Commentary Sexual Health

Men Are From Mars, Women Don’t Want Sex: Abstinence-Only Curricula Rife With Gender Stereotypes

Martha Kempner

Pointing out gender stereotypes in abstinence-only curricula got law professor Nina Pillard, who was nominated to the D.C. Circuit Court of Appeals, in trouble with the Senate Judiciary Committee, but it's something we should talk about more often.

As Jessica Mason Pieklo reported for Rewire on Thursday, Republicans in Congress are working to scuttle the nomination of Georgetown law professor Nina Pillard to the D.C. Circuit Court of Appeals. While this is part of a larger effort to block all of President Obama’s nominees to this influential bench, the specific issue that is holding up Pillard may surprise some. She is being condemned by conservatives in part because of her criticism of gender stereotypes in abstinence-only-until-marriage curricula.

In her academic writings, Pillard argues that these curricula perpetuate gender stereotypes and that as such teaching them in public school “violates the constitutional bar against sex stereotyping and is vulnerable to equal protection challenge.” Not surprisingly, proponents of abstinence-only-until-marriage programs and some Republican members of the Senate Judiciary Committee took issue with this. I, on the other hand—having spent much of my career poring over abstinence-only curricula and suffering through speeches and videos on the topic—applaud it. These curricula are riddled with dangerous gender stereotypes, and while I will leave the constitutional analyses to Pieklo, Pillard, and their legal colleagues, I can say as a sex educator that such blatant stereotypes have no place in a classroom.

Rife With Stereotypes

Abstinence-only curricula perpetuate the idea that men and women are very different when it comes to sex and everything else, suggest that women are responsible for setting limits because men want sex and they really don’t, and then make excuses for boys who are sexually aggressive while labeling women who have sex as forever tainted.

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In a 2007 article for the Emory Law Journal, Pillard argues that these messages might be unconstitutional and eloquently explains why they are so damaging. Since she focused primarily on the legal analysis she only used a few examples for the curricula themselves. Given the current furor over her academic writings, I think this is a good time to review other examples as well as her arguments. (Note: Unless otherwise linked, the examples below are taken from the Sexuality Information and Education Council of the United States fact sheet Sugar & Spice, Virtue & Vice: How Fear-Based, Abstinence-Only-Until-Marriage Curricula Perpetuate Gender Stereotypes, which I wrote in 2008 based on in-depth reviews of the most recent version of each curriculum available at the time.)

Men Are From Mars, Women Can’t Do Math

Typically, abstinence-only-until-marriage curricula begin their discussion of gender by enumerating differences between men and women, from the vaguely interesting (women have larger kidneys, livers, stomachs, and appendixes than men, but smaller lungs) to the ridiculous (boys carry their books under their arms while girls hug them to their chest) to the downright offensive (girls aren’t as good at math). To emphasize their points, the authors like to point out that these differences are real and “proven” by science. Some of my favorite examples include:

  • “New research data says that many basic male-female differences are innate, hardwired and not the result of condition.” (Worth the Wait, Section 5-11)
  • “Let’s face it, men and women are different. Not just in terms of anatomy, but even in the ways they typically think and act in various situations.” (WAIT Training, p. 183)
  • “Males … are usually better at spatial reasoning than females. … Males’ superior skills in this area give them an advantage in math, engineering, and architecture.” (Worth the Wait, Section 5-11)
  • Women need affection while men need sexual fulfillment; women need conversation while men need recreational companionship; women need honesty and openness while men need physical attractiveness; women need financial support while men need admiration; and women need family commitment while men need domestic support. (WAIT Training, p. 199)
  • “Real men” are “strong, respectful, and courageous.” “A man protects.” In contrast, a “real woman,” “knows herself, is confident, sends a clear message, and is caring.” (Heritage Keepers, Student Manual, p. 52 & 55)
  • “Tom walks Kristie to her classes and carries her books for her. He doesn’t want her to strain herself.” (Choosing the Best LIFE, Leader Guide, p. 42)

It is understandable why at first glance some people might not be all that offended by the presentation of these gender traits—for one thing, many of them ring true in everyday life. The majority of sitcoms and at least half of all stand-up routines in the 1980s were based on the idea that men and women are different, and psychologist John Gray got rich and famous for suggesting that “men are from Mars and women are from Venus.

