Zika and pregnancy: rethinking certain tools

Puerto Rico health sciences journal, 2018

On February 1, 2016, the World Health Organization (WHO) declared the ZIKV virus outbreak a Public Health Emergency of International Concern (PHEIC). Pregnant women and their infants, are vulnerable to the impact of this vector-borne illness (mosquito) and sexually transmitted viral infection. The uncertainty surrounding the possibility of congenital anomalies due to ZIKV infection during pregnancy bring a renewed debate about the rights of women to control their reproductive decisions. Current strategies, resources and services aimed at prevention priorities fall short of responding to a clear framework regarding sexual reproductive health, rights and justice. A comprehensive approach to reproduction, in times of Zika, needs to empower women of reproductive age and their families to make decisions and to act on those decisions. This paper highlights the contributions of the Maternal-Infant Studies Center (CEMI-Spanish Acronym) in close collaboration with the Department of Obstetric...

As the Zika virus pandemic continues to bring worry and fear to health officials and medical scientists, Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) have recommended that residents of the Zika-infected countries, e.g., Brazil, and those who have traveled to the area should delay having babies which may involve artificial contraceptive, particularly condom. This preventive policy, however, is seemingly at odds with the Roman Catholic Church's position on the contraceptive. As least since the promulgation of Paul VI's 1968 encyclical, Humanae Vitae, the Church has explicitly condemned artificial birth control as intrinsic evil. However, the current pontiff, Pope Francis, during his recent visit to Latin America, remarked that the use of artificial contraception may not be in contradiction to the teaching of Humanae Vitae while drawing a parallel between the current Zika Crisis and the 1960's Belgian Congo Nun Controversy. The pope mentioned that the traditional ethical principle of the lesser of two evils may be the doctrine that justified the exceptions. The authors of this paper attempt to expand the theological rationale of the pope's suggestion. In so doing, the authors rely on casuistical reasoning as an analytic tool that compares the Belgian Congo Nun case and the given Zika case, and suggest that the former is highly similar to, if not the same as, the latter in terms of normative moral feature. That is, in both cases the use of artificial contraception is theologically justified in reference to the criteria that the doctrine of the lesser of two evils requires. The authors wish that the paper would provide a solid theological-ethical ground based on which condom-use as the most immediate and effective preventive measure can be recommended in numerous Catholic hospitals as well as among Catholic communities in the world, particularly the most Zika-affected and largest Catholic community in the world, Brazil -123 million present Brazilian citizens are reported to be Roman Catholic.

Bangladesh Journal of Bioethics

This paper argues that Zika virus infection has its ethical implications beyond the reproductive health of women. It claims that Zika virus infection like public health emergency exposes the underlying health determinants and health status of women. Therefore, ethical mitigation of Zika like public health emergencies should consider these underlying health determinants and health status of women. For, undermining and overlooking these underlying determinants and health status of women, during the public health emergencies, enhance the health inequities. The recent Zika virus infection in Brazil has triggered different ethics consultation and has prompted to outline ethical recommendations. However, the recommendations have either focused on the reproductive health of women or on the core strategies of public health emergency. Considering this as a gap in perspective to prepare for Zika like public health emergencies, this paper argues that it is the underlying holistic health of wom...

