Understanding the sexual and reproductive health needs in Brazil's Zika‐affected region: placing women at the center of the discussion

Abstract

K E Y W O R D S : Brazil; Public Health; Sexual and Reproductive health; Unmet needs; Young women; Zika virus Zika virus (ZIKV) is a flavivirus that is mainly transmitted by the Aedes aegypti; it is also transmitted sexually, perinatally, via blood transfusion, and probably by breastfeeding. Unlike other flaviviruses, ZIKV has adverse effects on the pregnancy, embryo, fetus, and postnatal development. The effects of Zika virus congenital infection have been referred to as Congenital Zika Syndrome (CZS), as there is a wide range of presentations and severity of manifestations, not limited to microcephaly. 1 In addition, Zika virus infection during pregnancy can lead to damage to the placenta, fetal loss, and spontaneous abortion. 1 The Zika virus epidemic emerged in northeast Brazil in 2015; although the outbreak has subsided, Brazil continues to be the epicenter of the Zika virus. Studies estimate over 8 million symptomatic Zika cases between January 2015 and May 2017, with an overwhelming concentration of Zika case burden (93%) in northeast Brazil. 2 Since the monitoring of Zika infection cases began, the Brazilian epidemiological surveillance system has registered over 17 000 suspected cases of CZS; there is no official data at present for 2019. 3 Among the most affected populations are underserved women, most of them young Afro-Brazilians with little education, living in one of the poorest regions of the country. 4 From January 2015 to November 2016, most of the infection-related microcephaly cases were concentrated in the northeast region of Brazil and 83% of women who had a child with CZS were Afro-Brazilian and/or Native Brazilian, whereas only 49% of the female Brazilian population falls within these groups. 5,6 Moreover, northeast Brazil was disproportionately affected by the Zika epidemic: this geographical region ranks lowest among the country's macro-regions on the Human Development Index. 7 We conducted a social research study supported by WHO Human Reproduction Programme to investigate the sexual and reproductive health needs and challenges in accessing services of women living in the most affected areas. Focus groups and individual semi-structured interviews were conducted with women who sought sexual and reproductive care in public health facilities of three Zika-affected municipalities in northeast Brazil. The age range was 14-48 years. Each focus group was comprised of between 5 and 15 women. There were nine focus group with 81 participants in total. Individual interviews were conducted with 41 women from the different focus groups and municipalities. The national protocol for health professionals about clinical manifestations, prevention measures, prenatal and newborn care in the context of Zika has not been updated since early 2017. 8 Brazilian women continue to be at risk for Zika infection, as the national epidemiological surveillance reports new cases of Zika in the region. 9The link between the discovery and public announcement of the consequences of ZIKV epidemic with the decline of live b...

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

“…These policies are far to address the root causes of ZIKV and instead compromise women’s reproductive rights and condemn them to stigma and poorer physical, mental health and emotional outcomes [ 13 ]. It is imperative to place women and girls at the center of the discussions to understand their needs and address health issues related to ZIKV [ 20 ]. The pressure put on women impacted women’s mental health and emotional outcomes.…”

“…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.…”

The promise and pitfalls of social science research in an emergency: lessons from studying the Zika epidemic in Brazil, 2015–2016

“…19 24 25 27 Of course, we were not the only social scientists working within the Zika epidemic. Notably, Debora Diniz and team conducted excellent research probing the rights and realities of women affected by Zika in Brazil, [30][31][32][33][34] but there are too few other examples. Despite its potential importance, social science appeared to be a low priority within the Zika epidemic.…”

Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly

“…From 2015 through 2016, congenital Zika virus syndrome (CZS) caused approximately 83% of the microcephaly cases in Brazil. 3 This syndrome comprises a wide range of congenital defects resulting from the vertical transmission of Zika virus infections during gestation. Neurotrophic Zika virus infects progenitor neuron cells, increases neuronal apoptosis, and deregulates the cell cycle, resulting in impaired neuronal migration and brain development.…”