Solidarity, vulnerability and mistrust: how context, information and government affect the lives of women in times of Zika

Abstract

Background: The public health response to Zika outbreak has mostly focused on epidemiological surveillance, vector control, and individual level preventative measures. This qualitative study employs a social-ecological framework to examine how macro (historical, legislative, political, socio-economic factors), meso (sources of information, social support, social mobilization) and micro level factors (individual actions, behavioral changes) interacted to influence the response and behavior of women with respect to Zika in different contexts. Methods: A qualitative study was carried out. Women were recruited through the snowball sampling technique from various locations in Brazil, Puerto Rico, and the United States. They were of different nationalities and ethnicities. Data were collected through semi-structured interviews. The data transcripts were analyzed using thematic analysis. Results: Women in this study deemed the information provided as insufficient, which led them to actively reach out and access a variety of media sources. Social networks played a vital role in sharing information but also resulted in the spread of hoaxes or rumors. Participants in our research perceived socio-economic inequities but focused on how to remedy their microenvironments. They did not engage in major social activities. Lack of trust in governments placed women in vulnerable situations by preventing them to follow the guidance of health authorities. These impacts were also a result of the response tactics of health and government administrations in their failed attempts to ensure the well-being of their countries' populations. Conclusions: Our findings call for public health interventions that go beyond individual level behavioral change campaigns, to more comprehensively address the broader meso and macro level factors that influence women' willingness and possibility to protect themselves.

Uncertainties, Fear and Stigma: Perceptions of Zika Virus among Pregnant Women in Spain

“…We found similarities between our study and a recently published article by Linde-Arias et al [ 16 ]. Knowledge levels about ZIKV highly depend on news, access to health services and the kind of relationship with healthcare professionals; similarly, knowledge translates into perceptions that can crucially shape attitudes and practices towards preventive measures, healthcare-seeking behavior and reproductive decisions.…”

“…Regarding their emotional status, we reported different feelings captured during the interviews; sadness, responsibility, shame, guilt, stigma, loneliness, sorority/sisterhood and empathy, as well as psychological suffering, anxiety and depression. Same feelings and emotions, many of them reflecting poor mental health, were reported in other studies [ 16 , 39 , 40 ]. In our study, women declared that their partners and relatives were their main source of support during pregnancy to cope with uncertainties about ZIKV, the possible transmission of infection to the fetus and repercussions on children’s health.…”

“…Some women in our study reported mistaken ZIKV transmission routes (e.g., contaminated water and direct contact with a person) and preventive practices (e.g., washing hands and hygiene habits). Their reported primary source of information was the Internet, although they recognized lack of satisfaction with available data due to mistrust on the reliability of the information obtained, as similarly reported by Linde-Arias et al [ 16 ]. Even though they were not satisfied with the information coming from the Internet, its use could be associated with the fear of stigmatization, e.g., the fear of asking specific questions to healthcare staff, friends and/or relatives.…”

“…There are several studies reporting perceptions and knowledge gaps in pregnant women exposed to ZIKV in endemic areas [ 12 , 16 , 17 , 18 , 19 ]; access to the healthcare system, specifically to sexual and reproductive health services for women living in endemic settings [ 20 , 21 , 22 ]; perceptions of ZIKV among women, not necessarily during gestation [ 9 , 23 ]; the general public living in endemic settings [ 11 ]; knowledge and attitudes among travelers to the U.S.A. [ 24 ] and to Brazil [ 25 ]; and perceptions of ZIKV among healthcare professionals [ 26 ]. The previously mentioned studies are very diverse in design, methodology and population under study, as are in their results and conclusions.…”

Effectiveness of the non-pharmaceutical public health interventions against COVID-19; a protocol of a systematic review and realist review

“…They also concluded that lack of trust in governments made women more vulnerable because they did not completely follow the health authorities' instructions. This example indicates the role of political and social context in the success of a PHI [ 30 ]. Effectiveness of a non-pharmaceutical PHI is tailored to changing the behavior of the target population [ 31 , 32 ].…”