SOUTHAMPTON – 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.
Making matters worse, in most Latin American countries affected by Zika, abortion is illegal, or permitted only in exceptional situations. For example, in El Salvador, where more than 7,000 cases of Zika were reported between December 2015 and January 2016, abortions are illegal under all circumstances. Miscarriages, if proven to be self-induced, can even lead to homicide convictions.
The position of the United States hasn’t helped, either. Last year, US President Barack Obama’s administration asked Congress for $1.8 billion in emergency funding to help prepare for and respond to the Zika threat. But abortion politics intervened, as Republican lawmakers, leading a congressional hearing on the Zika outbreak, made the funding conditional on anti-abortion policies in recipient countries.
The problems with the dominant approach to containing the Zika virus – namely, that it saddles women with too much responsibility while giving them too little power – are not lost on everyone. Last year, the United Nations Refugee Agency and the World Health Organization emphasized the need to put human rights at the center of the response to the Zika outbreak.
But, while high-level recognition of women’s sexual and reproductive rights is a positive step, it is far from sufficient. And doing what is needed to protect those rights, particularly among poor and vulnerable women in developing countries, will require deep and sustained political commitment.
In particular, national legislation must be revised to ensure that all women – whether they are carrying a baby with microcephaly or not – have full reproductive autonomy. Women must be able to base their reproductive choices on their own physical and emotional needs and desires, not on the moral judgments of powerful agents or risk of criminal sanctions.
Advocacy groups in Brazil, for example, are already pushing for such an outcome, submitting legal cases to the Supreme Court to secure greater reproductive rights for women, including the right to safe and legal abortion. Those cases tend to lean on the 1988 National Constitution, which guarantees the right to abortion in case of rape, danger to the mother’s life, or anencephaly, another birth defect involving the brain.
In pursuing these changes, campaigns should also recognize and address the links between women’s and disability rights. Indeed, they should advance equality for all marginalized groups.
Zika’s medium- and long-term consequences must be addressed with this in mind. When a woman gives birth to a child with a congenital syndrome deriving from the Zika virus, the response should be grounded in the dignity, value, and rights of each individual. It should acknowledge the processes that keep certain individuals and groups in poverty and that deny them the basic rights of citizens. That is why campaigners must insist that the state be responsible for providing appropriate care and support services for each woman and child – services that both meet their needs and respect their rights.