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Zika and Health Literacy. Advice ignores context

Don’t get pregnant until 2018.
That is the current public health message from El Salvador’s health minister. Colombian women are warned to postpone pregnancy for 6 to 8 months. Jamaica just released similar advice. The intent is to prevent mother-to-baby transmission of Zika.

The mosquito-borne virus known since 1947 as a rare mild disease limited to central Africa, is spreading rapidly across dozens of countries in Latin America and the Caribbean. No one knows why. The World Health Organization (WHO) warns Zika is likely to reach every country in the Americas, except Canada and Chili. There is no treatment or vaccine, largely because only about 20 percent of infected adults have any symptoms. They might have a headache, body aches, a fever and red eyes for a few days.

Here is the public health concern: in Brazil, since an outbreak of Zika started there last May, more than 3800 babies have been born with microcephaly, 30 times the expected rate, according to WHO. Microcephaly is a rare birth defect characterized by a very small head and incomplete brain development leading to death or lifelong disability. There is little scientific evidence, but the apparent association between Zika and microcephaly warrants public health warnings, and delaying pregnancy seems wise. However…

The advice to women to avoid pregnancy ignores the context in which they are expected to comply. In El Salvador and Colombia there is little access to contraception, especially for poor rural women. Abortion is illegal in all cases in El Salvador, where the teen pregnancy rate is among the highest in Latin America accounting for a third of all births.  Abortion is illegal in 99% of cases in Colombia. In Jamaica, abortion is legal in some cases with the approval of the father and two medical specialists. There is little or no sex education in the schools. Sexual violence is prevalent. So women lack the knowledge, services and power to heed the advice.
 
Good risk communication?
Colombia’s health minister explained that his message to women is a good way to communicate risk. The minister seems to forget that women do not become pregnant by themselves. No similar messages have been directed to men. For sure, women who hear the warning will fear pregnancy and birth defects more than they already do, but left to protect themselves, this amounts to a “Just say No” campaign. It leaves women vulnerable to blame for unplanned pregnancy and birth defects in their babies, and to charges of non-compliance that could be misinterpreted as evidence of low health literacy.

Don’t get bit
A better message, free of gender bias, understandable and actionable, is to avoid mosquito bites. CDC has issued Level 2 travel advisories  (for all, not just pregnant women) for the Caribbean, South and Central America, Puerto Rico, Cape Verde, Samoa and Mexico.  Travelers are advised to “practice enhanced precautions”. In this case,

•       see your doctor before and after travel to areas where Zika is active
•       Use insect repellant (safe and effective for pregnant women)
•       Wear clothing to cover as much of your body as possible
•       Sleep under a mosquito net
•       Keep doors and windows closed or screened
•       Avoid standing water 
 
Important Notes:
The offending mosquitos bite in the morning, not just late afternoon and evening like other skeeters. 
 
The infection lasts only a week or less. The danger is only to a current pregnancy.  There is no danger to future pregnancies.
 
 
Resources:

US Centers for Disease Control and Prevention www.cdc.gov/zika. Information is being updated regularly
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