Tragically, pregnancies across the U.S. and around the world are deeply unequal. The outbreak of the mosquito-borne Zika virus in Brazil and Latin America and its association with microcephaly reflect this reality. Microcephaly is a condition in which newborns are born with an unusually small head and brain. If they survive, infants often face a lifetime of physical and developmental challenges.
During the first trimester of my pregnancy, my partner and I were living and working in Rio de Janeiro, Brazil. Within days of learning of the virus' presence in the city, we boarded a plane to return to the U.S. Our departure marked the difference between thousands of other parents and us - we had the immeasurable privilege of mobility.
Since October 2015, 4,180 cases of microcephaly have been reported in Brazil. A generation of Brazilian children will grow up in need of tremendous support; yet, the medical, scientific, and public health communities have limited knowledge of the virus' association to microcephaly. While the recent Center for Disease Control and Prevention and World Health Organization warnings advising pregnant women to postpone travel to countries affected by the virus will hopefully prevent those who would have otherwise traveled for work or pleasure from contracting the virus; women and their partners living in affected countries have little choice but to live in everyday fear.
My partner and I are grateful that we had resources and citizenship privileges to leave. When our local public health department in the U.S. called to say that I tested negative for Zika, we cried in gratitude. It was an unspeakable relief. But we also feel a real sadness. To make a major life decision that so clearly differentiated our unborn child from thousands of others was painful. Consciously embodying inequality is always uncomfortable; yet, this discomfort may be instructive in a world where we would often rather not look at the ways in which our decisions reproduce entrenched inequities.
Pregnancy is a deeply embodied experience. As a researcher of gender and inequality, I am aware of the ways inequality is marked on pregnant female bodies in innumerable ways. Whether in the U.S. or Brazil, privileged, frequently white, middle and upper-class women, such as myself, often spend nine months imagining a nursery, registering for baby gifts, attending prenatal yoga, eating nourishing food, writing a birth plan, and receiving excellent medical care. In contrast, far less-privileged, poor and working-class women, often of color, frequently labor in fields, factories, or other people's homes for the entirety of their pregnancy, placing them at higher risk for environmental and toxic exposure and for the dangers of heavy lifting. They often have limited access to nutritious food and safe drinking water, and receive limited or inadequate medical treatment and preventive care. In many ways, pregnancy marks the beginning of very unequal lives.
As with other infectious diseases, risk of exposure to the Zika virus mirrors racial, class, and geographic-based inequalities that run through all aspects of our lives. While mosquitos don't adhere to zip codes or neighborhood boundaries, outbreaks of infectious diseases tend to disproportionately impact poor and vulnerable populations due to the social, economic, environmental, and medical determinants of health. Poor and working-class women are far more likely than middle-class or wealthy Brazilian women to live in communities whose water and sanitation infrastructure has been neglected by the government for decades creating conditions for mosquitos to easily breed, reside in homes without air-conditioning resulting in open windows and doors, and travel to work at dawn and return at dusk when mosquito activity is at its peak.
As public health officials in Brazil, El Salvador, and other countries tell women to delay pregnancy for up to two years, limited access to affordable contraception, particularly emergency contraception, and strict abortion laws present many women with little recourse. Unfortunately, this leads to an increase in clandestine abortions that pose major health risks to the mother. A Brazilian judge recently began to approve a series of case-by-case legal abortions when a fetus is diagnosed with microcephaly despite intense political and religious opposition.
As feminist Sonia Corrêa has noted, the political approach of governments telling women to avoid pregnancy assumes "women themselves responsible for having or not having babies with microcephaly." This places the onus of responsibility for the condition and its life-long consequences onto women and moves it away from the state, whose insufficient actions since the Zika outbreak, inadequate control of mosquitos during prior mosquito-borne outbreaks, and historical neglect of women's sexual and reproductive health are exacerbating the situation. Moreover, since the outbreak began, women whose infants have been born with microcephaly in Brazil have reported inadequate care and attention by the public health system, which seems unprepared to deal with the crisis. As one mother, Marilia Lima, explained in a story reported on NPR, "We are alone. We have been abandoned by the state."
The impact of the Zika virus' recent outbreak on mothers, fetuses, and newborns serves as a tragic reminder that maternal, prenatal, and infant health are neglected and underfunded on national and global scales. While the Zika virus necessitates immediate coordinated national and regional approaches to combat its spread, the virus is only one of the myriad ways in which lives begin unequally. It is imperative that those with time, resources, and influence pressure their local, state, and national governments, international institutions, and non-governmental organizations to invest money and other resources in research, public policies, medical treatment, and preventive care that prioritize the health and well-being of women, fetuses, and infants who are most at risk.