National Partnership for Women & Families

In the News

Providers: Zika presents opportunity to increase access to contraception, reproductive health care

"For all its negatives, the Zika outbreak ... provides an opportunity to press strongly for universal access to contraception and reproductive services for women in all Zika-affected countries, but this opportunity is being largely overlooked," write Grace Tillyard, director of communications and outreach for Innovating Health International, and Vincent DeGennaro, president of Innovating Health International and assistant professor at the University of Florida College of Medicine, in an opinion piece for The Guardian.

The authors note that while both the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have called on women in affected areas to postpone pregnancy, they have not "pu[t] any resources behind widespread contraception."

According to Tillyard and DeGennaro, "Only 62.5 [percent] of Latin American women use some form of contraception, and in Haiti, only 34 [percent] of women have access to contraception." Meanwhile, 45 percent of pregnancies in the United States, 65 percent of pregnancies in Puerto Rico and up to 90 percent of pregnancies in El Salvador are unintended, the authors write, adding that "Haiti, without an effective public health system or quotable statistics, is likely not far off" from a 90 percent unintended pregnancy rate.

"The choice to focus on [pregnant women] rather than considering women as a whole will be costly, most of all for vulnerable women who are most likely to have an unintended pregnancy," Tillyard and DeGennaro write. Citing their own work in Haiti, the authors write that "the cost -- both social and economic -- could be catastrophically high as the scale of the epidemic is probably drastically under-reported to date." Further, they explain that "[i]n most low- and middle-income countries in Latin America, marginali[z]ed women's chances of resuming their schooling and work will be decimated when they have to look after a severely disabled child."

The authors explain that providing "contraception would be one of the cheaper options for dealing with the Zika crisis, at only $31 per woman per year, including all the personnel costs of healthcare workers." In contrast, in the United States, the estimated cost "of one child with Zika birth defects ... is $4M, including extra ultrasounds, hospitali[z]ations, surgeries and critical care," the authors write. Citing CDC estimates that "138,000 women of reproductive age in Puerto Rico (19 [percent]) do not currently desire pregnancy and are not using contraception," the authors continue, "At $31 per woman per year, the $4.3M additional cost for achieving universal access to contraception is dwarfed by the $250M in the US Senate bill allocated for the prevention of Zika infections in pregnant women and associated medical costs."

Tillyard and DeGennaro explain that in their own work in Haiti, they aim to empower women through health care services. "The failure to provide services that help women is in part due to the age-old problem of reducing women's health to simply maternal health, and propelling [programs] that tell women what to do rather th[a]n empowering them to make decisions for themselves," the authors write, adding, "Zika, it seems, is no different."

They contend that "[d]eclaring contraception as the cheapest and most effective way to deal with the crisis would be a bold step towards lobbying all governments in the region to expand these much-needed services." Moreover, they note that making contraception available "in low- and middle-income countries results in better birth-spacing, reduced maternal mortality and infant mortality, and advances in the socio-economic status of women."

Tillyard and DeGennaro argue that the "Zika crisis, like abstinence-based teachings for HIV prevention, is a missed opportunity to invest in women's health infrastructure, where ideology trumps public health and financial logic in Latin America and the Caribbean." According to the authors, "Transnational public health authorities, like the CDC and WHO, are allowing politics with antipathy to women's reproductive health to pollute public health logic, forcing countries to commit ineffective funds and set a standard that leaves women behind." They conclude, "Will we let yet another crisis go by without addressing reproductive health services for half our population?" (Tillyard /DeGennaro, The Guardian, 11/20).