcare services. The failure to provide services that help women is in part due to the age-old problem of reducing women’s health to simply maternal health, and propelling programmes that tell women what to do rather then empowering them to make decisions for themselves. Zika, it seems, is no different.
Declaring contraception as the cheapest and most effective way to deal with the crisis would be a bold step towards lobbying all governments in the region to expand these much-needed services. In addition, contraception in low- and middle-income countries results in better birth-spacing, reduced maternal mortality and infant mortality, and advances in the socio-economic status of women.
The Zika crisis, like abstinence-based teachings for HIV prevention, is a missed opportunity to invest in women’s health infrastructure, where ideology trumps public health and financial logic in Latin America and the Caribbean. Transnational public health authorities, like the CDC and WHO, are allowing politics with antipathy to women’s reproductive health to pollute public health logic, forcing countries to commit ineffective funds and set a standard that leaves women behind. Will we let yet another crisis go by without addressing reproductive health services for half our population?
Grace Tillyard is Director of Communications and Outreach for Innovating Health International in Haiti.
Dr Vincent DeGennaro Jr is President of Innovating Health International in Haiti and Assistant Professor in the Division of Infectious Diseases and Global Medicine at University of Florida College of Medicine.
Zika: Let"s give women the contraception they so desperately want
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