PLoS Currents, 2016

Because of the potential link between the ongoing Zika virus outbreak and a surge in the number of cases of congenital microcephaly, officials in Latin America have recommended that women postpone pregnancy until this association is firmly established or the outbreak subsides. However, in all these countries a large proportion of babies are still born out of unplanned pregnancies. Teenage girls are particularly at high risk, as they often lack access to preventive contraception methods, or the knowledge to use them appropriately. To gauge the magnitude of the barriers preventing the implementation of such a recommendation in Brazil, the country so far most affected by the Zika epidemic, we evaluated pregnancy rates in teenage girls, and their spatial heterogeneity in the country, in recent years (2012-2014). Nearly 20% of children born in Brazil today (~560,000 live births) are by teenage mothers. Birth incidence is far higher in the tropical and poorer northern states. However, in absolute terms most births occur in the populous southeastern states, matching to a large extent the geographic distribution of dengue (an indicator of suitable climatic and sociodemographic conditions for the circulation of Aedes mosquitoes). These findings indicate that recommendation to delay pregnancy will leave over half a million pregnant adolescents in Brazil vulnerable to infection every year if not accompanied by effective education and real access to prevention. Funding Statement LS is funded by a Marie-Curie EU grant. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Unintended pregnancies in Brazil-A challenge for the recommendation to delay pregnancy due to Zika The World Health Organization has recently declared the emerging Zika virus an international public health emergency 1. The virus, which reached Brazil to cause a major epidemic starting in April 2015, has rapidly spread to over 28 countries 2 and may still reach many more considering the widespread distribution of its vector species (Aedes aegypti mosquitoes) and the high transmission rates observed so far. Concerns also involve the possibility of a second vector of Zika transmission, Aedes albopictus, which is currently expanding its ecological niche globally 3 , 4. However, the biggest concern about the Zika outbreak is the potential link with the surge of reported cases of microcephaly and other malformations of the central nervous system in newborns from mothers infected with the virus during pregnancy 1. The proposed link between Zika infection and congenital microcephaly is not conclusive 1 , 5 , but given the long-term consequences of this birth defect (which can range from mild developmental delays to severe, lifelong motor and cognitive impairment), a number of Officials in Latin America have recommended that women avoid or defer pregnancy, giving time for the epidemic to subside and therapies to develop 6. Among these were representatives of the Health Ministries of Ecuador, Colombia, Jamaica and El Salvador. In Brazil the recommendation to postpone pregnancy has not been made official, yet the director of the Surveillance Department at the Ministry of Health-Cláudio Maierovitch-has stated that women from high-risk areas who can wait to conceive should do so 2. The implementation of such a recommendation requires, however, that women in these areas are not only clearly informed about the risks posed by infection, but also have control over their reproductive choices. There are few reasons to doubt that most women will be aware and informed about the disease and its consequences through the widespread media. Yet ensuring control over the timing of pregnancy is a more daunting challenge, especially considering that many babies are born out of unplanned pregnancies-even when strong motives for avoiding them exist (e.g. age, economic, social, professional and healthrelated). In Brazil, the country most affected by the Zika outbreak so far, data from a demographic survey from 2006 indicate that approximately half of all births that happened five years prior to the survey were unplanned 7. A demographic group at

The emergency of the Zika virus outbreak, with the risk of a presumed congenital syndrome and other events connected with its neurotropism, as well as unequal access to diagnostic and health care resources for the affected present a scenario with several ethical concerns. This paper discusses three ethical issues related to the Zika virus infection. The first one refers to the relationship between Brazilian states in a particular geopolitical context of " public health emergency of international concern ". The second one covers the balance between individual freedom and rights, and the need for State intervention. The third one refers to women's right to choose abortion, and to the assistance for a legion of children with neuropathic syndromes and their families. To cope with a possible pandemic disease in a world without boundaries, we should set up international cooperative teams, deal with different cultural approaches regarding the balance between individual and collective rights, and the consequences to assistance and public policies. Resumo Ética, saúde global e a infecção pelo vírus Zika: uma visão a partir do Brasil A emergência da epidemia pelo vírus Zika, com risco da síndrome congênita e outros eventos relacionados com seu neurotropismo, bem como o acesso desigual a recursos para diagnóstico e cuidados de saúde, constitui cenário com várias preocupações éticas. Abordamos três questões relacionadas com a infecção pelo Zika vírus. A primeira refere-se às relações entre os Estados nacionais num contexto geopolítico particular de " emergência de saúde pública de preocupação internacional " ; a segunda, ao equilíbrio entre liberdade e direitos individuais e a necessidade de intervenção do Estado; a terceira, ao direito das mulheres de escolher o aborto e a assistência para uma legião de crianças com síndromes neuropáticas e suas famílias. Para lidar com uma pandemia em um mundo sem fronteiras, devemos criar equipes internacionais cooperativas, lidar com diferentes abordagens culturais sobre o equilíbrio entre direitos individuais e coletivos e suas consequências para a assistência e políticas públicas. Palavras-chave: Bioética. Infecção pelo Zika vírus. Doenças transmissíveis emergentes. Saúde global. Brasil. Políticas públicas de saúde. Internacionalidade. Resumen Ética, salud global y la infección por el virus Zika: una visión desde Brasil La aparición de la epidemia por el virus Zika con el riesgo de síndrome congénita y otros eventos relacionados con el neurotropismo del virus, así como el acceso desigual a los recursos para el diagnóstico y cuidado de la salud constituyen un escenario con varias preocupaciones éticas. Este artículo analiza tres cuestiones éticas relacionadas con la infección por este vírus. La primera se refiere a las relaciones entre los estados nacionales en un contexto geopolítico particular de " emergencia de salud pública de preocupación internacional ". La segunda al equilibrio entre la libertad y los derechos individuales y la necesidad de intervención del Estado. La tercera al derecho de la mujer a aborto y la asistencia a una legión de niños con síndromes neuropaticos y a sus familias. Para hacer frente a una posible pandemia en un mundo sin fronteras, debemos crear equipos internacionales en base cooperativa, que trata de diferentes enfoques culturales para el equilibrio entre los derechos individuales y colectivos y sus consecuencias para la asistencia y la política pública. Palabras clave: Bioética. Infección por el virus Zika. Enfermedades transmisibles emergentes. Salud global. Brasil. Políticas públicas de salud. Internacionalidad.

