Brazil is in a state of crisis. Since October, there have been more than 4,000 suspected cases of babies born with a neurological syndrome associated with the Zika virus. The Health Ministry has suggested that women avoid pregnancy until the epidemic has passed or more is known about it.
I am a Brazilian woman. My friends who are planning to have children soon are worried about Zika. But they don’t need to be too concerned. In our well-to-do neighborhood in Brasília, the capital, there has not been a single case of a baby with the birth defects associated with the Zika epidemic. As far as I know, not one woman here has even been infected by the virus.
Lost in the panic about Zika is an important fact: The epidemic mirrors the social inequality of Brazilian society. It is concentrated among young, poor, black and brown women, a vast majority of them living in the country’s least-developed regions. The women at greatest risk of contracting Zika live in places where the mosquito is part of their everyday lives, where mosquito-borne diseases like dengue and chikungunya were already endemic. They live in substandard, crowded housing in neighborhoods where stagnant water, the breeding ground for disease-carrying mosquitoes, is everywhere. These women can’t avoid bites: They need to be outdoors from dawn until dusk to work, shop and take care of their children. And they are the same women who have the least access to sexual and reproductive health care.
The Zika epidemic has given Brazil a unique opportunity to look at inequality and reproductive rights, and to change how the country treats women. Asking women to avoid pregnancy without offering the necessary information, education, contraceptives or access to abortion is not a reasonable health policy. Sexual and reproductive rights for all women, poor and rich, must be taken seriously. The government should immediately offer a comprehensive package of sexual and reproductive health care to all Brazilian women, with a specific focus on those at most risk of Zika infection.
Brazil has some of the world’s strictest abortion laws. The procedure is legal only in cases when the life of the woman is in danger of complications, or she was raped, or she is carrying an anencephalic fetus. Knowledge that a child will suffer from serious neurological problems is not grounds for legally terminating a pregnancy. That doesn’t mean that abortion is uncommon, though.
In 2010, I conducted a national survey that found that by age 40, one in five Brazilian women had had at least one abortion. The overwhelming majority of these abortions were illegal and performed in unsafe conditions. According to Brazilian law, more than five million women should have spent time in prison. They would have amounted to almost 10 times our current prison population, which is the fourth largest in the world. In abortion, too, Brazil’s economic inequality is a factor: Wealthy women can pay to secure safe abortions; most women can’t.
The poor women who are most likely to contract Zika face tremendous barriers to getting safe abortions. They are forced to carry their pregnancies in fear. Public health clinics in poor communities rarely offer either the blood test that detects the presence of the virus or the ultrasound that can diagnose birth defects. We in Brazil need to know their stories to repair the harm inflicted by the government’s negligence in controlling the outbreak.
Low-paid women and domestic workers are the true face of the Zika virus. In Brazil, it is usually women who are responsible for family planning and child care. They will also be the caregivers of disabled, dependent children. Some news reports have included accounts of women being abandoned by their partners after the birth of a baby with neurological problems. The state shouldn’t abandon them, too. It needs to provide financial support and social services for the poor women and their children who are suffering from the effects of Zika.
The Health Ministry must help Brazil’s women. In the short term, the government needs to control the mosquitoes by destroying their habitat and working with the international community to advance knowledge about how to stop the disease. But that’s only a start. Women need to be given the power to manage their own pregnancies.
While family planning is a constitutional right, many women have trouble getting contraceptives because of poverty or inconvenience. This must change. And sexual and reproductive education must be a topic in Brazil’s public schools.
The government must finally give women basic control over their reproductive lives — accessible and affordable contraception, and safe and legal abortion. The organization I founded, Anis — Institute of Bioethics, is preparing to present a case to the Supreme Court with these demands. Ever since we announced our plans, I have been receiving phone calls from women from all over the country; some have seen their childbearing dreams turned into nightmares because of the Zika virus. Others worry about how they will get health care for their disabled children. Many wonder how many more will have to suffer or die before abortion is a right.
Debora Diniz is a founder of Anis — Institute of Bioethics and a law professor at the University of Brasília.