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This paper intends to identify current obstacles and challenges to women’s healthcare in Brazil specifically regarding the recent ZIKV epidemic that has plagued the nation. Research has demonstrated that the virus has taken a disproportionate toll on Brazil’s northeastern region compared to its southernmost regions, which are comparatively richer and less prone to the spread of ZIKV to humans through transmitting mosquito vectors. Solutions to the spread of ZIKV and its congenital effects on neonates requires an overhaul of Brazil’s universal healthcare system and its current inability to provide consistent, quality healthcare services for women of reproductive age, especially those women who are socioeconomically and regionally disenfranchised. There exist multiple solutions to this issue that have not yet been fully explored, but have been suggested by numerous scholars and medical researchers.
Beginning in 2015 and continuing through 2016, an international outbreak of the Zika virus (ZIKV) throughout the Americas plagued the Brazilian people. Most unfairly, this disease primarily affected women who were pregnant and women who could become pregnant. “Currently, the World Health Organization (WHO) considers Zika to be causally associated with microcephaly and other neurologic conditions,” Pablo K. Valente, an MD researcher from the American Journal of Public Health, states (Valente 1376). “Although the northeastern region accounted for 38.5% of all probable ZIKV infections, it concentrated 71.2% of notifications and 85.1% of confirmed cases of microcephaly,” researchers from the American Journal of Public Health reported in 2017 (Osorio-de-Castro, et. al 960-961). These results point to an extreme disproportion regarding women’s healthcare in the northeastern region of Brazil. In their research, Osorio-de-Castro, et. al speculate that natural susceptibility of the population, simultaneous infection with the disease chikungunya, having had a previous infection of dengue, mutating and enhancing characteristics of ZIKV, and “social determinants related to poverty, poor sanitary and living conditions, and lack of education” in Brazil’s northeastern region may all be contributing causes to the concentration and severity of ZIKV cases.
The disproportionately severe effect of ZIKV on pregnant women has been the center of much overdue conversation on women’s rights to reproductive healthcare in Brazil. In a twist of irony, the unification of Brazil’s national health system in 1988 granting that healthcare provisions be the sole responsibility of the state has proven degenerate at best in response to the ZIKV outbreak. The state’s incompetency of care is even more pronounced concerning women’s access to quality reproductive healthcare. Ineffective family planning aids, high maternal mortality rates, and furthermore, that abortion is criminalized with exceptions in the case of rape, risk of life to the mother, and anencephaly of the fetus, have led to extreme negative consequences for Brazilian women, especially the socioeconomically disadvantaged. “An estimate by Diniz and Medeiros indicated that more than 20% of women in Brazil will have had an abortion by the age of 39 years,” Valente reports, noting that “abortions are often illegal and unsafe, and socioeconomically vulnerable women are more commonly affected by complications related to the procedure” (Valente 1376).
Because of the massive disparities in the geographic locations and socioeconomic conditions in which pregnant women and their infants are disproportionately affected by ZIKV, research on this topic will likely show wealthier women in Brazil’s wealthier southeastern region having access to more reliable and effective family planning services as well as international access to legal and safe abortion providers. Additionally, the southeastern region should show less hospitable conditions for the mosquitoes that transfer ZIKV and allow it to mutate over time. The Amazon rainforest occupying most of the Brazil’s northeastern region likely provides a much more hospitable climate for ZIKV to thrive amongst its vector mosquitoes and within its human hosts, who are unable to access resources to combat the disease both socioeconomically and geographically, based on their poverty and geographic isolation. Brazil’s societally and religiously formed laws regarding reproductive health, specifically abortion, likely causes serious obstacles for women who are pregnant or could become pregnant who desire secular and accurate medical attention regarding ZIKV and reproductive health matters in general.
Why are women disproportionately affected by ZIKV in Brazil’s northeastern region? This includes the disproportionate number of ZIKV cases reported in the northeastern region versus the rest of the country, as well as the severity of complications to newborn infants of mothers infected with ZIKV belonging to and inhabiting the area.
Some research regarding women’s healthcare in Brazil describes a particularly alarming setting regarding the provision of contraception. For example, researchers Letícia J. Marteleto et. al reference research findings where, in one Brazilian region, “nurses intentionally do not provide information about emergency contraception to women in order to prevent the method from gaining popularity,” suggesting that perhaps healthcare providers are acting on their personal beliefs rather than the secular provision of healthcare services. Additionally, they state that when “women believe that the quality of care at public clinics is low or that clinics are crowded, they may avoid using public health services even when these are the only services they can afford. Likewise, women may fear a lack of privacy at public rather than private clinics. This lack of privacy may contribute to a fear of stigmatization when women are seeking services for unwanted or unplanned pregnancies or for treatment of sexually transmitted infections” (Marteleto et.al 205). These findings must be taken into serious account by Brazilian lawmakers in order to improve the current universalized healthcare system run by the state. Gaps in the provision of quality healthcare, including contraception and abortion, are likely culprits of the continuation of ZIKV infection in regions where people, especially women, are unable to access healthcare services to prevent the spread of ZIKV sexually and congenitally by way of accessible and affordable and safe methods of contraception and abortion.
