Understanding sexual and reproductive health needs of young women living in Zika affected regions: a qualitative study in northeastern Brazil

Abstract

Background: In 2016, the World Health Organization declared a Public Health Emergency of International Concern due to Zika's association with microcephaly and other neurological disorders. Brazil was the epicenter of this epidemic and the most affected region has the lowest Human Development Index and the highest rates of adolescent pregnancy. Despite the end of the epidemic, Brazil continues to be the epicenter of Zika illness. This study examined the barriers faced by young women who seek sexual and reproductive health (SRH) care services living in affected areas and their attitudes towards SRH needs and the available services. Methods: Individual semi-structured interviews were conducted with 22 young women, aged 14-24 years in three Zika affected municipalities in the Brazilian Northeast. This qualitative research used thematic analysis for data analysis. Results: Almost half (n = 10) of the participants had their first pregnancy during adolescence (from 12 to 19), all of which were unintended. Lack of information and barriers to access family planning were found to contribute to the unmet need for contraception. Participants reported knowledge gaps about contraception. Zika was not considered a health concern and participants were unaware of the possibility of Zika's sexual transmission. Conclusions: The young women's knowledge and attitudes towards their SRH needs highlight the barriers to access care. It also implies that comprehensive, biopsychosocial and political, understanding is necessary in order to adequately provide SRH to this population and meet their needs. The government should place women at the center of any public health response to an emergency affecting women of reproductive age and focus on improving access to information and family planning services in a culturally and age appropriate manner.

Zika Virus Public Health Crisis and the Perpetuation of Gender Inequality in Brazil

“…Besides, a woman could become infected through her partner, even if she diligently followed all recommendations for preventing the disease. Hence, we postulated since the emergency tapped into pregnancy and childrearing, both quintessentially female tasks, competencies were assigned to women as predicted by gender scholars (5,16,(27)(28)(29)(30)(31)(32)(33).…”

“…Only 1 in 10 women were asked about their pregnancy intentions by their health care provider and only 14.4% were advised about condom use to prevent Zika infection. In Diniz et al (28), none of the young women interviewed new about sexual transmission. Thus, focusing on pregnant women may be useful for pregnant women at the time of the epidemics, but unhelpful if we think half of all pregnancies are unintended and microcephaly is the only recognized consequence of the epidemics (28).…”

“…Besides, the moment women give birth, they stop worrying about Zika at all (24,28), another evidence that pregnant women have been extensively portraited by the campaigns. Participants in the study of Diniz et al (28) do not consider Zika an illness that still threats babies and they "justify their low level of concern by the fact that Zika is no longer broadcast on radio and television, is not part of the conversations in social gatherings, and is not even brought up by health professionals". The interviewees in the study also reveal Zika is no longer discussed during prenatal care, although the risk of getting infected hasn´t ceased to exist as a recent epidemiological report shows (7).…”

“…They also lack access to clean water and sanitation, which exposes them even more to the risks of getting infected by mosquito borne diseases. This fatal combination explain why the impact of the Zika virus reproduced existing inequality falling most heavily on the most disadvantaged members of society, leaving them unassisted to navigate mosquito control, contraception and pregnancy (5,8,9,16,(27)(28)(29)(30)(31)(32)(33).…”

“…When a public health crisis taps directly into reproductive health, typically a feminine realm, gender systems may reproduce traditionally and deeply-rooted gender norms, especially those linked to cultural beliefs and expectations playing out in different relational contexts. Despite its importance, most of the literature regarding the gender consequences of the Zika outbreak is theoretical (5,16,(27)(28)(29)(30)(31)(32)(33)(34)(35) with a dearth of empirical studies exploring how traditional gender stereotypes increase women´s vulnerability and how gender division of labor hinders arbovirus control. Exceptions have been able to explore gendered power and norms during the Zika outbreak in connection with sex and contraceptive use (24,28,36).…”