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Poor Brazilian Women Carry the Greater Burden of the Zika Virus Epidemic

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Much has been said about the Zika virus epidemic over the last few months and its association with neurological fetal malformations. With WHO announcing it as a global public health emergency, it has grabbed attention in both south and north countries. Brazil has been at the epicenter of the epidemic and although it did not need the extra attention since the country has been in state of political and economical turmoil, the Zika virus epidemic has opened up a wider discussion about the state of public health and health systems in Brazil.

The latest epidemiological bulletin issued by the Brazilian Ministry of Health showed that, between October 22nd 2015 until March 26th 2016, 6,776 cases of potential fetal “microcephaly and/or other alterations of the central nervous system” have been notified (which is determined by measuring the circumference of the fetus or newborn’s head. If the measurements fall under the current notification standards, it ensues a series of medical exams to either confirm or dismiss the case). Out of the notified cases, 944 have been confirmed and 4,291 remain under investigation. Although it has become common to discuss microcephaly in the scenario of the epidemic, this is otherwise an inaccurate description of the possible association between Zika virus and fetal neurological disorders. Microcephaly is only the first sign registered in perinatal notification of this new condition, which is being called congenital Zika syndrome by the scientific community and may include other severe malformations. Debora Diniz from Anis – Institute of Bioethics explains further how the notification and confirmation process works.

Although the epidemic has national reach, it is concentrated in the northeast of the country and impacts primarily poor women of reproductive age. They live in areas with precarious sanitation conditions and irregular access to safe water, which contribute to the proliferation of mosquito-borne diseases, and they have limited access to health care information and services. When pregnant, they are potentially subjected to psychological torture. They cannot know for sure, given the many unanswered scientific questions, if and how Zika might affect their pregnancies and their own health. They do not have the right to legally terminate their pregnancies and cannot afford to have illegal but safe abortions. They do not have the means to care for potentially affected children. Coverage of the epidemic has shown that their partners have abandoned many of these women during pregnancy or shortly after birth upon diagnosis of congenital Zika syndrome. Along with the limited social protection for maternity and childhood by the Brazilian State, this has exacerbated the burden of care work on poor Brazilian women. There is no question that the epidemic has a particular and traumatizing effect on women – on their health, on their social protection needs and on their rights, particularly their sexual and reproductive rights.

However, what we currently see in Brazil is a state that has neglected the basic health needs of entire communities and is not acting quickly enough to respond to the epidemic. Moreover some politicians in the Brazilian Congress are choosing this crisis to push their conservative fundamentalist agenda to undermine women’s bodily autonomy including by proposing a bill (PL 4.396/2016) that would increase the prison term for abortion linked to microcephaly to up to 15 years. It is a fact that increasing or further restricting abortion laws in Brazil will impact, primarily, poor women. And these are the same women who are experiencing the greater number of Zika virus and giving birth to babies with neurological singularities. They are the ones who have less access to health services and enjoyment of their rights, but who carry the greater burden of the epidemic. What the Zika virus has done for women in Brazil is to make visible a telling account of the growing inequalities in the country including income, gender and geographical inequalities. Reproductive justice for Brazilian women is needed now more than ever.

Anis – Institute of Bioethics in Brazil is preparing a case to present to the Brazilian Supreme Court. The case calls for a comprehensive package of family planning and social protection for motherhood and childhood, including access to quality information regarding the epidemic and its risks; the right to legal and safe abortion if desired by the woman, given the potential psychological torture of carrying a pregnancy to term during an epidemic of yet unknown effects; and, for women who give birth to babies with disabilities, social protection for the woman and child, including an immediate claim for a cash transfer policy. The case’s key message is that despite the current scientific uncertainties, Brazilian pregnant women’s suffering is certain and cannot be tolerated or ignored. It requires acknowledgement by the Brazilian State that promoting women’s sexual and reproductive health is a necessary condition for protecting public health, regardless of any epidemic, as well as the understanding that women’s reproductive autonomy and disability rights are completely compatible and intersectional agendas. Check out Anis Vozes da Igualdade blog to learn more about the strategic litigation.

Sexuality Policy Watch has compiled an amazing list of resources and news from around the world on the Zika virus crisis and its effect on women.

Authors: Marisa Viana (RESURJ) and Sinara Gumieri (Anis – Institute of Bioethics)
Image credit: Ramon Navarro

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