NEW YORK – Mosquitoes know no boundaries, and neither does fear. As public-health experts grapple with the Zika virus, panic continues to spread around the world. Yet the crisis has brought to light two important truths.
The first revelation is how badly degraded public health systems have become, across Latin America and beyond. This did not happen by chance. In large part, it is the result of pressure on developing countries by concessionary lenders, such as the International Monetary Fund, to cut social sector expenses, including health spending, beginning in 1980. In Brazil and elsewhere, state authorities could have deployed well-known and cost-effective measures to control mosquito-borne diseases, but they did not. Their most affected citizens, who tend to be poor, have been forced to live with the consequences.
Second, the Zika epidemic has revealed, with particular poignancy, another dire threat to public health: the denial of women’s reproductive rights. Governments are shirking their responsibility in this regard too, often in a grotesque manner. The reported spike in cases of microcephaly – a birth defect – among infants in Zika-affected areas led the governments of Brazil, Colombia, Ecuador, and El Salvador to warn their female citizens “not to become pregnant.”
This message, which places the blame and burden of the Zika epidemic on women, is as unjust as it is unreasonable. It is also toothless, as many women in the region do not have access to contraception or safe abortions. The Zika crisis has highlighted an obvious reality: Not providing women with reproductive health information and services places their lives – and those of their children – at grave risk.
Latin America’s abortion laws are among the world’s most restrictive. El Salvador, for example, bans abortion in all circumstances and has incarcerated women who have gone to emergency rooms after miscarriages, charging them with seeking illegal abortions. Contraception can also be expensive or difficult to access across the region, despite high rates of teenage rape and pregnancy. The result, especially with the addition of the Zika virus, is a recipe for tragedy.
Brazil, the Latin American country hit hardest by the virus so far, is emblematic of the problem: Abortion is allowed only in cases of rape, danger to the woman’s life, or in the case of fetal anencephaly (the absence of a major portion of the brain). In response to the Zika crisis, Brazil should immediately allow abortion in cases of suspected microcephaly as well.
The loosening of restrictions, however, should not stop there. Over the last few years, conservatives in the Brazilian Congress have been trying to place limits on abortion in cases of rape. These efforts – which demonstrate complete disregard for the rights and dignity of women – must end. Instead, women’s right to seek an abortion should be expanded – and quickly.
Governments must also ensure that services are accessible and affordable. Wealthy Brazilian women can afford to pay private health providers for safe abortions. Poor women are forced to resort to poorly trained and equipped providers who operate in unsanitary conditions, sometimes as part of criminal networks. In September 2014, two women died in Rio de Janeiro following clandestine abortions. In the region overall, 95% of abortions are unsafe.
In Latin America and the Caribbean, 62% of women aged 15-49 want to avoid a pregnancy. But nearly a quarter of these women are not using an effective method of birth control. Expense is only one barrier for poor women and girls; another is the lack of information. Men and women need comprehensive sexuality education, so they are informed about their reproductive health and family planning options and know where they can get modern contraceptives. Recent evidence suggesting that Zika might be transmitted sexually adds extra urgency to making male and female condoms and other contraceptives widely available.
The movement for reproductive rights has a long history in Brazil and in other parts of Latin America. Over the last several months – even before Zika – feminists had been taking to the streets in outrage at the lack of access to safe and legal abortions. The Zika crisis may mark a turning point in the fight for women’s health and equality. It is certainly a wake-up call for governments everywhere to rebuild and strengthen public health systems, and to guarantee all women and girls access to contraceptives and safe abortions. Women and girls around the world know the alternative – and it is terrifying.
Françoise Girard is President of the International Women’s Health Coalition.
By Françoise Girard