Global public health bodies accused of failing to act over ‘deeply political’ restrictions on contraception in Latin America and Caribbean
The Guardian – by Kate Hodal Public health experts are warning that the failure of global health agencies to challenge political and religious resistance to contraception in Zika-affected countries in Latin America and the Caribbean is leading to a humanitarian crisis for women .
The World Health Organisation (WHO) and US Centre for Disease Control (CDC) recommended women in the region delay pregnancy or not have sex well before the Zika virus was definitively linked in April to the birth defect microcephaly. But family planning experts say that women are merely being told to avoid pregnancy without being given the means to do so and that such advice is insufficient in the face of a global epidemic.
“This is in a region where rates of violence against women are high and women do not always have the power or ability to say no to sex,” says Giselle Carino, director of the International Planned Parenthood Federation’s western hemisphere region, which covers Zika-affected areas.
Most Zika-affected countries in Latin America and the Caribbean are predominantly Catholic and have strong political and cultural barriers to women accessing and using contraception. In Haiti, only 34% of women have access to contraception, while in El Salvador, almost 90% of pregnancies are unplanned. Terminating pregnancies is another minefield: more than 97% of women of child-bearing age in Latin America and the Caribbean live in countries where abortion is restricted or illegal.
Although the Pope suggested earlier this year thatcontraception could be used – in a departure from Catholic teaching – to prevent infection with Zika, he tempered the advice by calling it a lesser evil. Abortion, he stressed, was still “an absolute evil”.
But international funding to provide contraception in the region has all but dried up, say family planning experts. In the US territory of Puerto Rico, where a Zika epidemic is raging, two-thirds of pregnancies are currently unintended [pdf] and nearly 140,000 women are estimated to not use contraception, according to the CDC. Yet Congress stalled for months to push through an emergency funding bill to combat Zika in the US and its territories, thanks to a provision that would havebanned funding to a Puerto Rican Planned Parenthood affiliate that provides sexual health services, including contraception and abortion. Under US law, federal funds cannot be allocated for abortion.
As a result of such political in-fighting, countries most in need of family planning are at crisis point, says Carino: “The unfinished sexual and reproductive health and rights agenda has now become a humanitarian crisis in Latin America.”
Perhaps as a result of the delicate balance in the region, the WHO, CDC and Pan American Health Organisation (which works in the Americas) have been seemingly loth to stress the significance of contraception in relation to the Zika virus. The CDC, tellingly, refers instead to the timing of a woman’s pregnancy as a “deeply personal and very complex decision” that should be taken with her partner and healthcare provider.
Such tempered language points to the fine line that global health agencies walk, says James Hodge Jr, professor of public health law and ethics at Arizona State University.
“These issues are deeply political and at times legally contested in some countries where access to contraceptives and abortions is greatly restricted, if not prohibited,” he told the Guardian. In Latin America, for example, “public health organisations can be reticent to engage in policies that directly contravene national laws or politics”. As a result, recommendations remain recommendations, not global health policy.
While the WHO has developed a Zika strategic response plan that would also include family planning and education, the $122m required to put it into practice is “drastically underfunded”, says Dr Babatunde Osotimehin, executive director of the UN population fund, UNFPA, and under-secretary general of the UN.
“Women of childbearing age and their partners in Zika-prone or affected areas [must] have full access to sexual and reproductive health supplies and services,” he says. “We already know that voluntary family planning is one of the most cost-effective investments in our futures, with some estimated benefits as high as $120 for every dollar invested. The Zika outbreak means that, for affected countries, that return on investment could be even higher.”
But Dr Vincent DeGennaro of the University of Florida, who runs a clinicsupporting women’s health in Haiti, told the Guardian that the failure to put family planning at the heart of the response to Zika is contributing to a growing crisis.
“When we are in clinic and we offer women access to birth control they accept it like a hungry man eating food,” says DeGennaro. “The current policy on Zika is short-sighted and narrow. There are millions of women of reproductive age without access to contraception and the majority of pregnancies are unintended. We are failing women, and with the low cost of contraception, it’s hard to say it’s not deliberate.
“Why are we talking about Zika? Microcephaly. How do you prevent microcephaly? Prevent pregnancies,” DeGennaro adds. “I struggle to find a more urgent public health issue.”