Zika and pregnancy in Brazil: special thematic section

Cadernos de Saúde Pública 2016;32(5) Rio de Janeiro

  • Zika virus and women, by Debora Diniz

Epidemiological surveillance describes numbers and cases. As of March 12, 2016 (Epidemiological Week 10), there were 6,480 suspected cases, 1,349 rejected cases, and 863 confirmed cases of microcephaly or other alterations suggesting congenital infection caused by the Zika virus in Brazil. In 97 cases, the presence of the mosquito-borne virus was confirmed by specific tests 1. Epidemiological terminology makes us forget that these cases were preceded by women who were affected by the Zika virus – discarding these women cannot be justified by the biopolitics of diseases. The Zika epidemic, which involves cases of microcephaly and/or other alterations in the central nervous system associated with viral infection 2, affects women from a specific social class and region: poor women from Northeast Brazil. Seventy-two per cent of the babies born with the symptoms of Zika virus congenital syndrome in Brazil are born to women who live in the northeast states of Bahia, Paraíba, Pernambuco, and Rio Grande do Norte. Simply referring to cases ignores the stories and the suffering, the anguish and the abandonment…

  • The debate on abortion and Zika: lessons from the AIDS epidemic, by Thais Medina Coeli Rochel de Camargo

The Zika epidemic has brought renewed attention to (the lack of) abortion rights in Brazil. This current debate bears similarities with discussions regarding Rubella that took place in several countries in the mid-20th century. In Brazil, however, this debate never happened. At that time, abortion was not the focus of public debate, and this silence would remain well into the 1970s. Nonetheless, there is one national parallel that is of interest to the current debate, and it concerns HIV…

  • Women’s reproductive rights and the Zika virus epidemic, Jacqueline Pitanguy

… Brazil is experiencing a public calamity with the outbreak of microcephaly cases associated with Zika infection in pregnant women, in what specialists have called the Zika virus congenital syndrome, including, along with microcephaly, a series of other malformations and neuropathies affecting the infant’s vision, hearing, and upper and lower limb movements… Pregnant and childbearing-age women all across the country are living the stress and even the panic of giving birth to a child with microcephaly. Every prenatal visit and every ultrasound test is a moment of emotional torture. It is urgent and necessary that responses to the Zika virus epidemic include the issue of women’s reproductive rights… The Brazilian and international women’s movement has endeavored to show the intrinsic links between reproductive autonomy and the State… The epidemic of Zika virus… raises challenges for government in vector control, reliability, accessibility, and speed in diagnosis, vaccine production, and intensification of basic sanitation policies. However, the proliferation of cases of microcephaly in Brazil raises another challenge: to ensure women’s reproductive rights, including the right to terminate the pregnancy…

  • Comment on the paper by Pitanguy, by Florencia Luna

The article by Dr. Jacqueline Pitanguy is clear, relevant, and required. In this brief commentary, I wish to highlight the significance of this type of discussion for the Argentine population and its importance for an adequate understanding of the available tools for an ethical response to the epidemic…

  • Ensuring a rights-based health sector response to women affected by Zika, by Paige Baum, Anna Fiastro, Shane Kunselman, et al

In March 2016, the Brazilian Ministry of Health published its most recent guidelines for the health care response to Zika-related microcephaly (the “Protocol”). The Protocol provides recommendations for provision of care in the contexts of family planning through prenatal and infant care. Unfortunately, although the Protocol emphasizes the importance of access to information and contraception, it fails to appropriately acknowledge the practical challenges that many individuals face in obtaining and using contraception, particularly poor, black and brown and young women, living in areas most affected by the epidemic. It also entirely ignores the fact that unsafe abortion is a public health reality in Brazil and one that is likely to worsen in light of the Zika epidemic and its uncertainties…

  • Comment on the article by Baum et al, by Ana Maria González Vélez

Unlike Brazil, the guidelines adopted by Colombia address the management of childbearing-age women from a comprehensive perspective, and propose prevention first, centered on the availability of a wide range of contraceptive methods in the prevailing legal framework in the Colombian health system… With regard to abortion, unlike Brazil, Colombia’s protocol emphasizes the importance of information in the following terms: “pregnant women with Zika infection should be informed on the existence of an association between the infection and congenital anomalies in the newborn’s skull and central nervous system…” In this context, the protocol explicitly addresses the issue of abortion, reiterating the right of Colombian women to have an abortion under three circumstances, one of which includes harm to their health… From the protocol’s perspective, the application of “health grounds” 4 (the indication of legal abortion when the woman’s health may be in jeopardy) to the psychological sphere means considering that “mental health includes psychological anguish, mental suffering, forced sexual acts, or the diagnosis of severe fetal injury…

  • Zika and reproductive justice, by Alexandra Minna Stern

The appearance of Zika in Latin America over the past six months has prompted a wide range of responses, from the creation of microcephaly clinics for newborns in affected areas to the rapid roll out of transnational scientific research to determine the molecular and epidemiological dimensions of this mosquito-borne disease. This crucial knowledge is needed to understand the scope and scale of this emerging disease – to establish baselines for further studies, to determine the extent of the problem, and make evidence-based plans for prevention and potential medical treatments for children with Zika-related conditions… A reproductive justice perspective compels us to consider Zika in the context of reproductive stratification, gender inequalities, and social justice, and can help navigate the social complexities of the virus and its human implications.

PHOTO Relatives of patients suffering from microcephaly gather at the Altino Ventura Foundation in Recife, Brazil, in Irish Times, Brazilian women on the frontline of fight against Zika, 26 February 2016