Though these differences may seem benign, they are setting up a world view in which men and women take on specific roles in both society and their family. After all, if men are better at special relations and need domestic support, doesn’t it just make sense that they become engineers while women stay home and do their laundry?

In her article, Pillard explains why even those gender stereotypes that are based on kernels of truth about men and women are problematic:

Under the line of cases culminating in United States v. Virginia (VMI), even statistically accurate generalizations about “typically male or female tendencies”—such as men’s greater aggressiveness versus women’s comparatively more cooperate temperament or men’s tendency to harass and women’s victimization by sex harassment—cannot be ground for official sex-based discrimination … The [doctrine] thus recognizes that sex-role stereotyping is itself harmful because it projects patriarchal messages that make discrimination at once more likely and less apparent.

Women Are in Charge, But Only of Saying No

The myriad of generalized gender differences mentioned above seem to be used for the purpose of setting up and underscoring the differences that the abstinence-only-until-marriage curricula are really interested in driving home: those that have to do with sex. The basic message here is that boys want sex with anyone at any time. Girls, on the other hand, may think they want sex, but really they are just looking for love. Such differences are natural, we shouldn’t fight them, we should just learn how to handle them. To cope with these differences, girls must help boys by dressing modestly, setting clear limits, and acting as the enforcer. Here’s how some of the curricula explain this:

  • “Because they generally become physically aroused less easily, girls are still in a good position to slow down the young man and help him learn balance in a relationship.” (Sex Respect, Student Workbook, p. 12)
  • “Girls need to be aware they may be able to tell when a kiss is leading to something else. The girl may need to put the brakes on first in order to help the boy.” (Reasonable Reasons to Wait, Student Workbook, p. 96).
  • Q: “But aren’t there many girls who really want to have sex, and so they pressure the guys?” A: “Yes, there are. This is happening in larger numbers now than in years past, since the pop culture has removed the stigma from non-virgins and displays many role models of provocative women.” (Sex Respect, Student Workbook, p. 12)
  • “While a man needs little or no preparation for sex, a woman often needs hours of emotional and mental preparation.”(WAIT Training, p. 199)
  • “A young man’s natural desire for sex is already strong due to testosterone, the powerful male growth hormone. Females are becoming culturally conditioned to fantasize about sex as well.” (Sex Respect, Student Workbook, p. 11).

Young people need to understand that in a couple, both men and women have not just the right but also equal responsibility to determine what sexual behaviors will be part of their repertoire. Young men need to know they are perfectly capable of not having sex at any moment, while young women need to know it’s as normal for them to want sex as it is for a man. Setting up a double standard in which only men desire sex and women’s role within the sexual relationships is simply to deny their partners’ relentless requests is damaging on many levels.

In her 2007 article, Pillard explains it brilliantly:

Sexual double standards set up both young women and men to act irresponsibly. The notion that male sex drives are irrepressible, the valorization of male sexual “conquests,” and the failure to hold men accountable to care for the children they father all encourage heedless and even lawless sexual behavior destructive to male-to-male peer pressure, and disregard of women’s humanity. Relying on young women to be the gatekeepers of chastity and to respond with denial and shame to their own sexual drives, and encouraging women to care more about their relationships with men than their own plans intensify women’s ambivalence and difficultly in negotiating their own drives, desires, and best interests.

It’s also worth noting that such discussions of sexual behavior completely ignore even the possibility of same-sex relationships. Though Pillard does not make this argument, others have suggested that abstinence-only-until-marriage programs discriminate against gay and lesbian teens, as these young people are left out of the conversation entirely.

