The Zika virus has spread rapidly across central and South America and to some neighbouring countries, leading to the World Health Organization’s (WHO) declaration of an international public health emergency. The toxic combination of factors behind the epidemic is distinctly social: poor, cramped living conditions, insufficient sanitation and environmental problems. The virus’s possible effect on pregnant women has forced health organisations and the media to acknowledge the region’s desperate lack of reproductive rights. What is being largely ignored however is that social solutions are needed for social problems – socialist Cuba’s vital, organised response shows that another approach is necessary if the health of people is to be cared for. Rachel Francis reports.
An epidemic
The Zika virus, first identified in the 1940s in Africa, is spread primarily by the Aedes aegypti mosquito. Four out of five people with the virus will experience no symptoms and the remainder will experience flu-like symptoms. However, the current media storm follows both the rise in the spread of the virus and a possible link to the birth defect microcephaly. Babies who are affected are born with a smaller head than expected and usually abnormal brain development which can lead to chronic complications. There are also possible links with Guillan-Barré Syndrome (GBS), a rare but serious disorder of the nervous system.
Brazil first reported cases of Zika in May 2015, and estimated cases since then may total 1.5 million. 46 countries are reporting outbreaks. An increased number of microcephaly cases has been noted by Brazil, with the Health Minister reporting 4,690 suspected cases since October 2015. However, the link between the Zika virus and both microcephaly and GBS remains strongly suspected but not confirmed – the WHO is calling for further investigation, as well as for other potential causes of microcephaly to be investigated.
Poverty
The living conditions in north and north-east Brazil have made the spread of Zika all but inevitable. 71% of the north-east’s population, ten million people, do not have access to sewage systems. Women fare the worst through poverty – Brazilian journalist Nicole Froio argues that access to water governed by gender, with around 30% of women having no direct access to clean water. The rubbish that fills the streets offers endless spaces for pools of water to collect, the perfect breeding ground for mosquitos. Housing is cramped and overcrowded, making the spread of any illness rapid. There are fewer doctors than in richer regions; the country still has one of the highest rates of income inequality in the world. Here lies the crucial problem – mosquitos will continue to spread diseases when such conditions exist and when there is no co-ordinated social response. Debora Diniz, law professor and co-founder of advocacy organisation Anis: Institute of Bioethics, Human Rights and Gender, is clear: ‘the epidemic mirrors the social inequality of Brazilian society. It is concentrated among young, poor, black and brown women, a vast majority of them living in the country’s least-developed regions.’ Neighbouring countries, devastated by the legacies and actions of imperialist plunder and control, are plagued by similar poverty and lack of healthcare – and thriving mosquito populations.
Women and reproductive rights
There have been some practical responses to the epidemic, such as Brazil’s organised home fumigations and community initiatives such as ‘Sábados de Faxina’ (Cleaning-up Saturdays), to reduce possible mosquito breeding grounds. However, concern over the microcephaly cases has prompted the region’s main public health response, with advice aimed solely at women: do not get pregnant. The choice to not get pregnant is clearly not made by women alone. There is no ‘choice’ when contraception is rarely available. Abortion is almost completely illegal. El Salvador and Honduras, where abortion is illegal and women have been criminalised for miscarriages, have called on women to wait for two years before getting pregnant. Colombia, which has strict abortion laws limiting legal abortions to cases of severe fetal abnormality and where there are sparse resources to perform abortions in rural areas, is urging women to wait 6-8 months to become pregnant. The severe restrictions on abortions in Jamaica, Ecuador, Brazil, Bolivia, Guatemala and many others make terminations illegal in all but name.
Women have done and will continue to terminate their pregnancies; many will have no choice but to put themselves in dangerous and ‘criminal’ situations. 95% of abortions in Latin America take place in unsafe conditions, with women forced to visit backstreet providers, paying vast sums they cannot afford for procedures that could cost them their lives. It is the lead cause of maternal mortality in the region. The poorest women face the worst of all situations – as Diniz states ‘when we talk about abortion and reproductive rights in general […] we have a social class split in Brazil – wealthy women will access safe abortion, legal or illegal, and poor women will go to the illegal market or continue to be pregnant.’ The Pope’s hints about liberalising contraceptive use in the wake of the virus have been misrepresented; he argued we should not ‘confuse the evil of avoiding pregnancy by itself, with abortion’ and that abortion remains ‘a crime, an absolute evil’. Of course, this is not about morality – it is about the concrete lack of reproductive rights that come with the impossible combination of poverty, lack of health care and dangerous laws.
