Cases of the virus associated with fetal microcephaly have been detected in Dallas and Travis County. The state’s first response should be increasing access to family planning and resources for disabled children.
At this point, you’ve probably heard about the Zika virus. In pregnant women, the virus has been associated with fetal microcephaly, which can result in severe disability or death.¹ The CDC recently released a statement finding causality more and more likely.2,3 While a microcephaly diagnosis can include conditions ranging from a slightly smaller than normal head to a complete lack of brain development, cases related to Zika appear to be severe.4 Scientists and politicians have been advising women to avoid pregnancy to ensure that they do not find themselves carrying unviable or severely disabled babies. They don’t seem to have any options for the thousands of infected people already pregnant, who may want to terminate their pregnancies or access services for disabled children.
Between being stigmatized as a poverty issue as well as a women’s issue, Zika didn’t get too much attention in the United States until the announcement last month that a case had been sexually transmitted in Dallas.5 The Dallas case coincided with the WHO declaration that Zika is an “international health emergency” on February 1. On February 4, the first case was confirmed in the Austin area.6 Pregnant people in the Southern United States have gathered in Internet forums to discuss their risk. That risk will be high if a link is proven and Zika spreads, by sexual transmission or by mosquito when the season comes.
What policies have our southern neighbors been using to take action against Zika, and could Texas learn anything from them? El Salvador has non-ironically told women to avoid getting pregnant until 2018.7 Doing so, however, would require eliminating sexual violence and delivering sexual education to the entire population, not to mention condoms and hormonal birth control options. Brazil, Colombia, and Honduras have followed suit, advising women not to get pregnant. In all of these Catholic countries with limited birth control and zero abortion access, telling women to avoid pregnancy is equivalent to telling women to practice abstinence for the next two years – and to avoid being a victim of the high rates of sexual violence.8
Despite the fact that pregnancy cannot happen without men, they are conspicuously missing from the conversation around Zika. Perhaps this is because if officials tried to deal with a public health issue by explicitly asking men to practice abstinence for two years, they would be laughed out of office.9 It’s easy to ignore the role men play in pregnancy because our collective cultural discourse sees pregnancy as something that women do to themselves: “So-and-so went and got herself pregnant.” We might soon see the next Todd Akin claiming that after being bitten by mosquitoes, the “female body has a way to shut that whole thing down.” 10
While South and Central American government policies on Zika and women seem shockingly insufficient, women in Texas might find themselves in a similar bind. Some articles point out that in Brazil, unplanned pregnancies are estimated to make up over half of all births.11 The authors don’t seem to realize that this is also the case in the United States, and the rate is climbing higher in Texas.12
Last month, the Texas Policy Evaluation Project at the University of Texas at Austin released a study showing that more than half of Texas women face barriers to birth control access.13,14 The repeated defunding of Planned Parenthood in Texas since 2010 has led 46 Planned Parenthood clinics to close, as well as 36 other clinics also denied funding as “abortion affiliates”. That the closure of 82 sexual and reproductive health clinics would have an impact on people’s access to family planning should shock no one.15
Those clinics also provided pregnancy and prenatal care and resources, resources that pregnant Texans now lack access to. In 2014, nearly one in six women who gave birth in Bexar County received no prenatal care whatsoever. More than 6,000 women only accessed care late in pregnancy – and Zika has the gravest effects in the first trimester.16 Besides the closing clinics, access to prenatal care is difficult for the 766,000 people in Texas’s so-called “Medicaid gap”. 67% of these uninsured people are people of color, and 55% are women.17 In addition, incarcerated women in Texas have abysmal access to sexual health and prenatal care.18
Although abortion is legal in Texas, unlike in many of the Central and South American countries facing a Zika crisis, access to abortion has plummeted in the wake of HB2, the 2013 omnibus abortion bill that has resulted in the closure of 26 providers. TxPEP research found that wait times have increased drastically from a maximum of 5 days to up to 20, making abortions costlier and pushing them closer to Texas’s 20-week limit.19 Microcephaly is usually diagnosed in the 19- or 20-week ultrasound, leaving women on the edge of the 20-week ban, and new research shows that Zika contracted later in pregnancy can threaten the viability of the fetus as well.20 The Texas law does have a fetal abnormality exception, which allows for abortion if the fetus has a terminal condition, but it is vulnerable; lawmakers tried to abolish it in the 2015 legislative session.21
Some abortion activists hope that Zika could motivate expanded family planning access as rubella did in the 1960s. Similar to Zika, rubella’s effect is greatest in pregnant women, leading to fetal abnormalities. Doctors began performing therapeutic abortions for the white, middle-class mothers who could afford them. LIFE ran a cover story and the nation began seeing abortion as more respectable and decent – even as the moral decision. State laws began changing and just a few years later, the Supreme Court decided Roe v. Wade.22
Other activists predict a response closer to that received by HIV/AIDS, due to the stigmas the virus has already picked up. Pamela Merritt, the cofounder of Reproaction, is skeptical that Zika will make states rethink Medicaid or sexual and reproductive health care policies. She warns that families of babies with microcephaly who survive will them find themselves trapped in a system hostile to those with disabled children.23
Her warning that you can build walls on the border, but you can’t stop mosquitos, is particularly chilling in Texas. The state government can take immediate action by reducing mosquito breeding sites, using non-toxic insecticides, beginning a public education campaign, and distributing mosquito nets. Texas could also look into the genetically modified sterile mosquitoes being used in Brazil to bring down mosquito populations.24 Because Zika is also sexually transmitted, I would advise the state to
make condoms widely available and conduct sexual education campaigns as well. And since everyone deserves a real choice about every pregnancy, services for disabled children will need to be made more widely available so anyone who wants to keep a child with non-fatal microcephaly can do so.
Zika has already come to Texas. Hopefully the government will do more than abstinence education and telling women to wear bug spray.
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For an overview of how Zika might be connected to microcephaly – or how it might not be – check out this article on Wired. [http://www.wired.com/2016/02/the-zika-epidemic-is-real-a-link-to-birth-defects-may-not-be] Patricia Pestana Garcez, a neurodevelopment expert at the Federal University of Rio de Janeiro in Brazil, is skeptical until the link is proven, but even she is warning women to avoid getting pregnant. Circumstantial evidence argues that women should not take the chance, she said.