Outbreaks of communicable diseases in the developing world are bad enough from a health perspective. But they also have serious implications for social justice, because they exacerbate longstanding human-rights crises, including by undermining already-weak public-services provision and deepening existing inequalities.
Like the 2014 Ebola outbreak in West Africa, the Zika outbreak in Central and South America in 2015 hit vulnerable social groups – women and children, ethnic minorities, and the poor – the hardest. Like yellow fever, dengue, and other diseases, Zika is transmitted by Aedes aegypti mosquitoes. But, unusually for a mosquito-borne virus, Zika can also be transmitted sexually. Even more unusual, it is associated with neurological and developmental conditions affecting babies: microcephaly and Guillain-Barré syndrome. Otherwise, its symptoms are often rather mild.
This means that, of the more than 1.5 million people stricken by Zika since the outbreak, the consequences were most worrying for women of child-bearing age, especially those who were already pregnant. Between 2016 and 2017, a total of 11,059 Zika cases in pregnant women were confirmed, producing 10,867 cases of microcephaly and other congenital malformations of their babies’ central nervous systems. Fifty-six percent of those babies were born to poor women and women of color from northeast Brazil.
Clearly,the Zika crisis is not gender-neutral. In addressing its medium- to long-term consequences, a focus on women – especially poor women – is needed. That does not mean more media coverage of the deformities associated with microcephaly or even of the difficulties faced by their mothers. And it certainly does not mean more efforts to police women’s behavior.
To avoid infection, women have been advised to use mosquito repellent; remove standing water around their homes; wear long sleeves; and, if possible, use condoms or avoid sex. The US Center for Disease Control and Prevention advised pregnant women to refrain from traveling to affected countries. Most extreme, health officials in El Salvador and Colombia urged women not to get pregnant until 2018.
Such recommendations, however well intended they may be, are fundamentally flawed. For starters, they emphasize short-term-vector control and surveillance, while delinking the disease from the social and structural determinants of health, including public infrastructure such as running water, proper sanitation, and access to care.
They also place the responsibility for avoiding disease and pregnancy primarily on women, while failing to recognize the lack of control many women have over their bodies and pregnancies. Many of the areas affected by Zika have high rates of sexual violence and teen pregnancy, a lack of sex education, and inadequate access to contraceptives. For these reasons, more than 50% of pregnancies in Latin America are unintended.
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