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As the Zika virus spreads across the Americas, it’s shedding light on the systemic shortcomings some countries face in providing family planning and reproductive health services.Last week, the World Health Organization declared the virus a global public health emergency. It has been linked (although not yet conclusively, we are cautioned) to severe birth defects in babies whose mothers contract the virus during pregnancy. More than 4,000 suspected cases of microcephaly—a birth defect marked by an unusually small head and an underdeveloped brain—have been reported in Brazil since October. For families already living in poverty, providing ongoing medical care for their disabled children will be especially challenging.
So when the vice minister of health in El Salvador recommended that women postpone getting pregnant for up to two years, it begged the question of how exactly they should do that.
Meanwhile, as the virus continues to spread wildly, women who are pregnant or may become pregnant are in a tough spot.In many of the Latin American countries most affected, abortion is illegal and while modern contraception is lawful, using it goes against church teachings for the millions in these countries who identify as Roman Catholic. And, in many areas, health services and commodities like contraceptives are in short supply.So when the vice minister of health in El Salvador recommended that women postpone getting pregnant for up to two years, it begged the question of how exactly they should do that. Many women in El Salvador do use contraception, but it’s not always accessible. Women face an under-staffed and under-resourced public health system, particularly in rural areas where clinics are already straining to meet the day-to-day needs of the population. Many women and girls across the region also face stigma from their communities and a provider bias against contraception. In many ways the minister’s recommendation is akin to saying to women: keep your legs shut. But in a patriarchal society where incidence of sexual assault and rape are high, and where regular sex is considered part of a woman’s marital duties, that choice, sadly, is not always hers to make.
Now is the time to make exponential progress toward securing access to contraception as part of a comprehensive package of sexual and reproductive health services for women and girls who have gone far too long without it.
It is unlikely the Zika virus will change religious doctrine thousands of years strong, but perhaps it will change the hearts and minds of individuals and government officials. National leaders calling for postponed conception will see their recommendations fall flat if they’re not backed by strong health systems able to crank out the contraceptive tools women need to heed their recommendations, and a robust health workforce able to deliver them. Women and couples deserve to weigh the known risks of the virus to make informed choices about when and whether to get pregnant. Advocates can use the momentum of this crisis to make access to contraceptives a priority and to make sure all women can exercise the right to obtain contraceptives and access reproductive health services. In the meantime, the world is turning its attention to preventing the spread of this mosquito-borne illness. In addition to calls for delaying pregnancies, interventions will run the gamut from spraying insecticides to removing stagnant water to unleashing genetically engineered self-destructing mosquitoes, all bringing both predictable and unforeseen consequences. Concerns about the environmental impacts, as well as the economic repercussions of sudden, drastic declines in population growth, abound.At the global or national level, it’s a complex problem. There is no easy answer. But at the individual level, one thing is clear. While no woman should be forced to use modern contraceptives due to a public health crisis, any woman who wants to heed the recommendations to delay pregnancy—and many do—should be given the means to do so.Now is the time to make exponential progress toward securing access to contraception as part of a comprehensive package of sexual and reproductive health services for women and girls who have gone far too long without it. Photograph courtesy of Trevor Snapp for IntraHealth International
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