Countering Zika: Women’s Right to self-determination must be central
Policymakers and public health officials in a number of countries—in particular, those in Latin America and the Caribbean, as well as in the United States—are scrambling to counter the threat of the Zika virus, which has been causally linked to an increase in births of infants with microcephaly, a condition in which children have unusually small heads. Babies with microcephaly often have smaller brains that might not have developed properly.
Zika is a mosquito-borne disease, but there are also reported cases of sexual transmission of the virus.
As of early May, there were almost 290,000 suspected cases of Zika in Latin America and the Caribbean, and on the U.S. mainland, there were over 500 confirmed cases, all of them acquired during travel outside the United States or through sexual transmission. However, several U.S. territories—chief among them Puerto Rico, which saw its first confirmed Zika-related death in late April—have seen more than 700 confirmed cases, almost all of them locally acquired.
The specific challenges posed by Zika are new and still emerging. But the current emergency has highlighted another long-standing public health challenge: the often hostile policy, programmatic and legal environment women face on issues surrounding pregnancy, whether they are looking to have a healthy birth and raise their child, prevent an unplanned pregnancy or obtain an abortion.
Latin American and the Caribbean
All women should have the right to self-determination when it comes to decisions about pregnancy and childbearing. Unfortunately, the reality of women’s lives often falls far short. In 2014, 23 million women in Latin America and the Caribbean wanted to avoid pregnancy but were not using a modern method of contraception,6 which contributed to well over half of all pregnancies in the region (56%) being unintended. And these statistics are likely even higher now, because the emergence of Zika may have prompted more women and couples to want to delay pregnancy or avoid it altogether.
Meeting all women’s needs for modern contraception in the region would cost an estimated $1.7 billion annually.6 Given that such spending already stood at $1.1 billion in 2014, the needed additional annual investment is roughly $600 million, which would cover new contraceptive users and provide improved quality of care for current users.
But it is not just preventing an unintended pregnancy that can be challenging for women in Latin America and the Caribbean. The situation is even worse when women find themselves facing an unwanted pregnancy that they wish to end, as access to abortion is severely restricted by law across the region. Access to abortion provided by trained providers in appropriate medical settings is minimal and generally only available to women from privileged social and economic classes.
Clandestine abortion—often self-induced and without appropriate medical supervision—is common and carries the risk of criminal prosecution, as well as the potential for serious complications and even death. In 2014, at least 10% of pregnancy-related deaths in the region were because of such unsafe abortions, and 760,000 women are hospitalized there each year for treatment of complications from unsafe abortion.
Debates are underway in some countries in the region about decriminalizing abortion in specific circumstances in response to the current crisis. But narrow exceptions, even if enacted, are unlikely to address the range of circumstances under which women will likely seek an abortion, in response to the Zika epidemic or otherwise.
Moreover, lifting any restrictions on abortion must go hand-in-hand with training abortion providers and taking other steps to make services accessible and safe, including ensuring that women know services are available and where to obtain them.