National Partnership for Women & Families

Monthly Women's Health Research Review

Commentary highlights role of reproductive rights in addressing Zika crisis

Summary of "Countering Zika globally and in the United States: Women's right to self-determination must be central," Joerg Dreweke, Guttmacher Policy Review, May 2016.

The Zika virus "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 [unintended] pregnancy or obtain an abortion," according to Joerg Dreweke, senior policy communications associate at the Guttmacher Institute.

Dreweke wrote that officials in the Caribbean, Latin America and 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." He noted that as of early May, there were 290,000 suspected cases of the mosquito-borne, sexually transmittable virus in Latin America and the Caribbean, more than 700 confirmed cases in several U.S. territories and more than 500 confirmed cases in the continental United States.

Latin America and the Caribbean

Dreweke highlighted the situation facing women in Latin America and the Caribbean, where they face challenges preventing pregnancy and obtaining abortion care.

He explained, "In 2014, 23 million women in Latin America and the Caribbean wanted to avoid pregnancy but were not using a modern method of contraception, which contributed to well over half of all pregnancies in the region (56%) being unintended." According to Dreweke, "[T]hese 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."

Moreover, Dreweke noted that "access to abortion is severely restricted by law across the region." Because medically supervised abortion care is limited, and often available only to higher-income women, most abortion care is clandestine, entailing both medical and legal risks, he wrote. He continued, "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."

Dreweke explained that while the Zika crisis has spurred lawmakers in these regions to consider limited exceptions to abortion bans, the "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." Further, he wrote that easing the abortion bans "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."

According to Dreweke, "At every step of the way, the impact of the Zika virus in Latin America and the Caribbean is falling hardest on those with the fewest resources." He wrote that low-income women, particularly those in remote regions, have limited access to contraception; are "the least protected from mosquitoes that transmit the Zika virus"; and are "less likely than other women to have access to safe abortion care, which puts them at higher risk of complications and prosecution from clandestine procedures." Moreover, if they want to continue a pregnancy, low-income women often do not have access to the "necessary services to help them have a healthy pregnancy and birth" and "are least financially equipped to access the medical and social supports that a child with a disability may require."

Dreweke criticized the "inadequate" response to the virus in Latin America and the Caribbean, particularly the "blanket recommendations that women should avoid pregnancy over long periods of time." He wrote that such guidance "rings hollow in the face of countries' ongoing failure to provide women with access to the range of contraceptive services that would help them prevent pregnancy, if they so desire." Moreover, according to Dreweke, it "shift[s] the burden of responding to the current public health crisis to individual women," potentially stigmatizing women -- particularly low-income women -- for pregnancy and childbirth.

The U.S.

Dreweke wrote that women in the United States face similar challenges to those facing Latin American and Caribbean women, noting federal and state lawmakers' "long-standing failures ... to ensure adequate access to sexual and reproductive health coverage and care, including contraceptive services and, especially, abortion care."

Moreover, as in Latin America and the Caribbean, "those in the United States with the fewest resources may be at the greatest risk of negative health and economic consequences from Zika," he wrote, adding that low-income women and "women of color fare worse than others on a range of critical indicators, from access to health insurance to unintended pregnancy rates to difficulty obtaining a[n] ... abortion." Such women "are also more likely than others to lack the resources to parent a child born with microcephaly, a situation that is further exacerbated by an absence of affordable health care, paid family leave, paid sick leave and a living wage for many women and families," he wrote.

Dreweke also pointed out that "many of the states that may feel the initial brunt of Zika" -- including states in the U.S. South and areas of the mid-Atlantic region -- "are among the least equipped to deal with the outcomes of a possible epidemic, as they tend to have high rates of poverty, uninsurance and unintended pregnancy." Dreweke noted that the virus could also affect large cities on the East Coast, and could eventually "expand to include many more states and cities."

Regarding states in the South and mid-Atlantic region, he explained that Florida, Georgia, Louisiana, Mississippi and Texas rank "among the top 10 U.S. states" in terms of unintended pregnancy rates and rates of women of reproductive age who are uninsured. Moreover, lawmakers in "19 states -- including many that may be affected by Zika -- have worsened this situation by refusing to expand Medicaid under the Affordable Care Act (ACA)."

Further, he wrote that "women in these states who are facing an [unintended] pregnancy and have decided on abortion generally face a hostile environment when it comes to accessing abortion care." Dreweke explained that the majority of states in the South and mid-Atlantic regions have been categorized as either hostile or extremely hostile to abortion rights, meaning that "obtaining an abortion [in these regions] has become more costly and time-consuming, and can be out of reach for women who are [low-income] or otherwise vulnerable." Moreover, Dreweke wrote that 12 states have enacted 20-week bans, and state and federal lawmakers continue working to implement such bans. Further, at least nine states have imposed bands on abortions sought because of a fetal anomaly. These bans complicate efforts to diagnose and address microcephaly, which often cannot be detected until later in pregnancy.

Dreweke also cited shortcomings at the federal level, where conservative lawmakers have combatted proposals from the Obama administration "to counter a possible Zika epidemic" by repeatedly trying to overturn the ACA and its associated gains in insurance and contraceptive coverage, as well as "efforts to defund the federal Title X family planning program, which underpins the nation's network of safety-net family planning centers." Congress also "has failed to act decisively in appropriating $1.8 billion requested by the Obama administration to fight the Zika virus epidemic in the United States and abroad," Dreweke wrote. He added, "Another harmful development, motivated by antiabortion sentiment, is the ongoing campaign by the U.S. Congress and in the states against voluntary fetal tissue donations and fetal tissue research -- the very kind of research that could be critical to understanding, preventing and treating Zika."

Supporting women

The "common pattern where ideologically and religiously rooted hostility to abortion and contraception has left far too many women vulnerable to the Zika virus ... is unacceptable as a matter of public health, as well as a matter of human rights," Dreweke wrote. According to Dreweke, the Zika crisis underscores why all women need access to "the necessary counseling, information and services" for family planning, abortion and pregnancy, as well as "access to the medical, social and economic supports that are necessary to raise [a] child securely and with dignity, especially if their child has a disability."

Moreover, Dreweke wrote that "as public health responses intensify and women in some circumstances are warned against becoming pregnant, governments and health care providers have a responsibility to protect individuals -- especially women of reproductive age -- from discrimination and coercion." He wrote that a woman's decision whether to use contraception, what method of contraception to use and whether to carry a pregnancy to term "should be based on voluntarism and informed consent."

Noting that countries affected by Zika "would have found themselves in a far stronger position to respond to the current emergency" had they prioritized women's health, Dreweke concluded, "Sound policies and resources to support the rights of women to prevent pregnancy, obtain safe abortion care or become a parent and raise a child should be an ongoing priority, rather than something that receives fleeting attention at a moment of acute crisis."