Accelerating progress on Zika through better family planning

In a statement declaring the clusters of birth defects that appear to be linked to Zika virus infection in Brazil “a public health emergency of international concern,” the World Health Organization recommends important measures for tackling this emerging infectious disease threat: improving surveillance, developing better diagnostic tests, intensifying vector control efforts and carrying out other prevention and treatment measures.

More remarkable were calls from public health officials in Colombia, Ecuador, El Salvador and Jamaica for women to postpone pregnancy until more is known about the association between the Zika virus and microcephaly, a severe birth defect affecting the brains of newborns. Salvadoran health officials have even advised women to delay pregnancy until 2018, when the risk of being infected with Zika may be lower.

The spread of Zika in the Americas adds urgency to the need to help all women — and their male partners — avoid unintended pregnancies. But, women and couples in countries affected by Zika face formidable barriers to achieving their fertility intentions, including lack of access to contraceptives and other reproductive health services, some of the world’s most restrictive abortion laws and high rates of sexual violence.

Placing the burden of protecting unborn children from the virus’ effects solely on women who have limited reproductive rights and contraceptive options is discriminatory and unsustainable. Expanding access to reproductive health services must be part of a comprehensive response to the Zika virus, and these services should be supported in ways that protect and strengthen the reproductive rights of women and girls.

Governments, local and international organizations, and donors can draw on a wealth of evidence about what works in family planning. Here are five ways to effectively integrate rights-based family planning into the response to Zika:

  1. Expand contraceptive options. Rates of modern contraceptive use in the affected region range from 34 percent in Haiti to 76 percent in Costa Rica. These rates tend to be much lower among women in rural areas and impoverished communities, who are likely to be at highest risk of Zika infection, and not all methods are equally effective. Expanding access to long-acting reversible contraceptives — intrauterine devices and contraceptive implants — and permanent methods such as vasectomy and tubal ligation is critical. With typical use, pregnancy rates may be 100 times higher among women who use shorter-acting methods such as oral contraceptives than they are among women choosing long-acting reversible methods.
  2. Improve access. Countries can expand access to a wider range of family planning services by adopting proven high-impact practices, such as developing an effective system to manage the supply chain for contraceptive commodities, deploying mobile outreach services, and training and supporting community health workers to provide family planning information, services and referrals. Integrating postpartum family planning into routine child immunization services and well-baby visits is another promising practice that could help programs reach women in the first year after they give birth — a time when many women want to avoid pregnancy but do not use an effective contraceptive method.
  3. Engage men. Men have an equal stake in protecting their children from the birth defects that may be associated with Zika virus infection and an important role to play in preventing unintended pregnancies. Evidence shows that male involvement in family planning improves the health and survival of women and children. Simply bringing men into family planning clinics is not enough, though that’s a good start. The most effective programs promote open communication, equality and shared decision-making between men and women. For example, an evaluation of a project with couples in Malawi found that contraceptive use rose as communication increased.
  4. Support youth. More than one-third of young women in Latin America and the Caribbean give birth before the age of 20, and almost half of sexually active adolescents in the region have an unmet need for contraception. Young people are often reluctant to seek care at family planning clinics for fear of stigma. However, establishing dedicated clinics or special services for youth has shown mixed results. Instead, experts recommend incorporating proven youth-friendly measures into existing services. The use of mobile phones to provide reproductive health information and link young people to youth-friendly services has also shown promise.
  5. Change gender norms. Sexual violence is pervasive in the region (for example, 14 percent of women in Brazil and 47 percent of women in Peru reported ever experiencing sexual violence by an intimate partner), and women can be particularly vulnerable to violence during a crisis. Family planning programs should train counselors to screen clients for sexual violence and provide referrals to organizations that offer care, including emergency contraception and psychosocial support. Policymakers and programs must also address the underlying causes of sexual violence, which are rooted in gender inequality and discrimination against women. Research has shown that changing unequal gender norms at the community level — not just at the individual level — can help improve sexual and reproductive health, and efforts are underway to scale up effective approaches.

Like other emerging infectious diseases that came before it, Zika has drawn attention to a dangerous gap in essential health services: the limited options available to many women who want to delay or avoid pregnancy. By integrating these five approaches into the response to Zika, we can begin to provide women and couples in the Americas with the family planning services they need to protect the health and well-being of their families.

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