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The Zika virus outbreak and the increase of babies being born with birth defects seemingly linked to the mosquito-transmitted disease have generated a series of prescriptions from governments of the most affected countries about what people need to do and not do. These include asking women to delay pregnancies—until 2018 in El Salvador, for example.
Sadly, these recommendations do not match what is in the realm of possibility for many women living in or near Latin America, the region from which we hail. We propose instead local governments and public officials look to the reproductive rights and HIV and AIDS movements for insights into the ways in which they can more effectively center the needs of those most marginalized while fighting this crisis.
Calls to delay pregnancy in several countries where the Zika virus has spread have revealed gaps in health systems resulting from unfulfilled demands for sexual and reproductive health-care services. While women in Latin America generally have access to contraception—a real demonstration of decades of activism and leadership—in some Central American countries such as Guatemala, over 26 percent of married young women who do not want to become pregnant have an unmet need for birth control, and therefore are at risk of an unintended pregnancy.
Sex. Abortion. Parenthood. Power.
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In the regions that have seen a spike in Zika cases, there are also high rates of sexual violence. The World Health Organization reports that one in three women experience violence in her lifetime. Those rates in Peru, where health officials in late January confirmed the nation’s first case of Zika, appear to be higher: A 2005 report found more than half of women in Lima and Cusco experienced physical or sexual violence by a partner some time in their life.
Without access to contraception, many women, including some young girls, will experience unintended pregnancies. And once pregnant, women and girls do not have control over their own reproduction as the laws provide limited options for termination. In countries that have very restrictive abortion laws, women and girls face an even greater health crisis should they experience an unintended pregnancy, become infected with the Zika virus, and want an abortion.
In light of this situation, how realistic is it to expect the public to delay their pregnancies as they are prescribed to do? Is this top-down approach to tackling a health-care emergency grounded in the realities and needs of women? Are policymakers once again “instrumentalizing” women to solve a threat or a global challenge?
Activists have known for a long time what is needed at a structural level to ensure that women’s health and rights are respected and promoted. Reproductive rights and HIV and AIDS advocates have said it all along.
The response demands long-term commitments to three rights pillars: First, access to information and services. Women need access to information about the virus, including how to prevent transmission. They also have a right, as UN bodies have argued, to access the type of sexual and reproductive health services they need, including a range of contraceptive options. If pregnant, every woman should be able to decide if they will carry to term their pregnancy—and have access to safe abortion or maternal health care and social support services.
Second, governments and stakeholders need to scale up their commitments to protect women’s agency. Women have to be empowered to make choices regarding their own health, and those choices need to be respected. Women living with HIV have shared their painful experiences of being subjected to coercive sterilization or abortion and of having their right to reproductive autonomy erased. Advocates and policymakers need to reinforce the rights and dignity of women and show that respect for their decisions is at the center of any policy and health intervention. As we learned from the AIDS response, this work of fighting a global health crisis must start with the concerns of those most vulnerable and marginalized, and their voices must be heard at all times.
Lastly, in a world where leaders look for magic bullets and advance biomedical approaches as one-size-fits-all solutions to health challenges, governments and different stakeholders need to bolster all efforts aimed at eliminating discrimination and violence against women and girls. These efforts should include removing obstacles to reproductive health services, investing in the empowerment of adolescents, and training health providers to protect and promote women’s sexual and reproductive decision making. These interventions will ensure that when a crisis hits, all persons—whether women or those from other marginalized groups—are enjoying the legal, policy, and cultural conditions that recognize them as full citizens and agents of their health and lives.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of UNAIDS.