“I can tell you that I have never read, heard or encountered a public request like that,” Dr. David Bloom, a professor at the Harvard School of Public Health, told The New York Times. Dr. Howard Markel, a professor of the history of medicine at the University of Michigan, echoed the same sentiment: “I have never seen or read of any instance of a government warning its citizens not to get pregnant.”
The government under discussion was that of El Salvador, which at the end of January advised all women in the country to refrain from getting pregnant until 2018 due to an outbreak of the Zika virus.
On February 1 the World Health Organization (WHO) declared the Zika virus a global emergency. The virus, which is spread through mosquito bites, has infected increasingly large swaths of the population throughout the Caribbean and South America. The virus often has few to no negative side effects for infected persons.
But there have been large numbers of reported cases of microcephaly—a birth disorder where infants are born with abnormally small heads and incomplete brain development—amongst infants of women who were infected with the virus. “The experts agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven,” said a statement from the WHO. “After a review of the evidence, the Committee advised that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes an ‘extraordinary event’ and a public health threat to other parts of the world.”
This has led to a global outcry, both from pregnant women and from policymakers in the largely catholic countries in which Zika is flourishing. As cases spread, the government of Colombia advised that women avoid getting pregnant for the next six to eight months. The Deputy Health Minister of Brazil, the country with the highest rate of infection, released a statement advising that “…all the women of fertile age…take steps to plan their pregnancies, and avoid getting pregnant between this year and next.” Even the Pope chimed in, stating that in an epidemic as impactful as Zika, contraception would be the “lesser of two evils” compared to abortion—apparently the only two options.
But though governments have been warning women not to become pregnant in an attempt to protect public health concerns, Zika virus has not been conclusively linked to microcephaly, drawing into question the legitimacy of the panic. Though there was a spike of both Zika virus and microcephaly in Brazil, correlation does not imply causation. Furthermore, there is data tracking how common microcephaly was in Brazil before the outbreak is imprecise, and sometimes seems to show upticks in cases as early as 2012, before the virus hit Brazil.
Despite this shaky connection between Zika and microcephaly, women have still been told to avoid pregnancy at all costs without being given any advice about how to do so. How is a woman in El Salvador, a catholic country where birth control is stigmatized and abortion is illegal in all circumstances, supposed to avoid becoming pregnant? What is an El Salvadoran woman supposed to do in the case of rape or sexual violence? Where are the edicts from governments telling all men to use condoms for the next two years? Why are efforts not more focused on procuring and encouraging the use of insect repellent or mosquito nets?
“Once again, governments put the burden on women to protect themselves from any risks,” Paula Avila-Guillen, a programs specialist at the Center for Reproductive Rights, said to the Thomson Reuters Foundation.
This is not the first time that pregnant women have had to bear the brunt of these kinds of public health concerns. “No it’s not new at all in fact,” said Sarah Pinto, a professor of medical anthropology, gender, and reproduction at Tufts. “Globally speaking, governments have been telling women not to have babies, and not just telling them, but sometimes directly altering their bodies in coercive ways so women don’t reproduce. It’s historically been in the name of some sort of greater population good, or a logic of a sort of public well-being, but it of course falls most heavily on oppressed people and marginalized people and impoverished people.”
In her fieldwork in northern India, Dr. Pinto studied traditional birth attendant training done by the government. She explained, “…as I was living among rural poor women in Dalit communities…the reproductive health interventions that were…in the name of population were falling very heavily on them and there was a very strong but subtle moral discourse to those interventions.” The women in the already disenfranchised Dalit communities were getting moral messages about how they were bad mothers and didn’t see doctors frequently enough, while also being tasked with getting medical treatment from a system that sometimes forcibly sterilized them. “You talk to the women and they would say, ‘We don’t want to go to the hospital because we don’t know if we’re there if we’ll be forcibly sterilized while we’re on that table.’” Pinto continued, “[They want to know] ‘why would I participate in a moral and practical vision that sees me as the other or sees me as the problem?’”
Forced sterilization is not unique to India. In fact, the US has a long history of forcibly sterilizing Black, incarcerated, or otherwise disenfranchised women. “I think at the turn of the 20th century with the whole eugenics movement and with the issues around ‘race purity,’ sterilization became part of a conversation in which it was legitimated as a reasonable policy to control who reproduces and who doesn’t,” explained Dr. Virginia Drachman, a professor of American history at Tufts who specializes in the history of women, medicine, and society. By 1932, 26 states had passed compulsory sterilization laws to prevent “unfit” people, usually meaning persons of color, from getting pregnant. For decades in the 1900s Puerto Rico’s poor economy was blamed on the “hyper-fertility” of Puerto Rican woman and thousands of women (and some men) were sterilized. Sterilization meant that many women in the US were forcibly barred from having children, and though a very different situation from the Zika crisis, the reasoning was also ostensibly to promote public health and preserve the greater good of society.
Certain American women were also told to avoid pregnancy well after the turn of the century: “With the development of welfare in the second half of the 20th century, there was the idea that women who get pregnant and go on welfare become an increasing burden on taxpayers and on the country,” said Drachman. She mentioned that the threat of sterilization was also prevalent for these women, particularly women who get pregnant multiple times out of wedlock, when they don’t have access to reliable birth control.
In the current Zika virus crisis, women are not being physically forced to adhere to government edicts, but they are still bearing a large brunt of the responsibility for public health concerns. “I think what is similar [between the Zika crisis and histories of forced sterilization] is the sexual double standard,” explained Drachman. “It assumes that it’s women’s responsibility, but they can’t do it by themselves. Because who is the government talking to when they say don’t get pregnant? They’re talking to the women because they’re the only ones that get pregnant, but they should be talking to both sides.”
Unlike the edicts given to Dalit women in India or women of color in the US, the warnings against pregnancy in Central and South America are intended for all women in the country. But these admonishments are especially difficult to adhere to for poor, young, or disenfranchised women who will have even more difficulty accessing birth control or abortion in countries where access is incredibly limited. Furthermore, these prescriptions ignore instances of rape or sexual assault.
Globally and historically, the question of how to navigate public health concerns versus personal privacies and freedoms is often played out on women’s bodies. Perhaps concerns about the Zika virus and microcephaly will fade from view in the coming months, or swell to new levels. Regardless—and not for the first time—governments have declared that women should attempt to sacrifice their personal freedoms for public health good.