This post was written by Debora Diniz. Debora is a tenured professor at the Law Faculty of the University of Brasília and visiting professor on the Bioethics, Applied Ethics and Public Health Program at Oswaldo Cruz Foundation (Fiocruz) in Rio de Janeiro, as well as a researcher at Anis – Institute of Bioethics. Debora is the Vice-Chair of the board of the International Women’s Health Coalition (IWHC), an Advisory Committee member of Global Doctors for Choice, and member of Renezika, the National Network of Specialists in Zika and related diseases. Any questions or comments can be directed to d.diniz@anis.org.br.
The Zika virus arrived in Brazil in 2014, probably during the World Cup. As of September 2016, over 200,000 probable cases of Zika fever have been diagnosed in the country. The Zika infection itself can be an ordinary, mostly harmless disease that causes skin rash and pain, and was commonly referred to as a lighter version of Dengue before the new virus was identified. But in late 2015, Brazil began facing what the World Health Organization (WHO) came to recognize as a Public Health Emergency of International Concern (PHEIC) in February 2016: neurological disorders associated to the Zika virus epidemic.
For women of reproductive age, a Zika infection can be devastating, because it can cause significant harms to pregnant women and to their future babies. Although Zika is primarily spread through mosquito vectors, it can also be sexually transmitted, and other forms of transmission are still under investigation. Initially described as capable of causing microcephaly – a condition in which the baby’s head is significantly smaller than expected – through vertical transmission, scientists now know that what Zika can cause is the congenital Zika syndrome, which refers to a wide range of conditions including not only – and not always – microcephaly, but also physical, hearing and visual impairments and frequent seizures.
As of December 2016, the Zika virus was circulating in 75 countries and territories of the Americas and Western Pacific and South-East Asia regions, and 28 of them have reported cases of microcephaly and other central nervous system malformations suggestive of congenital infection. Brazil remains at the center of this crisis, with over 10,200 suspected cases of congenital Zika syndrome, of which 2,189 have been confirmed so far. For the last four decades, the Brazilian population, especially those living at the Northeastern region – the least developed area in the country – have been made to live with Aedes aegypti, the primary Zika mosquito vector, due to failed vector control, sanitation and access to water policies.
As a sexually transmitted infection with potentially devastating effects from vertical transmission, the Zika epidemic is a sexual and reproductive health and rights issue. The populations at higher risk for the epidemic are poor black and brown women from the region. Having scant access to health care information and services, when pregnant, these women are potentially subjected to psychological torture. They cannot know if and how Zika might affect their pregnancies and their own health. They do not have the right to legally terminate their pregnancies (abortion is illegal in Brazil except in cases of rape, if the woman’s life is at stake or anencephaly) and cannot afford to have illegal but safe abortions. They do not have the means to care for potentially affected children and these children are frequently abandoned by their partners. The Zika epidemic is a public health emergency tragically aggravated by the social disparities in the country. To share stories of the first generation of Brazilian women affected by the epidemic, Anis – Institute of Bioethics, the organization I co-founded, produced the short documentary film Zika, available online.
The Brazilian government’s response to this crisis has been slow and inadequate, and the epidemic has become invisible in the middle of the worst political and economic crisis in decades. In response to the government’s inadequate actions, Anis developed the strategy for a judicial case filed by the National Association of Public Defenders (ANADEP) before the Brazilian Supreme Court last August. The case demands basic protections for women, affected children and families: the right to access information related to the epidemic; the right to access a diverse range of contraceptive methods and distribution of mosquito repellent as a family planning method; the right to interrupt the pregnancy if the woman has been infected by Zika and is experiencing mental distress; the right to free transportation to health care facilities and the right to a disability cash transfer program (BPC) for all children with the congenital Zika syndrome.
Over the last few months, several organizations – including many anti-choice groups – have presented amicus curiae admission requests on the Zika case. In its own request, Anis filed a submission by some of the UN Human Rights Council Special Procedures mandate holders which concludes that the denial of abortion services in the context of Zika may amount to torture and/or cruel, inhuman or degrading treatment. The Brazilian Supreme Court is set to rule on the preliminary injunction of the Zika case on December 7th 2016. The case’s claim before the Brazilian Supreme Court is clear: we might not yet know everything there is to know about the Zika virus, but we do know that women and girls are at the center of the epidemic and that protecting their sexual and reproductive health and rights is essential to protecting public health.