Boys Will Be Boys, But Girls Might Get Ruined

One of the most obvious dangers of putting young women in charge of their partners’ insatiable sexual appetites is the impact it has on rape and sexual assault. Though some programs spend a token amount of time discussing date rape and may pay lip service to the idea that “no means no,” most include language that suggests otherwise. Girls are constantly blamed for tempting boys whose hormone-addled brains just can’t handle short skirts or flirtatious smiles. And while boys will be boys—meaning they can be forgiven for most sexual behaviors, perhaps including non-consensual behaviors—girls should know better. A girl who wants or actually has sex, according to these programs, has been permanently damaged. Here are some gems from the curricula:

  • “Date rape is a crime that young women must be on the lookout to avoid.” (Sex Respect, Teacher Manual, p. 101)
  • “The young girl learning to understand her changing body often has no idea the effect it has on surrounding males. Signals she doesn’t even know she is sending can cause big problems.” (Why kNOw, 6th grade, p. 17).
  • “Males and females are aroused at different levels of intimacy. Males are more sight orientated whereas females are more touch orientated. This is why girls need to be careful with what they wear, because males are looking! The girl might be thinking fashion, while the boy is thinking sex. For this reason, girls have a responsibility to wear modest clothing that doesn’t invite lustful thoughts.” (Heritage Keepers, Student Manual, p. 46).
  • “Deep down, you know that your friend’s plunging necklines and short skirts are getting the guys to talk about her. Is that what you want? To see girls who drive guys [sic] hormones when a guy is trying to see her as a friend. A guy who wants to respect girls is distracted by sexy clothes and remembers her for one thing. Is it fair that guys are turned on by their senses and women by their hearts?” (Sex Respect, Student Workbook, p. 94)
  • “Generally female dogs allow the male to mount them/get on top of them, do their business, and leave. Some girls appear to act as if they want this.” (HIS, Teacher’s Manual, p. 27)
  • “If [a girl] has been involved in sexual activity… sexually, she is no longer a virgin, she is no longer pure, unspoiled, fresh.” (HIS, Teacher’s Manual, p. 9)

Pillard takes this on in her article as well and points out just how damaging it can be to both genders. “Painting all males with the brush of sexual brutishness both naturalizes the wrong done by the rapist and obscures the good of the non-aggressor,” she writes. “Failure to acknowledge women’s very real and powerful sexual urges also abets sexual abuse and rape: If women are taught to deny their desire, their ‘no’s’ appear ambiguous, making it easier for men to believe that no means yes—i.e., that male insistence will merely lead to what both ‘really’ want.” She adds, “The female chastity norm also punishes women who repudiate it—or are presumed to do so—by viewing them as ‘fair game,’ disentitled to protection from uninvited sex.”

Possibly Unconstitutional, Definitely Inappropriate

As Pieklo explained, Pillard essentially argues that such blatant sex discrimination violates our equal protection laws: “[the curricula’s] prescriptions for women and men resonate vividly with the traditional sex roles that were targets of so many of the early sex equality cases.” As such, this content would be out of place in any public education program, but Pillard goes on to argue that perhaps an even stricter standard should be applied to sexuality education programs, which are by their nature trying to change how young people behave. She says:

Obligatory education permeated with discriminatory content alone raises serious constitutional concerns. But the conduct-shaping of sex education curricula makes them vulnerable to equal protection challenge even if communicating retrogressive sex roles in traditional academic classes might not be.

I have always felt that one of the most important goals of sexuality education is to help young people think critically about their own decisions in order to shape their future behavior for the better. Sure these courses should provide information about sexually transmitted infections, contraception, and sexual health, but that is not nearly as useful as the skills to apply it to their own lives. Presenting gender stereotypes in an effort to help young people understand the origins of these ideas, question their validity in today’s society, and examine how they affect communication within sexual relationships would be an ideal exercise for a sexuality education program. Unfortunately, abstinence-only-until-marriage programs are not interested in helping young people think critically about gender roles or any other aspect of sexuality. Instead, they present these stereotypes as universal truths and prescribe different behavior for men and women accordingly.

Over ten years ago, the toy company Mattel found itself in the center of a public relations nightmare when it released Teen Talk Barbie. Among the 470 phrases she would say was this winner: “Math class is tough.” Reaction to this was so strong that the doll was pulled from the shelf. A couple of years ago, retailer J.C. Penney got similarly lambasted in the media for a t-shirt that said “I’m too pretty to do homework so my brother has to do it for me.”

It turns out that kids are being exposed to even worse gender stereotypes in federally funded abstinence-only-until-marriage programs, but can calling these into question prevent someone from getting a seat on the bench? Professor Pillard was right to question whether abstinence-only programs belong in our schools, and she made excellent arguments about why the gender biases they tout are so damaging. I hope that her academic writings on this topic do not, in the end, prevent her from becoming a member of the D.C. Circuit. Though, I can’t help but wonder if she missed her true calling as a sexuality educator.

