The politics of global maternal health

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The public health messages disbursed in North America and western Europe warn pregnant women to avoid travel to Zika-affected areas as a result of potential maternal health risks. Zika is a virus primarily transmitted through the bite of infected Aedes mosquitoes, which are predominantly found in the Southern Hemisphere.

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Opinion

Hey there, time traveller!
This article was published 03/02/2016 (2496 days ago), so information in it may no longer be current.

The public health messages disbursed in North America and western Europe warn pregnant women to avoid travel to Zika-affected areas as a result of potential maternal health risks. Zika is a virus primarily transmitted through the bite of infected Aedes mosquitoes, which are predominantly found in the Southern Hemisphere.

In endemic areas, such as Brazil, there has been an explosion in cases of microcephaly, a serious birth defect, as well as increases in Guillain Barré syndrome, an immune disorder. The result, beyond the few cases of infection that have already resulted in fetal abnormalities, is mostly inconvenience, as women and their families abandon or delay travel to those areas.

It is reasonable to also assume this travel will mostly be for vacation and leisure and that the recent announcement by airlines they will refund tickets for pregnant women has resulted in collective sighs of relief. But for women of the global south who are living in affected areas, primarily in Latin America and the Caribbean, the solution is not so easy. The public health messaging in El Salvador recommends women avoid getting pregnant for the next two years. This would seem comical if it were not so devastating, not just to women’s maternal desires but to their maternal health.

Felipe Dana / The Associated Press Tainara Lourenco, who's five months pregnant, at her stilt home built over polluted water in a slum in Recife, Brazil.

The unfortunate reality is in most countries in the region, the vast majority of women do not have access to birth control, prenatal screening (which can detect microcephaly and other abnormalities) or abortion. In El Salvador, abortion is illegal in all instances, and women are jailed for “suspicious” miscarriages. Women in the region also have little household authority, which means they tend not to make decisions about family planning or sexual behaviour, all of which have an impact on health. These disparities in maternal-health realities for women of the global north and south are prime examples of what has been called stratified reproduction, a term that identifies the differences in significance and risk for mothers in different contexts. In the case of the Zika virus, the vector of disease is constant — the Aedes aegypti mosquito — but the risk is varied according to both geography (this mosquito does not live in most northern areas) and inequality.

While this mosquito has been found recently in Washington, D.C., (as a result of adaptation to colder environments), the impact of its migration is likely to be minimal, in global terms. Mosquito control — such as fogging and elimination of standing water — is a fairly straightforward public health measure, epidemiological surveillance is sophisticated, and the availability of health services will reduce the potential for an unmanageable outbreak. But the effects, such as they may be, will reveal the socio-economic inequalities that exist wherever the infected mosquitoes are able to breed and thrive. In a city such as Washington, D.C., women with greater ability to control their environments (because they live in detached suburban homes rather than public housing) and better access to health information and health care will fare better than their less privileged counterparts.

Much of what needs to be done to reduce maternal risk and suffering in any society is well-known. Developing countries are rife with what Indian economist Amartya Sen calls “remediable injustices,” terribly unfair conditions and problems that are relatively simple to fix. To begin, accessibility of birth control could be improved as a public health goal, even if the larger goal of women’s reproductive rights is still unpalatable in many countries in the region. Access to prenatal screening, which requires fairly sophisticated and expensive technology, and abortion, which does not, would also improve disparities, as the range of choices available to women would be expanded.

While these are complex goals fraught with all sorts of political, religious and cultural problems, the admonition to “not get pregnant for the next few years,” is nonsensical. If only it were that simple.

It is also the case that in most of the countries in the region there is no capacity to care for babies born with microcephaly — no universal health coverage and virtually no access to private insurance. Furthermore, women who give birth to babies with obvious defects (babies with microcephaly have disproportionately small heads) tend to be ostracized and further marginalized.

Brazil is racing to produce a vaccine in order to sanitize its Olympic mandate. But what else can be done? Countries such as Canada, which have been influential in shaping the global maternal and child-health agenda, could insist on better recognition of a full range of reproductive rights and maternal health programs in developing countries as a condition of aid or diplomacy.

This, of course, is unlikely, as global maternal health policy directives from countries such as Canada and the United States tend to be restrictive rather than progressive. What is needed is global maternal health policy that addresses the complex social and biomedical sources of inequality and infection in developing countries as a serious priority of international politics.

 

Candace Johnson is an associate political science professor at the University of Guelph.

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