Category Archives: Zika

Zika and Access to Reproductive Health Services in Brazil

Twice a year students in the Johns Hopkins Bloomberg School of Public Health write blog postings as part of the course “Social and Behavioral Foundations of Primary Health Care.” We often share blog posts that relate to tropical health issues.  Below is a posting by class members Linda Cho, Linda Chyr, Rebecca Earnest, and Sarah Rosenberg on Zika, family planning, and reproductive health in Brazil.


In the 1960s, the Brazilian government adopted a laissez-faire attitude, which lead to the predominance of private organizations in the provision of family planning services. Since then, Brazil has witnessed one of the most dramatic reductions in family size in modern history in part due to increased access to family planning services. (Photo New York Times: Members of the Union of Mothers of Angels.)

However, in early 2015, the widespread epidemic of the Zika fever caused by the Zika virus in Brazil caused persisting gaps in access to contraception to resurface. Since it was first detected it has instilled fear and uncertainty in pregnant women whose fetuses could be at risk of Zika-related birth defects like microcephaly should the virus be contracted during pregnancy. This makes access to comprehensive reproductive health services and education a critical need for women who are pregnant or considering becoming pregnant.

While contraceptive use is fairly high in Brazil with 75.2% of women using modern forms of contraception, barriers to access remain. Some women face challenges, some of which include but are not limited to incomplete insurance coverage or lack of reimbursement for long-acting reversible contraceptives (LARCs), high up-front costs, low number of contraceptive service sites, and/or a lack of supply of the implants in the public sector . This may be one driver behind why LARCs only make up 0.5% of all contraceptive sales. Furthermore, 55% of all pregnancies in Brazil estimated to be unplanned and 20% of all lives births are attributed to teenage girls, indicating that there may be substantial reproductive knowledge gaps  in how to effectively prevent pregnancy.

Amid the spread of a virus that poses unique health risks to pregnant women and their fetuses, there is an urgent need to address these gaps in reproductive health access and education. First, the Brazilian National Health System, which laudably provides most contraceptives free of charge to about 74% of the population, needs to reevaluate existing policies that may be still limiting access to contraceptive services. Secondly, organizations like the Brazilian Society for Family Welfare (BENFAM), which provides reproductive health services and education to underserved Brazilian communities, need greater financial and political support from policymakers, civil society, and even organizations traditionally opposed to such services like the Catholic Archdiocese.

Despite Brazil’s great strides to improve access to contraception and reproductive health education in recent years, Zika’s arrival highlighted gaps in the existing system that must be addressed through policy reform and greater political and financial support. Especially in the time of Zika, Brazilian women deserve no less.

PAHO Head Reflects on Zika, Obscurity to Crisis, during 65th ASTMH Keynote

The Following blog from the 65th American Society of Tropical Medicine and Hygiene Annual Meeting opening keynote address has been re-posted here.

20161113_174950From moving quickly to train heads of state in risk communications, to making major decisions based on limited evidence, to sitting with Zika victims whose children had just been diagnosed with microcephaly, the head of the Pan American Health Organization (PAHO) offered a detailed assessment Sunday night of her experience with the sudden explosion of the Zika virus in the Americas.

In her keynote address to a packed hall at opening of ASTMH 2016 Annual Meeting, PAHO Director Dr. Carissa F. Etienne, MBBS, MSc, described the extraordinary experience and lessons learned from encounters with a once-obscure disease that now has been documented in 48 countries and territories in the Americas—and 67 globally.

20161113_180235Dr. Etienne credited “vigilant, astute, front-line health care workers” with first noting the unusual clusters of rash disease in Brazil in late 2014 that turned out to be an early indication that Zika virus had arrived. She noted it was also front-line health workers who first noted the spike in cases of microcephaly and Guillain-Barré Syndrome and connected them to the Zika virus.

Dr. Etienne said their “astute” observations have re-enforced her conviction that, when it comes to protecting the public from infectious disease, there is no substitute for “good clinical judgment and alertness for atypical events.”

Dr. Etienne recalled how quickly the situation escalated and the challenges this presented on a day-to-day basis. For example, heads of state wanted to take charge of discussing the emergency in radio and television appearances. So PAHO moved quickly to provide technical information along with training in risk communications.

There was also the fact that Zika was first discovered while many countries in the Americas were in the middle of preparing for potential Ebola infections and responding to outbreaks of chikungunya. Yet despite this confusing swirl of activity, she said health officials had to move 20161113_180647swiftly to declare Zika an emergency, even though they lacked a complete picture of the true extent of the threat.

“Determination of causality needs to run its course, but PAHO cannot wait until the final verdict of the scientific community,” Dr. Etienne said. “We must be willing to make decisions based on incomplete evidence.”

Dr. Etienne said her experience with the Zika response has reminded her of the many ways infectious diseases take their toll on people, communities and countries. She said Zika has been particularly hard on countries in the Americas that already were suffering economically. And she said it was profoundly moving to spend time with parents whose children have been diagnosed with microcephaly linked to Zika.

“It was quite emotional,” she said. “Here are mothers and fathers loving their child and caring for their child but recognizing that this child’s life will probably be marked by disability.”

Dr. Etienne said that given limitations with diagnostic tests and disease surveillance, the current case count probably underestimates the true magnitude of Zika infections in the Americas. She also believes that “microcephaly is merely the tip of the iceberg” and it will take years to assess the full impact of Zika on children whose mothers were infected with Zika during pregnancy.

Among other things, Dr. Etienne said the experience with the Zika outbreak should prompt a re-thinking “of our approach to reproductive health services.”

“There is still a long way to go with Zika,” she said. “This is not going to be a 100 meter dash. This is a marathon in which science and public health must work hand in hand.”

Emergency Funding for Zika Virus Response

Class members from the course “Social and Behavioral Foundations of Primary Health Care” at the Johns Hopkins Bloomberg School of Public Health write a policy advocacy blog as part of their assignments. Here we are sharing the blog posted by Hanna B. More of the SBFPHC postings can be read at this link.
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Source: wh.gov/Zika

On February 22nd, the Presidential office requested $1.9billion in emergency funding to support activities related to Zika virus, but these efforts have dangerously stalled in Congress. To date, nearly $600 million has been redirected by the Obama administration to fund Zika related research, front line response efforts, and vaccine development. More than half of this money was redirected from within the U.S. Department of Health and Human Services (DHHS).

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Source: Healthcareit

On August 3rd, Sylvia Burwell, DHHS Secretary, informed Congress that due to the delay in approving the emergency funding, the DHHS had been forced to further reallocate up to $81 million from other programs, including the National Institutes of Health. This was extremely important because it could impact the progression of the vaccine studies currently underway, as Secretary Burwell suggested in her letter to Congress. Her letter also outlined the response by the CDC and predicted that they too would be out of Zika funding by the end of the fiscal year (Sept 2016).

Funding approval for Zika virus related activities from the U.S. is more urgent than ever. As of August 17th, the U.S. has confirmed 14 cases of locally acquired Zika virus disease – all from Florida. This was after the U.S. Centers for Disease Control (CDC) announced on August 2nd that an additional $16 million was awarded to 40 states and territories to support Zika related public health activities.

So what can you do? It is time we let our political leaders know that their constituency will not wait any longer. Follow Secretary Burwell’s lead – petition your local congressional representatives (House, Senate) and let them know this is an issue you care about. Or submit pre-formatted online petitions at Project Hope and AmeriCares. And spread the word and call to action amongst your peers.

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Source: Project Hope