A new Human Rights Watch (HRW) report looks at the aftermath of the Zika epidemic in Brazil—and also holds disturbing lessons for the U.S. The group interviewed more than 180 people impacted by Zika, mostly women with affected babies and those who were still pregnant.
A 25-year-old pregnant woman stands near uncovered water storage containers in her home in Recife.... [+]
The HRW findings are disturbing but sadly unsurprising. Women and girls predictably bear the burden of the disease and its aftermath, being the ones largely responsible for care taking of the affected babies.
Reproductive Care
Two other aspects highlight disparities in Zika’s impact. One is the restriction on sexual and reproductive rights. Women still lack access to both education about reproduction and contraceptives, resulting in unwanted pregnancies. Then, despite Brazil proclaiming a right to healthcare, poor women (especially) are often unable to access adequate prenatal care and testing, let alone abortion, which is illegal.
Clandestine abortions remain too necessary, resulting in needless deaths—the fourth leading cause of maternal death, per HRW. Tragically, since 2005, about 17% of these abortion-related deaths were in young girls and women only 10-19 years old.
When Dr. Margaret Chan, the director general of the WHO, declared the Zika epidemic over, she added:
Zika revealed fault lines in the world’s collective preparedness. Poor access to family planning services was one. The dismantling of national programmes for mosquito control was another.
Sanitation and water
An ongoing problem in Brazil, and many countries, is that of inadequate access to water and sanitation.
The government’s response to the initial outbreak of Zika was to focus on vector control of the mosquito. There have been some great technological advances, such as trials of Wolbachia-infected mosquitoes or Oxitec’s genetically modified insect. These have been innovative and fascinating to watch, but the biggest response has been by increased spraying.
While focused on damage control, the Brazilian government has failed to fix the country’s underlying problem of poor sanitation and lack of access to clean water. According to HRW, “More than one-third of Brazil’s population lacks access to a continuous water supply.” So women store water in containers that might become breeding grounds for the mosquitoes. Poor sanitation leaves standing water and sewage, which again serve as breeding grounds for the mozzies. Both of these problems disproportionately affect poor communities…and women again bear most of the responsibility to try to implement burdensome attempts to eliminate standing water, which will likely be futile.
Lack of access to clean water and sanitation is a global health problem, ranging from the cholera epidemics in Haiti and Yemen to the lack of clean water in Flint, now two-plus years after exposure to its lead-contaminated water. In fact, the UN special rapporteur stated last year:
“There is a strong link between weak sanitation systems and the current outbreak of the mosquito-borne Zika virus, as well as dengue, yellow fever and Chikungunya,” and added further that, “the most effective way to tackle this problem is to improve the failing services.”
A huge problem facing Brazil is that in December 2016, a constitutional amendment was approved which freezes public spending for 20 years (except for inflation).
So while Brazil is more advanced than the U.S. in declaring that healthcare, clean water and sanitation are human rights, they are failing to implement necessary interventions.
What can be done?
Some of the recommendations from the HRW report would be more readily undertaken than others, given the austerity measures. The relatively inexpensive ones focus on education for both men and women as to preventing Zika infections, especially by sexual transmission. Men should be taught about their responsibility in reducing infection, be tested before the couple tries to conceive and educated about the need for condom use. Another would be to provide free insect repellents to pregnant women and those seeking to conceive.
Decriminalizing abortion and providing better post-abortion care when needed would make a huge difference. Education and access to contraceptives are critically important. Beatriz Galli, senior Latin America policy advisor for Ipas, a reproductive rights NGO, explained that an underlying problem was the focus on the mosquito and fumigation, rather than on the reproductive risks and prevention. She stressed that more emphasis needs to be placed on fixing structural problems. Further, funds for education and health were frozen. As appears universally true, poor, disadvantaged women are disproportionately affected. In Brazil, it is by getting infected with Zika and having babies with severe neurologic defects, and then not being able to access care for their children. She concludes, “These are not families that have a voice.”
Zika has all too clearly shown the socioeconomic fault lines that run through societies like Brazil's, which, although it has declared access to healthcare to be a universal human right, has failed to implement the policies and strategies that would make that declaration a reality. We not only have never made such a commitment, but are implementing policies that will greatly increase the disparities and the divide between rich and poor; I'll detail these in my next post.
