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.

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.

News Sexual Health

Congress Fails to Act on Zika Before Seven-Week Recess

Christine Grimaldi

There was no last-minute deal on funding to address the Zika virus, even in the middle of mosquito season.

In the midst of summer mosquito season, the U.S. Congress is set to recess until September without taking action on the Zika virus.

Democrats in the U.S. Senate Thursday again blocked Republicans’ proposal for $1.1 billion in funding for the mosquito-borne virus linked to microcephaly and other fetal brain defects. The GOP-engineered agreement falls short of the $1.9 billion that the Obama administration staunchly contends is needed to combat Zika. The Senate plan also restricts what advocates consider to be essential contraceptive access, even though the virus can be sexually transmitted.

NARAL Pro-Choice America President Ilyse Hogue condemned Senate Republicans for their response to Zika.

“Instead of digging deep to adequately respond to this global health threat, anti-choice Republicans are trying to restrict funding for the very clinics and health care that allow women to plan for healthy families,” she said in a statement. “Their constant claim that they are dedicated to ‘protecting the unborn’ falls flat when they refuse to give women the resources we need to bear healthy children.”

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The Republican-led U.S. House of Representatives previously passed even less Zika funding—$622.1 million. House Republicans made a separate attempt to limit contraceptive access through gutting Title X in the appropriations process. “It is particularly foolish to target Title X at a time when the nation is at the precipice of a public health emergency resulting from the Zika virus,” National Family Planning & Reproductive Health Association President and CEO Clare Coleman said in a statement at the time.

Republicans insisted that their various plans protected women’s health, contrary to Democrats’ characterization of the plans as attacks on the same. Partisan bickering aside, Congress failed to strike a last-minute deal before a seven-week recess as Zika cases are already on the rise.

As of July 7, nine infants with Zika-related birth defects had been born in the continental United States, according to the U.S. Centers for Disease Control and Prevention (CDC). As many as 346 pregnant people in the United States and 303 in U.S. territories, including Puerto Rico, may have the Zika virus, the CDC found.