The link between Zika virus infection during pregnancy and birth defects poses yet another threat for girls and women of reproductive age in the Americas as they struggle to chart a positive course through life transitions.
Unfortunately for girls and young women, the choice of whether or when to become pregnant is often not their own. Age and power dynamics heighten the impact of traditional gender and social norms for girls and young women and can inhibit informed decision making and positive sexual and reproductive health behaviors. Lack of empowerment leaves them more vulnerable to gender-based violence, increasing the risk of unintended pregnancy, while fear of discrimination from health providers or condemnation from family and community means girls and young women delay seeking and receiving contraception or antenatal care.
A public health response to the Zika virus must include addressing some of these root causes that preclude girls and young women from realizing their sexual and reproductive health choices — and social norms that inhibit contraceptive use for girls and young women need to be addressed in programming.
Activists claim little or no sex education is available in schools in Latin America and the Caribbean. Young girls in the region with no education have a much higher birth rate than girls with a secondary education or more, and girls living in the poorest 20 percent of households are five and a half times as likely to give birth as girls in the wealthiest households. According to the Guttmacher Institute, 56 percent of all pregnancies in Latin America and the Caribbean are unintended, and unintended pregnancies are especially common among young girls.
Successful approaches to social norm change could include community campaigns and media events to catalyze discussion, such as radio dramas; mobilization of social networks, schools and community leaders to promote and sustain changes; training health providers to improve the quality of youth-friendly reproductive health services; and advocacy to ensure a policy environment that supports reproductive health among girls and young women.
According to UNFPA, contraceptive use among unmarried sexually active girls is 65 percent, half of which is condom use — 20 percentage points higher than their married counterparts, who often have less power to negotiate contraception than unmarried girls. Although the threat of Zika virus may lead to greater contraceptive use overall, we cannot be complacent. Unintended pregnancies will occur, some of which will be terminated unsafely. Not surprisingly, the emergence of the virus has reopened the debate on access to safe abortion in the region. While there is now intense focus to reduce pregnancies in the context of Zika, we call for long-term solutions to reduce unintended pregnancies that change the fundamental status of women and girls, reduce the rates of gender-based violence, and broadly improve access to contraceptive methods and services.
In spite of some government’s recommendations that women delay pregnancy, not every woman has this option. Many girls and young women are faced with unintended pregnancies, uncertain access to contraception, high rates of sexual violence and restrictions on safe abortion.
Instead of broad government statements concerning women’s health, we look to potential trendsetters and communities to engage in the discussion about gender and social norms as they relate to the consequences of Zika infection during pregnancy and birth defects.
A comprehensive response should invest in generating and implementing evidence-based efforts to change social and gender norms around reproductive health, contraceptive use, gender-based violence, and gender equity, and build local capacity enabling young women and men to live gender-equitable lives free of violence, coerced sex and unintended pregnancy.
We need to challenge and transform environments to enable girls and young women to make decisions about their reproductive health.
The authors would like to thank their colleagues from thePassages project team. FHI 360 is part of a team of global health organizations implementing this new reproductive health initiative in Asia and Africa, which aims to improve the healthy timing and spacing of pregnancies by youth and first-time parents in developing countries.
Emily Keyes is a research associate for reproductive, maternal, newborn and child health at FHI 360. Her expertise is in quantitative and qualitative research, health facility assessments, program evaluation, and operations and implementation research. Emily is skilled in research design and methodology, quantitative and qualitative analysis, spatial analysis, data management and quality assurance, training and technical writing.
Donna McCarraher has 20 years of experience in conducting and managing operational and behavioral research in numerous countries. She is currently the director of reproductive, maternal, newborn and child health at FHI 360. Donna has expertise in content areas that include post-abortion care, adolescent health, gender, gender-based violence, and integration of contraception into HIV services, health services research, and assessment of HIV risk among the vulnerable.
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