Women resist
Women were protesting in Brazil for reproductive rights long before the Zika virus, sparked again recently by politician Eduardo Cunha’s call for a law to further restrict the already limited availability of abortion. Women across the region have used the renewed focus on women’s health to start grassroots community groups to educate each other about reproductive health and sexual rights. WomenOnWeb, a Dutch organisation committed to women’s reproductive autonomy, have offered online consultations to women affected by the Zika virus, irrespective of ability to pay, and will post medications to induce abortion.
The coming Olympics, due to be held in Brazil in 2016, has been considered a chance to raise awareness of the situation for women in Brazil, although the concern of the mainstream international media has been focused on the safety and health concerns of athletes and distinguished guests. Slick government and Olympic committee adverts and lies also pose a problem – they have already covered up the recent evictions that have taken place to make way for stadiums, with residents attacked with batons, tear gas and rubber bullets. Protests that surrounded the 2014 World Cup in Brazil remain close in people’s memories; the causes – poverty, police brutality and racism – have only intensified since the stadiums emptied. The spread of the Zika virus adds another burden – and cause of anger.
Cuba – a beacon of hope
Mosquito-borne yellow fever, chikungunya, and dengue are already familiar to the poorest areas now being affected by the Zika virus. One country, however, stands alone in its ability to resist and withstand such epidemics – socialist Cuba. With the major structures – sanitation, waste disposal, recycling, housing – in place due to the planned economy focused on meeting people’s needs, the possibility of viruses spreading is considerably reduced. The community-led public health campaigns, which see people organised to sweep their neighbourhoods of sitting water thus reducing the possibilities for mosquitos to breed, is simple, free and remarkably effective – and an example of what is possible when people work together in this way. Homes are fumigated and doctors are plentiful, 6.7 for every 1,000 people. Brazil’s doctors number 1.9 per 1,000 people and are concentrated in wealthier urban areas. Britain has 2.8 doctors per 1,000 people. Cuba’s extensive health system enables close monitoring of potential symptoms. Take dengue as an example: Cuba had 1,641 cases in 2015, all of whom recovered. Nearby and similarly-sized Dominican Republic faced almost 17,000 cases, 103 of whom died. Dengue has a huge impact on rural Brazil, with 853 deaths in 2015 alone.
Despite Cuba’s successes, it is of course not impossible for Zika to spread to the island. Cuba has released a statement urging improvement in their prevention measures and the need for the conscious participation of all the population. In an ‘appeal to our people’, President Raul Castro Ruz was confident that ‘our people will be able to show their capacity for organisation, to maintain the levels of health reached by the Revolution, and thus avoid suffering for our families. More than ever before in similar efforts, it is imperative to be more disciplined and exacting.’ Cuba must continue to fight to defend and push forward its achievements in the context of the US blockade, which continues to deny essential medicines and equipment. Crucially, women in Cuba can make choices that are impossible across the rest of the region, with abortion legal and accessible and contraception provided by local doctors.
Cuba responded to a crisis in Brazil in 2014 which saw millions take to the streets to demand access to health care. As part of Cuba’s health missions – active, practical solidarity which sees 37,000 doctors and medical professionals working in 77 countries around the world – doctors travelled to Brazil and committed to working in the poorest, neglected regions. That they faced resistance, protests and racism from sections of doctors in Brazil who have only been prepared to work in wealthy, urban areas, shows the different approach that is necessary when caring for the health of all people.
The Zika virus shows how rapidly epidemics can spread where poverty, a lack of sanitation and cramped housing are widespread and where access to health care is limited. That poor and predominately non-white women are most affected, and are expected to face the burden of reproductive control alone, is no surprise. In the media outpouring of moral judgements and fearful questions, it is crucial to look to the example of Cuba, which shows that another way is necessary – and possible.