Analysis Abortion

Legislators Have Introduced 445 Provisions to Restrict Abortion So Far This Year

Elizabeth Nash & Rachel Benson Gold

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. Of these, 35 percent (445 provisions) sought to restrict access to abortion services. By midyear, 17 states had passed 46 new abortion restrictions.

Including these new restrictions, states have adopted 334 abortion restrictions since 2010, constituting 30 percent of all abortion restrictions enacted by states since the U.S. Supreme Court decision in Roe v. Wade in 1973. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

Mid year state restrictions


Signs of Progress

The first half of the year ended on a high note, with the U.S. Supreme Court handing down the most significant abortion decision in a generation. The Court’s ruling in Whole Woman’s Health v. Hellerstedt struck down abortion restrictions in Texas requiring abortion facilities in the state to convert to the equivalent of ambulatory surgical centers and mandating that abortion providers have admitting privileges at a local hospital; these two restrictions had greatly diminished access to services throughout the state (see Lessons from Texas: Widespread Consequences of Assaults on Abortion Access). Five other states (Michigan, Missouri, Pennsylvania, Tennessee, and Virginia) have similar facility requirements, and the Texas decision makes it less likely that these laws would be able to withstand judicial scrutiny (see Targeted Regulation of Abortion Providers). Nineteen other states have abortion facility requirements that are less onerous than the ones in Texas; the fate of these laws in the wake of the Court’s decision remains unclear. 

Ten states in addition to Texas had adopted hospital admitting privileges requirements. The day after handing down the Texas decision, the Court declined to review lower court decisions that have kept such requirements in Mississippi and Wisconsin from going into effect, and Alabama Gov. Robert Bentley (R) announced that he would not enforce the state’s law. As a result of separate litigation, enforcement of admitting privileges requirements in Kansas, Louisiana, and Oklahoma is currently blocked. That leaves admitting privileges in effect in Missouri, North Dakota, Tennessee and Utah; as with facility requirements, the Texas decision will clearly make it harder for these laws to survive if challenged.

More broadly, the Court’s decision clarified the legal standard for evaluating abortion restrictions. In its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court had said that abortion restrictions could not impose an undue burden on a woman seeking to terminate her pregnancy. In Whole Woman’s Health, the Court stressed the importance of using evidence to evaluate the extent to which an abortion restriction imposes a burden on women, and made clear that a restriction’s burdens cannot outweigh its benefits, an analysis that will give the Texas decision a reach well beyond the specific restrictions at issue in the case.

As important as the Whole Woman’s Health decision is and will be going forward, it is far from the only good news so far this year. Legislators in 19 states introduced a bevy of measures aimed at expanding insurance coverage for contraceptive services. In 13 of these states, the proposed measures seek to bolster the existing federal contraceptive coverage requirement by, for example, requiring coverage of all U.S. Food and Drug Administration approved methods and banning the use of techniques such as medical management and prior authorization, through which insurers may limit coverage. But some proposals go further and plow new ground by mandating coverage of sterilization (generally for both men and women), allowing a woman to obtain an extended supply of her contraceptive method (generally up to 12 months), and/or requiring that insurance cover over-the-counter contraceptive methods. By July 1, both Maryland and Vermont had enacted comprehensive measures, and similar legislation was pending before Illinois Gov. Bruce Rauner (R). And, in early July, Hawaii Gov. David Ige (D) signed a measure into law allowing women to obtain a year’s supply of their contraceptive method.


