A few weeks ago, the World Health Organization declared that the recent cluster of microcephaly cases and other neurological disorders reported in regions where the Zika virus is emerging constitutes a “Public Health Emergency of International Concern”.
It soon became clear this growing health crisis would highlight the anthropological fundamentals of health, in particular issues of sexual and reproductive health and rights, and of gender inequalities in the field of health.
The Societal Challenges beyond a Global Health Crisis
According to WHO Director-General, “the increased incidence of microcephaly is particularly alarming, as it places a heart-breaking burden on families and communities”. While having previously noted the consequences of the Zika infection in terms of public health, Dr Chan’s statement stresses the societal impacts of the disease. Indeed, the increase of microcephaly cases urges to review the disease consequences in terms of behaviour and social norms and not only in terms of research for a vaccine and a treatment, and improvement of health-care systems to better inform and provide products and services.
Anthropologist Françoise Héritier described the structurally unequal places and roles devoted to males and females in the value systems/scales around the world, and demonstrated that all societies have, historically and universally organized, justified and codified norms and practices around the control of women’s bodies, in the very questioning issue of reproduction. And, by raising the issue of the burden of microcephaly on families and communities, Dr Chan has brought to the fore the issue of the infected women’s capacity to terminate their pregnancies and the cultural injunctions that influence their use of contraception. The overall issue is, by no doubt, that of their freedom of reproductive choices. Not surprisingly, religious activists have seized the moment to mobilize against these reproductive rights.
The right to access contraception and abortion is about freedom of women to make decisions about their bodies
Dramatic increases in Zika infections have occurred in more than 22 countries, in particular in Latin America, a continent where the weight and influence of religious values both from the Catholic church (40% of the Catholics in the world live in Latin America) and from various expanding Evangelical Churches, sometimes even more radical in their teachings, strongly determines collective behaviours and individual gender expectations.
The official doctrines of these institutions/organisations widely and explicitly prohibit or limit the rights to contraception and abortion and are inscribed in domestic repressive legal systems.
Even when access to family planning services is a recognized constitutional right, as in Brazil, it remains largely ignored because of poverty and lack of education/information. As for the right to abortion, it too remains extremely limited: abortion is possible only in case of complications that endanger the mother’s life, rape, and foetal anencephaly.
In practice, a recent study has shown that one woman out of five in Brazil, under the age of 40 had recourse to illegal abortion at least once in their life. Such abortions carried out in non sanitary, and therefore, dangerous conditions, have led to increasing maternal mortality and morbidity rates. Only women in higher social classes can afford the cost (both psychologically and financially) of safe abortions. An overwhelming majority of women and adolescent girls, mostly coloured and poor, living in less developed areas, and subject to recurrent gender based violence, had access only to unsafe abortions that were also deemed illegal.
In such conditions of poverty, chronic sexual violence, denial of access to health-care and facilities in reproductive matters and their overall criminalization, the institutional and official recommendation given to women “ to avoid or delay pregnancy ” appears to be ignoring the reality that (poor and uneducated) women and girls are not in the capacity and legitimacy to decide if, when and under which circumstances, they do not wish to become pregnant.
Human rights at the heart of Global Health Challenges
Zika thus reveals starkly both social and gender inequalities, reinforced by climate change inequalities amplified by environmental degradations on the pathogen vector.
The disease (and its gendered specificities) is an appropriate moment to point out that a global response to this public health challenge must make human rights effective by integrating sexual and reproductive health products and services, comprehensive sexuality education, maternal health, safe abortion into national legal frameworks.
Serge Rabier, PhD
Centre Virchow-Villermé on Public Health, Paris-Berlin
1, Parvis Notre-Dame F-75004 Paris
I am a Research Fellow at Centre Virchow-Villermé, I declare that I have no competing interest
 F. Héritier. Masculin/Féminin I (1996) , II (2002).. Odile Jacob, Paris
 In Paragraph 7.3 International Conference on Population and Development Program of Action (1994)
 Itineraries and methods of illegal abortion in five Brazilian state capitals. Debora Diniz & Marcelo Medeiros. (2010). Programa de Pós-Graduação em Política Social, Departamento de Sociologia, Universidade de Brasília. firstname.lastname@example.org
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