Aedes aegypti mosquito. (John Tann/Flickr | CC BY)

Mosquitos and Mothers: The Zika Virus and Real Talk on Birth Control

Mosquitos carrying the Zika virus in Latin America are wreaking havoc in people’s lives into the next generation. It’s only a matter of time before Zika is found in more places in the United States, as the first case of infant brain damage linked to the virus has already occurred in Hawaii. The baby’s mother had previously lived in Brazil, where the virus has affected thousands of newborns. Zika’s effects are being felt in other Latin American countries as well, and the governments of El Salvador, Ecuador, Jamaica, and Colombia have recommended that women avoid pregnancy for at least two years because the virus, which is broadly present in these countries, likely causes microcephaly, an incomplete development of the brain.

The Rochina favela near Rio de Janeiro, Brazil. (Edmund/Flickr | CC BY-NC-ND)
The Rochina favela near Rio de Janeiro, Brazil. The Zika virus has affected thousands in Latin America, particularly people in poorer areas. (Edmund/Flickr | CC BY-NC-ND)

Two years?! According to a recent NPR report, this is the first time in history that a government has told women not to get pregnant. But this might be easier said than done. Right now the mosquito that transmits the Zika virus is most prevalent in countries that are predominantly Catholic, nations that offer no real support for any birth control other than the rhythm method — in other words precluding all of the methods that are 99% effective. Unless those Latin American governments and the Catholic Church come together to encourage birth control, such admonitions to avoid pregnancy essentially tell women not to have sex. That doesn’t strike me as a very realistic or effective public health strategy.

This conversation reminds me of an earlier era in the United States, when discussion of birth control was much more limited, and women were largely in the dark about how to avoid pregnancy. Dissemination of birth control did not become legal until the 1930s, and then only married women could get it; it wasn’t until 1972 that single women could legally gain access. Because of these restrictions, many women simply did not know how to limit their family size. Naturally, this led to an enormous amount of anxiety about heterosexual intercourse.

November 1923 cover of The Birth Control Review, edited by Margaret Sanger. (HathiTrust)
November 1923 cover of The Birth Control Review, edited by Margaret Sanger. (HathiTrust)

Margaret Sanger, at the time a nurse on New York City’s Lower East Side who later founded Planned Parenthood, saw thousands of women patients seeking such information. Sanger was a complicated and even flawed character. She believed in women’s autonomy over their own bodies so ardently that she linked her cause with eugenicists who had their own nefarious reasons for limiting women’s reproduction — that is, they were women of color, poor, or immigrants. But Sanger knew scores of women who wanted and needed birth control for themselves and were determined to avoid pregnancy, even at the expense of their lives.

Sanger credited her early involvement with the birth control movement to one such desperate woman, though historians debate the apocryphal nature of the story that Sanger told: When the woman’s doctor told her that her health would suffer if she had any more children, Sanger related, the woman begged him to tell her how she could avoid that. Sanger recalled his words: “’Oh, ho,’ laughed the doctor in good humor, ‘You can’t have your cake and eat it too! Tell Jake to sleep on the roof.’” She later wrote, “I shall never forget the look on that woman’s face. Tremendous emotions were surging within her. Conquering her feelings, she turned to me beseechingly, ‘Tell me the secret,’ she begged. ‘Tell me — and I’ll never breathe it to [a] soul!’” Not only was birth control (condoms and diaphragms) illegal, but it wasn’t until the 1930s that scientists adequately understood ovulation in women’s reproductive cycles and hence the best and worst times to achieve or avoid conception.

Department of Health workers in Brazil, one of the countries particularly affected by the zika virus, work to combat spread of the aedes aegypti mosquito and provide guidance to the public. (Tony Winston/Agência Brasília | CC BY)
Department of Health workers in Brazil, one of the countries particularly affected by the Zika virus, work to combat spread of the aedes aegypti mosquito and provide guidance to the public. (Tony Winston/Agência Brasília | CC BY)

Of course, women in Latin American countries today know the secret to birth control, but unless religious authorities decree that avoiding pregnancy falls within Catholic ethical standards it is likely that many women will share the desperation women in earlier eras endured. Some might argue that the stakes right now are even higher; exposure to the Zika virus can create personal tragedy as well as a public health catastrophe if thousands of infants are born with severe cognitive disabilities that require the kind of support many will be unable to provide.

Given the fact that some women from Latin America and the Caribbean (especially Puerto Rico) have previously endured state-sponsored sterilization, we know that their reproductive lives have been subjected to the needs of the state, usually without informed consent. It is time now to learn from past mistakes and for the Church and the government together to provide information about and access to reliable birth control to ensure reproductive justice in women’s lives.

The distraught woman who implored Sanger in vain to help her avoid getting pregnant ultimately died, Sanger reported, from a self-induced abortion, leaving three young children motherless. Abortion isn’t the answer here either, for obvious religious reasons, but also because there is no test for the Zika virus, and its effects can be seen on an ultrasound only very late in the pregnancy. Surely in today’s world where access to safe and reliable birth control is limited by religious edict rather than scientific knowledge, we can do better.