But the Assault Continues

Even as these positive developments unfolded, the long-standing assault on sexual and reproductive health and rights continued apace. Much of this attention focused on the release a year ago of a string of deceptively edited videos designed to discredit Planned Parenthood. The campaign these videos spawned initially focused on defunding Planned Parenthood and has grown into an effort to defund family planning providers more broadly, especially those who have any connection to abortion services. Since last July, 24 states have moved to restrict eligibility for funding in several ways:

  • Seventeen states have moved to limit family planning providers’ eligibility for reimbursement under Medicaid, the program that accounts for about three-fourths of all public dollars spent on family planning. In some cases, states have tried to exclude Planned Parenthood entirely from such funding. These attacks have come via both administrative and legislative means. For instance, the Florida legislature included a defunding provision in an omnibus abortion bill passed in March. As the controversy grew, the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, sent a letter to state officials reiterating that federal law prohibits them from discriminating against family planning providers because they either offer abortion services or are affiliated with an abortion provider (see CMS Provides New Clarity For Family Planning Under Medicaid). Most of these state attempts have been blocked through legal challenges. However, a funding ban went into effect in Mississippi on July 1, and similar measures are awaiting implementation in three other states.
  • Fourteen states have moved to restrict family planning funds controlled by the state, with laws enacted in four states. The law in Kansas limits funding to publicly run programs, while the law in Louisiana bars funding to providers who are associated with abortion services. A law enacted in Wisconsin directs the state to apply for federal Title X funding and specifies that if this funding is obtained, it may not be distributed to family planning providers affiliated with abortion services. (In 2015, New Hampshire moved to deny Title X funds to Planned Parenthood affiliates; the state reversed the decision in 2016.) Finally, the budget adopted in Michigan reenacts a provision that bars the allocation of family planning funds to organizations associated with abortion. Notably, however, Virginia Gov. Terry McAuliffe (D) vetoed a similar measure.
  • Ten states have attempted to bar family planning providers’ eligibility for related funding, including monies for sexually transmitted infection testing and treatment, prevention of interpersonal violence, and prevention of breast and cervical cancer. In three of these states, the bans are the result of legislative action; in Utah, the ban resulted from action by the governor. Such a ban is in effect in North Carolina; the Louisiana measure is set to go into effect in August. Implementation of bans in Ohio and Utah has been blocked as a result of legal action.


The first half of 2016 was also noteworthy for a raft of attempts to ban some or all abortions. These measures fell into four distinct categories:

  • By the end of June, four states enacted legislation to ban the most common method used to perform abortions during the second trimester. The Mississippi and West Virginia laws are in effect; the other two have been challenged in court. (Similar provisions enacted last year in Kansas and Oklahoma are also blocked pending legal action.)
  • South Carolina and North Dakota both enacted measures banning abortion at or beyond 20 weeks post-fertilization, which is equivalent to 22 weeks after the woman’s last menstrual period. This brings to 16 the number of states with these laws in effect (see State Policies on Later Abortions).
  • Indiana and Louisiana adopted provisions banning abortions under specific circumstances. The Louisiana law banned abortions at or after 20 weeks post-fertilization in cases of diagnosed genetic anomaly; the law is slated to go into effect on August 1. Indiana adopted a groundbreaking measure to ban abortion for purposes of race or sex selection, in cases of a genetic anomaly, or because of the fetus’ “color, national origin, or ancestry”; enforcement of the measure is blocked pending the outcome of a legal challenge.
  • Oklahoma Gov. Mary Fallin (R) vetoed a sweeping measure that would have banned all abortions except those necessary to protect the woman’s life.


In addition, 14 states (Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, South Carolina, South Dakota, Tennessee and Utah) enacted other types of abortion restrictions during the first half of the year, including measures to impose or extend waiting periods, restrict access to medication abortion, and establish regulations on abortion clinics.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.

Analysis Maternity and Birthing

Why Are Some Countries Advising Against Pregnancy as the Zika Virus Spreads?

Martha Kempner

Spread by a mosquito that thrives in tropical climates, the Zika virus is hard to prevent; so hard, in fact, that some governments are asking women not to get pregnant until they have the outbreak under control.

Read more of our articles on the Zika virus here.

Researchers suspect that a poorly understood virus is linked to an alarming number of babies born with microcephaly in South America. The Zika virus is not new—there have been outbreaks in Africa, Southeast Asia, and the Pacific Islands for decades—but the number of cases is quickly growing in a new part of the world. On Monday, the World Health Organization (WHO) declared the outbreak to be an international public health emergency. Spread by a mosquito that thrives in tropical climates, the virus is hard to prevent; so hard, in fact, that some governments are asking women not to get pregnant until they have the outbreak under control.

