February 29, 2016 Lucía Berro Pizzarossa and Marinella Matejcic Women Deliver Young Leaders

Love in the Times of Zika: Public Health Strategies and Women’s SRHR in Latin America

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The World Health Organization has declared a public health emergency in response to the Zika virus, stating that "the level of alarm is extremely high." At the same time, Latin American governments are asking women "not to get pregnant." The virus, first discovered in 1947 in the Zika forest of Uganda, was initially thought to be harmless until a causal relationship between Zika virus infection and birth malformations and neurological syndromes was suspected.

In light of this emergency, various countries have recommended that women delay pregnancy. In Colombia—where more than 3,000 pregnant women are infected with the virus—Health Minister Alejandro Gaviria urged women to delay pregnancies for up to eight months. El Salvador has asked women to delay pregnancy until 2018.

Once again, women’s sexual and reproductive rights are in the spotlight and these ignorant health strategies, to say the least, reveal governments’ failure to comply with their international obligations. The consensuses achieved at the United Nations International Conference on Population and Development Programme of Action (ICPD), Beijing and more recently the Millenium Development Goals (MDGs) and the Sustainable Development Goals (SDGs) remains an empty promise for people in Latin America. Every individual has the human right to decide freely the number, the spacing, and the timing of their children. They also have the right to access the information and means to do so, including their right to make decisions free from discrimination, coercion, and violence. These rights are still far from being a reality. The Zika outbreak has opened the debate on sexuality, women's rights, and religion. The odds are that women will be the victims of this global health crisis.

“Don’t get pregnant” has been the official response of several Latin American governments so far. Let's look at the stats and break down this response.

First of all, the states’ response so far is grounded in the assumption that women can choose if, how, and when to get engage in sexual intercourse and get pregnant. This naïve hypothesis—that all sexual intercourse is consensual—completely disregards the region’s alarming rate of gender-based violence and sexual violence. While globally it is estimated that one in three women will experience physical, sexual, or psychological violence in her lifetime, this rate is higher in some areas of Latin America and the Caribbean. Recent research indicates that 1.68 million women in the Americas are raped each year.

Secondly, in Latin America and the Caribbean nearly half of sexually active young women have an unmet need for contraception. Of the 222 million women in developing countries with this unmet need for modern methods, 23 million are in Latin America. This response is completely inadequate in a context in which more than 50 percent of pregnancies in are unwanted. Furthermore, no attempt has been made to take into account the fact that while the health risks of childbearing are unavoidably gender-specific, the health risks of contraception can be assumed by either partner. There is evidenceindicating that Zika may be sexually transmitted, although male methods of contraception have been scarcely promoted, which poses both responsibility for and the risks onto the shoulders of women. While evidence of pregnant women being abandoned by their partners in cases of microcephaly is growing in Brazil, states are still placing the burden of contraception and childbearing exclusively on women.

What about those who are already pregnant? In this regard, the statistics are overwhelming and reveal the inadequacy of the response.

On one hand, only three of the 34 countries of the region have provisions de-criminalizing abortion. Various countries such as El Salvador—which has one of the highest rates of Zika infection on the continent—and Nicaragua have instituted a complete ban on abortion with devastating results. According to Guttmacher Institute, from 4.4 million abortions that occurred in 2008, 95% were unsafe. In places where abortion is illegal, women often turn to inadequately trained practitioners who employ unsafe techniques or attempt to self-induce abortion using dangerous methods. In the region, nearly one million women are hospitalized each year because of complications from unsafe abortion, and the World Health Organization (WHO) and Guttmacher estimate that one in eight maternal deaths in the region result from unsafe abortion.

Furthermore, the states’ obligation to guarantee Sexual and Reproductive Health and Rights includes providing women who decide—free from coercion—to continue with their pregnancy, as well as the information and the means to do so. All the affected states should guarantee access to comprehensive pregnancy, maternal, pre-and post-partum care and neo-natal care services,as well as special needs therapy, health care, and educational services as needed for children born with microcephaly. The absolute failure of states to achieve Millenium Develop Goal (MDG) 5 proves that there is still much scope for improvement.

The lack of women’s sexual and reproductive rights in Latin America is very alarming, and has been so for long before the virus arrived. Recently, the UN High Commissioner for Human Rights Zeid Ra’ad Al Hussein stated that “laws and policies that restrict access to sexual and reproductive health services in contravention of international standards, must be repealed.” While we welcome some countries’ efforts to revise their abortion laws, we hope for a holistic public health strategy that has women’s sexual reproductive rights at its core.

Photo courtesy of: CYNTHIA FLORES MORA / World Bank

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