Dr. David A. Schwartz, M.D. begins an article reporting his research findings on ZIKV with this description: “Pathology studies have been important in concluding that Zika virus infection occurring in pregnant women can result in vertical transmission of the agent from mother to fetus. Fetal and infant autopsies have provided crucial direct evidence that Zika virus can infect an unborn child, resulting in microcephaly, other malformations, and, in some cases, death” (Schwartz 68). Additionally, Schwartz mentions that, despite a remarkable increase in the amount of research dedicated to ZIKV in recent years, “the risk factors for developing fetal infection and the congenital syndrome following infection of a pregnant mother remain unknown” (Schwartz 71). Because these risk factors have not yet been fully understood, the results point to a growing necessity for other risk management solutions in the wake of more precise treatments for women living in high-risk areas for ZIKV infection.
Brazil’s public officials have issued multiple statements advising women in areas highly affected by ZIKV to avoid and postpone pregnancy. However, the Brazilian state has not provided women the resources to do so. After the United Nations called attention to this disparity in ample advice versus meager support for Brazilian women’s healthcare and reproductive services, Brazil’s government began to take some notice. After years of remaining off the political agenda, contraception and abortion began to show up in political and public conversation more seriously as the urgency of controlling and managing ZIKV grew larger. Valente states that “the lack of reciprocity, between what the state is delivering and what it is demanding that women and their families do,” is the lead issue plaguing Brazilian politics regarding the ZIKV conversation and demands “a renegotiation of the social contract between state and individuals” (Valente 1377). Dr. Michele Kadri has offered a tri-part solution to challenging the prevalence and severity of ZIKV in Brazil. She mentions “three essential actions that must be taken to control and eventually eradicate” the virus, including the improvement of “social and environmental conditions to eliminate mosquito breeding sites,” the ability to “fund research to expand knowledge about the disease and develop a vaccine, and [to] provide health care and social support for those families who have children with permanent special needs” because of microcephaly damages from ZIKV infection (Kadri 28).
What Kadri does not mention is the necessity for women’s healthcare in addressing the ZIKV fallout in Brazil, particularly in its northeastern region. This lack of acknowledgment for preventative reproductive healthcare, including safe abortion, may suggest something about the controversial nature of women’s healthcare in Brazil. The stigma surrounding abortion, and in turn, women’s reproductive healthcare, has carried over negative externalities as consequence. In one study by researchers at the University of São Paulo, another study referenced said that “in three Brazilian northeastern capital cities, researchers reported postabortion contraception care falls short of that advocated under Brazilian guidelines and by international agencies because less than 10% of women hospitalized were discharged with a contraceptive method prescribed” (Borges et. al 171). This is a staggering low number of women who receive what should be standard quality treatment care following a hospitalization that could have been prevented through the consistent access to and use of effective contraception. Kadri’s discussion of ZIKV is incomplete without the acknowledgement of how stymied access to reproductive healthcare for women has both exacerbated and extended the effects of the virus.
If Brazil is neither religiously nor culturally ready to move its stance on the legality of abortion, it must move to provide readily available contraception and other forms of legitimate reproductive healthcare for women. This suggestion includes all Brazilian women, with special emphasis on women belonging to lower socioeconomic backgrounds and regions chiefly affected by the ZIKV outbreak and high case severity. Regarding both obstacles to quality healthcare, Brazil’s northeastern region finds itself at the forefront of necessity in finding and implementing fast and effective solutions to cases of ZIKV infection in women and neonates. In a recent study by four woman researchers for the Population and Development Review of Brazil, they state: “Despite disparities in reproductive health, Brazil’s unified health system (Sistema Único de Saúde-SUS) is designed to provide universal and equitable health care to all citizens. Brazil’s SUS system provides most health procedures and prescribed medications free of charge, including contraception” (Marteleto et. al 201).
However, researchers Borges et. al report much different findings related to Brazilian women’s access to contraception and most health procedures, which legally do not include abortion regardless of circumstance. They state:
The type of contraceptives used by Brazilian women with an abortion, however, varies from those reported elsewhere: they use the pill less—and no LARC [“long-acting reversible”] methods at all—compared with women without an abortion. That there was no report of LARC methods can be attributed to the limited availability and provision of these contraceptives at primary health care facilities (implants, hormonal IUD, patches, and vaginal rings are not available from the Brazilian Health System) rather than to women’s actual choices, which clearly configures a gap in fully meeting their reproductive rights. On the other hand, pills and condoms are widely available for free in
primary health care facilities and are easily purchased at any pharmacy without a medical prescription. (171, 174)
LARC methods seem the most likely effective solution to women’s contraceptive needs in the Brazil’s northeastern region, particularly in the face of rampant ZIKV infection. Methods like the IUD do not require refrigeration or frequent visits to a healthcare provider in order to remain effective, in some cases, for up to twelve years.
In conclusion, as Dr. Valente succinctly states, “the public health crisis unveiled by Zika contains important moral, legal, and political elements for transforming the state of reproductive rights in Brazil. Improvements should include the discontinuation of practices that criminalize women for dealing with their reproductive health needs while making an effort to reduce barriers to health care” (Valente 1377). These efforts might include the expansion of contraceptives available under the national Brazilian Health System, the decriminalization of abortion, and the construction and operation of legitimate healthcare clinics, with special attention to the provision of women’s healthcare services in Brazil’s comparatively impoverished and disproportionately affected northeastern region. It is imperative that Brazil’s policymakers seriously consider the cultural, social, and economic factors at play in obfuscating effective solutions to the ZIKV crisis in Brazil where the virus has taken such damaging effect on vulnerable women who otherwise trust the Brazilian health care system to provide veritable answers and solutions to the national epidemic. In good news, there are multiple obstacles to women’s healthcare that have been identified in recent research that points to tangible solutions. Now, it is time for Brazil’s leaders to address them with innovative solutions based on the data that has been provided.
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