The Zika virus is spread by Aedes mosquitoes, which are also known to spread dengue, chikungunya, and yellow fever. Most people infected with the Zika virus won’t ever know they have it. According to the Centers for Disease Control and Prevention (CDC), only about one in five people infected report symptoms, and those are usually quite mild. The disease often begins with a fever and rash, and can also cause joint pain and conjunctivitis, also known as pink eye. The symptoms last from between two days and a week.

What makes this virus scary, however, is the effect it is suspected to have on fetuses when pregnant women become infected. The exact relationship between microcephaly in babies and the Zika virus is not yet understood, but evidence suggests that the current outbreak of the virus in Latin America is related to 4,000 babies born with the condition in Brazil since May 2015.

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Microcephaly is an uncommon condition in which a baby’s head is much smaller than expected. It can occur because a baby’s brain has not developed properly during pregnancy or has stopped growing after birth. In the United States, the condition occurs in approximately 2 in 10,000 live births. Babies born with microcephaly often suffer from other health issues such as seizures, feeding problems, hearing loss, vision problems, developmental delays, and intellectual disabilities, all of which can vary in severity.

The exact causes of microcephaly in most babies are not known: Though it can be genetic, it can also be the result of prenatal exposure to toxic chemicals, drugs, alcohol, or certain infections, such as rubella, toxoplasmosis, and cytomegalovirus. The sheer number of babies born with microcephaly in Brazil during the current outbreak of Zika is a strong indicator that the virus is somehow responsible, although the link has not been as evident in other countries where it has spread.

According to the CDC, the Zika infection usually lasts in a patient’s blood for about a week; it does not pose a risk for future pregnancies.

As of now, there is no way to prevent Zika virus other than to avoid the mosquitoes that cause it; a vaccine study in humans may begin this year. For this reason, the CDC is recommending that pregnant individuals consider postponing travel to the regions affected by the virus, and that those planning to become pregnant talk to their doctors before they travel to these areas.

For people who live there already, however, the guidance is very different. Many countries—including Brazil and Colombia—have advised women not to get pregnant until the crisis has passed. Government officials in El Salvador have taken it even further, and asked women to postpone pregnancy until 2018. After thousands of cases of the Zika virus were detected in the El Salvador in the first weeks of the year, Deputy Health Minister Eduardo Espinoza announced, “We are recommending that women of childbearing age take the precaution of planning their pregnancies and try to avoid pregnancy this year and next.”

The WHO says it would not advise suspending pregnancies for two years, and public health experts say this is the first time that they’ve ever heard such advice coming from a government body. David Bloom, a professor at the Harvard School of Public Health, told the New York Times, “I can tell you that I’ve never read, heard, or encountered a public request like that.”

Dr. Howard Markel, a professor of the history of medicine at the University of Michigan, agreed and explained to the Times that it reminded him of the early days of the HIV epidemic, before there was any way to prevent transmission from mother to child. He said, “There was some sotto voce debate about whether it was morally ethical for a doctor to advise a woman not to get pregnant because of the risk to her child. … But no one said, ‘It’s verboten, don’t do it.’”

The advice to postpone pregnancy is particularly complicated in countries in which contraception is not widely available and abortion is illegal.

Despite the strong influence of religions in the region that resist many forms of contraception, the majority of married women in Latin America use a modern method of birth control. In Brazil, more than three-quarters percent of married women ages 15 through 49 use a modern method of contraception; in Colombia, 73 percent of these women do; and in El Salvador, 68 percent. Still, the WHO believes that there is an unmet need for contraception in this region, especially among adolescents, poorer populations, and unmarried women. It estimates that about 10 percent of women in the region who need contraception do not have access to it.

As Kathy Bougher wrote for Rewire about contraception availability in El Salvador:

[In a] study-in-progress carried out by the feminist organization Organización de Mujeres Salvadoreñas por la Paz (Organization of Salvadoran Women for Peace, known as ORMUSA), which shared a preliminary draft with Rewire, early findings based on interviews indicate that although local health centers might prescribe contraceptives, centers can go for months at a time without actually having any in stock. Young women say they routinely encounter humiliating treatment or have their requests to purchase contraception denied at public clinics and private pharmacies.