Editor’s note: This article was corrected from an earlier version. Eisendtadt v. Baird in 1972 established the right of single individuals to possess contraception (not Griswold v. Connecticut in 1965, which only affected married women).

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9 Comments

Heather Munro Prescott

Nice article, but one inaccuracy. The Griswold decision in 1965 only affected married women. Prior to that use of contraceptives in the state of Connecticut was a crime. It wasn’t until the Baird v Eisenstadt decision in 1972 that the right of privacy established in Griswold was extended to unmarried women.

Heather Munro Prescott

PS the One Package decision you allude to in the 1930s only affected the federal Comstock law prohibiting the shipment of contraceptives and birth control advice through the mail. The state laws such as the one in Connecticut remained in place.

Mary Wood

Interesting article about the history of birth control in America and the need for accessible birth control to combat the Zica virus. However I wouldn’t assume that Catholic countries don’t provide such access in today’s world. Despite the consternation of the pope, Brazil’s government provides free, widely available condoms as well as low-cost birth control pills, which are made available to poor people at both government- run pharmacies and local private drugstores. The socialist president Lula Da Silva was a strong advocate of birth control even before the Zica virus appeared.

Cassia Roth (@MixmasterCass)

This is an important contribution to the discussion on Zika and women’s health and reproductive autonomy. But I agree with the discussant above–birth control is widely available and cheap in Brazil, a country where I lived for many years. The same is true in other Latin American countries such as Argentina and Chile. The real problem is abortion access. In El Salvador, abortion is illegal under all circumstances, and women are imprisoned for the procedure, often for up to 30 years. Sometimes, they are arrested and found guilty for a miscarriage. Nicaragua and Haiti also have extreme abortion laws. Brazil, while allowing abortion in the cases of rape, incest, danger to the life of the mother, and severe brain deformities, also criminalizes abortion. Many Brazilian physicians and feminist leaders are debating whether microcephaly, the brain defect caused by Zika, would qualify as a severe brain deformity. If not, many women will have to resort to illegal–and often unsafe–abortions.

Stephanie Wood

This is a hugely important topic, Lizzie, and I thank you for your analysis. I agree with Mary that the situation in Latin America is complicated. Access to knowledge/methods varies by country (whether owing to governmental policies or even dissidence within the church) and it varies by region and ethnicity. This is anecdotal, but a student of mine who worked among indigenous communities in Paraguay in the 1980s said that women approached her to ask why she was not having babies even though she was married; they wanted to know her secret. I remember she was somewhat nervous about sharing her knowledge, for fear that the women would face retaliation if they stopped having children, but she gave it to them anyway. They had to rely mainly on the rhythm method, which meant the change was not so dramatic or obvious that they had to face immediate consequences in their partnerships. Despite exceptions such as Brazil or Cuba, I fear that the stark social inequities in Latin America and the notable urban-rural divide will be made more apparent by the Zica virus, which is super alarming.

Nathaniel Comfort

Nice, thoughtful piece, thanks. However, I doubt NPR that this is the first time ever that women have been advised to reduce pregnancy. Asia and some countries in Europe have been doing it for some time. Viz, China.

Also, might point out how gendered this is. Are men being distributed condoms? Told in any way to curb their sexual appetites? Try out homosexuality for a while? I think we know the answers…

keyarris

Thank you for initiating this provocative discussion, Lizzie. I want to chime in on themes raised by Mary and Stephanie above. First, there are significant shifts around reproductive health policy in Latin America and the Caribbean in the past decade, and – while access to abortion remains restricted by state policy in all but a few countries (Cuba, Uruguay, Guyana) – there are notable movements towards greater reproductive equity – including the passage in Mexico City (in 2008) of a law legalizing abortion. Further, and along these lines, many countries in Latin America have state-funded national health care systems (Mexico among them) that, while not including all contraceptive services to be sure, do offer women access to a number of modern contraceptives, free of charge. I would note, as a matter of state policy, this is quite a ways more progressive than the tendency in the U.S. to carve out such reproductive health services from the ACA and remove contraceptive services from state and employer health plans. This is all to say that it’s important not to over-generalize about reproductive health in the Americas, nor to place the US in front of our neighbors in the rest of the region. Still, women in Latin America, especially poor and rural women, continue to suffer the effects of lack of access to reproductive health care including contraceptives, effects which include high rates of maternal and infant mortality. Given this context, the Zika virus is one of many threats to women’s health in Latin America, but I wouldn’t vilify state attempts to respond as indeed lives are at stake. It’s also notable that there is a much stronger cultural history of the state taking a role in the public’s health in many Latin American countries than in the US – with some positive effects in terms of real improvements in indicators of population health such as declines in maternal and infant mortality rates. The US has not always been a partner to these progressive health and development efforts, however – the Global Gag Rule casts a long shadow over any US discourse about promoting women’s health in the region.

Elizabeth Reis

Thank you, everyone, for your thoughtful comments! As readers can see, this is a very complex and complicated medical and political issue. I hope we continue this conversation!

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