JBRA assisted reproduction, 2016

Although the causality between Zika virus, microcephaly, and other central nervous system disorders has been taken for granted by the scientific community, many uncertainties remain. The gap of knowledge at the moment is large enough to remove part of the confidence physicians have on the advice given to patients - and infertile women in particular - on their reproductive plans. Pretreatment serologic screening is a possible strategy to offer more confidence for individuals choosing to bear children regardless of the Zika virus, but the tests currently available do not seem to be sufficiently adequate. Until now, there is no formal recommendation to avoid pregnancy solely because of the Zika virus outbreak, and the choice of becoming pregnant has been regarded as a personal decision to be made by each woman and her family.

The American journal of bioethics : AJOB, 2016

The Zika pandemic provides biomedical scientists, clinicians, public health advocates, and governments a unique opportunity to advance reproductive justice by addressing the paradoxes outlined in this essay. The circumstances in which pregnancies occur are morally relevant to women’s reproductive life decisions, to the provision of reproductive health care, and to the development of reproductive health policy. Whether the Zika pandemic might foster context-driven reproductive pandemic planning and response is yet to be determined. Maintaining the status quo will surely increase a range of global health disparities and further stratify reproduction, producing predictable and preventable outcomes in which some people receive the necessary care and resources to achieve family building while others are neglected. Women and men should be able to count on biomedical researchers to answer the questions that need answering without undue influence from political agendas. Women should be able...

Journal of Human Growth and Development

Introduction: The Zika virus was identified in 1947 in Rhesus monkeys in the Republic of Uganda and isolated in humans in 1952 in the same country. Up to 2007 there were few cases of human infection in African and Asian countries. The first outbreak of the Zika virus occurred in Brazil in 2015, becoming a serious public health problem due to the increase in the number of cases of microcephaly in infected pregnant women. Objective: To describe the legal abortion at Zika virus infection during pregnancy regarding medical, emotional and social consequences. perspectives of abortion for the pregnant woman with Zika virus regarding the medical, emotional and social consequences. Methods: This is a documentary study based on documents about abortion and its outcomes in Brazil. Technical norms, textbooks, indexed articles of Scopus and PubMed, documents extracted from international human rights treaties and conventions, and legal documents on the subject were used. It was decided to direct...

Philosophy, Ethics, and Humanities in Medicine, 2017

Much of the fear and uncertainty around Zika epidemics stem from potential association between Zika virus (ZIKV) complications on infected pregnant women and risk of their babies being born with microcephaly and other neurological abnormalities. However, much remains unknown about its mode of transmission, diagnosis and long-term pathogenesis. Worries of these unknowns necessitate the need for effective and efficient psychosocial programs and medical-legal strategies to alleviate and mitigate ZIKV related burdens. In this light, local and global efforts in maintaining fundamental health principles of moral, medical and legal decision-making policies, and interventions to preserve and promote individual and collectiveHuman Rights, autonomy, protection of the most vulnerable, equity, dignity, integrity and beneficence that should not be confused and relegated by compassionate humanitarian assistance and support. This paper explores the potential medical and ethical-legal implications of ZIKV epidemics emergency response packages and strategies alongside optimizing reproductive and mental health policies, programs and best practice measures. Further long-term cross-borders operational research is required in elucidating Zika-related population-based epidemiology, ethical-medical and societal implications in guiding evidence-based local and global ZIKV maternal-child health complications related approaches and interventions. Core programs and interventions including future Zika safe and effective vaccines for global Zika immunization program in most vulnerable and affected countries and worldwide should be prioritized.

Medicine Anthropology Theory, 2022

In this article, I address an issue that emerged during my ethnographic fieldwork in Brazil in 2018, which received little attention during the Zika virus outbreak that took place in the country during 2015–17. My fieldwork revealed that, interestingly, despite the epidemic and its associated risk of birth defects, some couples who were attending a fertility clinic (most of whom came from a middle-or upper-class background, with access to private health care) chose to take the risk of a pregnancy instead of delaying their plans. I argue that this case study of assisted reproductive technology (ART) is a ‘grey zone’ whose investigation aids understanding of how the Zika epidemic was managed in Brazil. By looking at the potentiality of pregnancies and prospective babies for (infertile) couples, we can analyse how fertility clinics influenced the ability of couples to engage in ART during the epidemic and explore which kinds of reproductive services were offered to patients during this time. More broadly, this case study permits the examination of how the specific case of ART sheds light on the issue of risk/reward in wider reproductive decision-making during the epidemic. In many ways, I conclude, one can say that the Zika virus epidemic came to challenge both the timing of reproduction and the choice to become pregnant.