In addition, the study reports, although the country’s policies direct that there be specialized services and personnel trained to serve adolescents and young adults, in reality those services rarely exist. Gang violence and territoriality also impact clients’ ability to physically access clinics, and the reporting of rapes for fear of retribution.

Paula Avila-Guillen of the Center for Reproductive Rights told the Huffington Post, “These recommendations are really empty words. They aren’t going hand in hand with policies to make contraception and emergency contraception available, especially in El Salvador where those things are very inaccessible.”

None of these countries have, thus far, announced plans to make birth control more available. And religious leaders, especially those who have historically been against contraception, have yet to weigh in. El Salvador’s auxiliary bishop, Gregorio Rosa Chávez, suggested last weekend that the bishops were discussing this issue, saying in an interview that he expected Church leaders to take the situation very seriously.

For those already pregnant, there is no cure for microcephaly, even if it is detected in the womb. In Brazil, abortion is permitted only to save a woman’s life; in Colombia, abortions are legal in cases of fetal anomaly but often very difficult to obtain because of physicians’ reluctance to perform them. El Salvador has such strict laws against abortion that women who are suspected of attempting abortion, possibly because they have suffered a miscarriage or stillbirth, have been jailed for homicide. Women in these countries who find out in the second or third trimester that their fetus has microcephaly may or may not want to terminate the pregnancy; however, they have no choice but to expect to carry to term or seek an illegal abortion. In 2008, there were 32 abortions per 1,000 women in Latin America, 95 percent of which were considered unsafe.

The requests for women to avoid pregnancy is not the only attempt by governments of these nations to prevent Zika’s spread. Brazil is sending 220,000 members of its armed forces into the most heavily hit areas, according to the Guardian, to try to eradicate the Aedes mosquitoes. The soldiers will go house-to-house to distribute leaflets and make suggestions about what people can do to limit the mosquito population, such as emptying all sources of standing water around their homes. They will also provide advice for preventing mosquito bites, such as covering as much as the body as possible with light-colored clothing, closing doors and windows, sleeping under mosquito netting, and using repellent, which is becoming hard to find in the country.

Despite this effort, however, Brazil’s health minister is not optimistic. He noted that his country had already failed in its efforts to eradicate this insect when it was responsible for outbreaks of dengue, chikungunya, and yellow fever. He told reporters, “The mosquito has been here in Brazil for three decades, and we are badly losing the battle against the mosquito.”

El Salvador’s vice minister of health also promises that asking women to put off pregnancy is not the country’s primary strategy—its officials, too, are trying to get rid of standing water and have asked religious leaders to get congregations to clean up trash in the streets that can also be breeding grounds for insects. But, he says the secondary strategy of pregnancy prevention is necessary because “of the fact that these mosquitoes exist and transmit this disease.”

Many of the issues that these countries are facing are not problems in much of the United States because of geography and resources. The mosquitoes likely to carry the virus are limited to the warmer, more southern parts of the country. And because of the spread of West Nile virus and other mosquito-borne illnesses, many municipalities are already careful to eliminate pools of standing water; some even spray insecticides. Finally, although the Zika virus is still fairly little-known, it does not appear to be carried by birds, which is one of the things that makes the spread of West Nile so hard to prevent.

Though there have been cases of the Zika virus reported in the contiguous United States, thus far, all seem to have been contracted in another country. Dr. Beth Bell, director of the CDC’s National Center for Emerging and Zoonotic Infectious Disease, told NPR that she doesn’t expect to see a full-fledged outbreak here.

The CDC and scientists around the world are carefully studying the current outbreaks to learn more about the virus including confirming that it is, indeed, the cause of microcephaly and determining when in pregnancy infection is most risky. Some reports have also suggested that like many other viruses, Zika might be sexually transmitted through the semen of men who have had the illness. This has not been confirmed, and even if it were true, it would undoubtedly account for far fewer cases than those transmitted by mosquitoes. Unfortunately, some research is made harder by the fact that the virus does not infect most lab animals such as mice and rats.

While scientists gather information, women who are pregnant or planning to become pregnant are left to decide how much they are willing to do to prevent the disease. Some can just avoid the areas of outbreak, but others who do not have the luck of geography are left to decide if they are willing—or able—to avoid pregnancy or childbirth altogether.