“Upholding human rights is essential to an effective public health response and this requires that governments ensure women, men, and adolescents have access to comprehensive and affordable quality sexual and reproductive health services and information, without discrimination...”– Zeid Ra’ad Al Hussein, U.N. High Commissioner for Human Rights
The World Health Organization announced on November 18, 2016 that the Zika virus is no longer a global public health emergency. Over the course of the last few years, Zika spread most rapidly in Latin America and the Caribbean. However, its long-term effects on vulnerable communities, particularly poor women, have yet to be seen. In order to fully eradicate Zika, comprehensive sexual and reproductive health care and information must be made available to those most in need of services such as sex education, contraception, and safe abortion.
The Zika virus was first discovered in Uganda in 1974. The virus thrives in warm, tropical environments and is primarily spread through the bites of two types of infected mosquitos: the Aedes aegypti and Aedes Albopictus. Evidence also links Zika to sexual transmission. Symptoms are similar to those of the common flu, and can include muscle aches and pains, fever, chills, skin rash, and vomiting. In some cases, Zika virus can cause neurological disorders. Birth defects and brain abnormalities can develop in the fetuses of pregnant women who test positive for the virus.
In fact, research scientists have discovered a direct link between the infection of pregnant women by Zika virus and a congenital brain condition called microcephaly in their fetuses. A limited number of studies indicate that between 1 percent and 30 percent of pregnant women infected with the Zika virus experience fetal abnormalities. The ranges are even higher for women in areas with the highest infection rates, like Brazil and other parts of Latin America and the Caribbean.
According to the Pan American Health Organization, 48 countries and territories in the Americas have reported Zika cases. The majority of these countries and territories are concentrated in Latin America and the Caribbean. Though Zika transmission is no longer deemed a public health emergency by the WHO, cases of infection continue to increase in Mexico, Panama, Turks and Caicos, and Peru. In Brazil, the rate of birth defects affecting the nervous system has nearly doubled since Zika first hit the country in 2014.
Increases in Zika transmission are centralized in poor communities, which often lack access to adequate sanitation systems, clean water, and health care. Living in close quarters to neighbors, or in “packed conditions,” can also contribute to Zika outbreak. According to the World Bank, 1 out of 4 Latin Americans live in poverty. Approximately 25% of people in the region live on $4.00 per day.
Poor women, who often face major barriers in access to reproductive health services and information, are disproportionately affected by Zika virus. In Latin America and the Caribbean, access to abortion is highly restrictive. According to the Guttmacher Institute, more than 97 percent of women of childbearing age in the region live in countries where abortion is either restricted or banned. Additionally, use of contraception is lowest in the world among women in Latin America and the Caribbean, where there is a vast unmet need for family planning and a lack of access to comprehensive sex education. More than half of pregnancies in the region are unplanned.
Lack of access to reproductive health care severely affects poor women and young women. Poor and rural women are more likely to use unsafe methods to terminate a pregnancy or seek out untrained providers. The burden of unmet need for family planning also falls hardest on poor and rural women. Religious norms and values tend to exacerbate the situation, as Latin American is predominantly Catholic. Though Pope Francis condones the use of contraceptives to help slow the spread of Zika virus, he has condemned abortion as an “absolute evil” and “a crime.”
Obstacles such as these, which hinder access to safe abortion care and contraception, are deeply troubling in the face of a public health concern such as Zika. Public health authorities have advised women living in high-impact areas like Latin America and the Caribbean to avoid or delay child bearing. However, barriers to basic reproductive health services and abortion render avoidance of or delay in child bearing extremely difficult for Latin American and Caribbean women.
On September 28, 2016, after several months of negotiations, the U.S. Congress approved $1.1 billion in support of Zika-response efforts at home and abroad. However, barriers to reproductive health services are also present in U.S. foreign aid programs. The Helms Amendment, enacted in 1973 as part of the U.S. Foreign Assistance Act, prohibits the use of U.S. foreign assistance funds for the performance of abortion “as a method of family planning.”
However, exceptions for rape, incest, and life endangerment are legally permitted by the text of the Amendment, as abortions performed under these circumstances are not carried out for the purpose of spacing births or family planning. Despite this, the U.S. government has applied the Helms Amendment as a total ban on funding for abortion. Under the Amendment, U.S.-funded programs that operate abroad are directed by the U.S. Agency for International Development and the U.S. Department of State to refrain from providing abortion-related services under any circumstance. For over 40 years, it has blocked access to abortion services for women in developing countries.
In addition to the Helms Amendment, the Global Gag Rule, also known as the Mexico City Policy, imposes barriers to vital reproductive health services. Originally implemented by President Ronald Reagan in 1984, the policy in its earlier iteration prohibited foreign, non-governmental organizations that received U.S. funding for family planning from using non-U.S. funds to provide legal abortions, counsel or refer for abortion, or lobby for its legalization. President Clinton rescinded the policy in 1993, after which President George W. Bush reinstated it in 2001 and President Obama rescinded it again in 2009.
Under the anti-choice Trump administration, it has been reinstated and expanded to restrict recipients of all U.S. global health funding—a move that will undoubtedly have a negative effect on the ability to adequately address Zika transmission. Both the Helms Amendment and Mexico City Policy denied thousands of women access to reproductive health care. Additionally, these policies lead to the stigmatization of abortion and confusion about permissible health services, even in countries where abortion is legal.
Access to comprehensive sexual and reproductive health care is recognized as a human right in the international context. It is referenced in several intergovernmental agreements and international and regional human rights instruments, including United Nations (UN) and African conference consensus documents, UN Treaty Monitoring Committees’ guidance to governments, and regional human rights treaties. In 2005, the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa, also known as the Maputo Protocol, became the first human rights treaty to explicitly address women’s right to safe abortion.
Notably, in 2011, abortion was recognized in the report of the United Nations Special Rapporteur on the right to health. The report calls on countries to rescind criminal and restrictive laws related to abortion, sex education, contraception, and conduct during pregnancy; and to ensure that abortion is safe, accessible, and of good quality. As Zeid Ra’ad Al Hussein articulated in response to global Zika transmission, any efforts to withhold a woman’s right to sexual and reproductive health care is clearly out of step with international human rights standards.
Women require access to sexual and reproductive health care in the face of Zika virus. Comprehensive sex education, contraception, maternal health care, and safe abortion are all critical components. Restrictions on abortion in U.S. foreign policy, as well as restrictive abortion laws in Latin America and the Caribbean, must be lifted. Additionally, women who have given birth to infants with Zika-related neurological disorders must have access to quality health care and support services for their families. While Zika transmission is no longer classified as a global public health emergency, the communities that have been most susceptible to transmission, including poor women and their families, must not be abandoned.