Thursday, May 5, 2016

MosquitoDeveloping and communicating public health messages for a new or emerging epidemic is fraught with challenges. In many cases, we know little about the disease or transmission and often treatment options are limited or non-existent. Thus, we are left with communication and guidance as our primary mechanism for outbreak control. Public health professionals have struggled with unrealistic, unhelpful, and, at times, harmful prevention messages compounding or exacerbating fear in the face of a poorly understood public health issue. If our messages lack nuance and the acknowledgment of complex decision-making and life circumstances, we risk generating both confusion and anxiety.

The Zika virus seems to be posing such a challenge; what do we tell the public in the face of so many uncertainties and unanswered questions? What do we say to our patients when there’s so much we don’t know? And how do we avoid making this solely a woman’s problem with little to no messaging targeting men? Our approach to Zika messaging is complicated further by a political climate that threatens women’s autonomy and underfunds reproductive health services here and abroad.

Zika, a virus spread by the Aedes species mosquito, has reached epidemic status in some countries and U.S. territories. Local transmission of the virus on the U.S. mainland is expected this summer. Given that warm weather and high humidity can facilitate the spread of Zika and the life cycle of its mosquito host, CDC has predicted that southern states and cities are at highest risk. The thing that makes this mosquito-borne virus unique is the potential devastating impact it can have on children born to women infected with the virus. The challenge is further compounded by the fact that it can be transmitted sexually by a man to his partners.

While some from the infectious disease community argue that avoiding conception is the only sure way to prevent births defects, many others from the medical and women’s health community are troubled by this message. The divide became evident in an April 14 New York Times article offering contrasting perspectives. Perhaps the most divisive comment came from Baylor College’s Dr. Peter Hotez: “It’s a no-brainer. They should say, ‘Don’t get pregnant — watch TV for six months and you won’t have a badly hurt baby.’” Comments like his greatly oversimplify a complex and multi-faceted issue and are woefully inadequate, especially for health care providers in support of their clients.

To better understand the issues, it is important to be aware of the complexities associated with contraception, pregnancy decisions, risk assessment, and relationship dynamics. It is also critical to take note of the history and modern-day challenges between some populations, specifically women of color, and the health care system. As we noted in our 2014 posting, stark disparities exist related to contraception use. A host of issues contribute to this disparity, but by using a cultural and historical lens, we can begin to understand how a history of mistrust, bias, and coercion has played a major role. It is likely that the same women facing these disparate experiences and outcomes are likely to be most affected by the Zika virus. As we mentioned before, southern states are most likely to see local transmission. Southern states have some of the highest rates of unintended pregnancy, and many of these states face the most significant health disparities in terms of women and infant health due to lack of funding and access to high quality reproductive and prenatal care. 

The Zika virus poses a unique challenge for family planning and reproductive health providers. While it is critical that everyone be informed of risks of the Zika virus, it is equally imperative that women be treated as uniquely autonomous individuals. In addition, we need to ensure that men are part of our Zika virus prevention messaging. This virus will challenge providers to take note of their own biases and remove them from the equation. The decision to use contraception is a very personal one. Talking a woman out of pregnancy or into a specific form of contraception is not our goal. Rather, our goal is to make sure they are making an informed decision that considers the risks of Zika in the context of the various methods of birth control that differ in terms of effectiveness, side effects,  ease of use, and personal circumstances and preferences.  

As a Family Planning National Training Center, Altarum maintains a host of resources on Zika as well as the syndicated CDC updates on the website.

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