How America Can Avoid a Zika Virus Crisis
Picture your next child or grandchild, or your neighbor’s child, with a head size “minus five to six standard deviations below the norm.” Cringing? According to experts, microcephaly may be just the “tip of the iceberg” when it comes to fetal defects caused by Zika infection during pregnancy. The more likely scenario is one in which invisible brain damage shows up over time. Fortunately, this version of every parent’s nightmare doesn’t have to become a reality. Most future birth defects caused by Zika virus can be prevented via a simple upgrade in reproductive health services using technologies currently available.
But first, the bad news.
Zika News Is Getting Worse, and It’s Not Just Microcephaly.
Mosquitos capable of carrying the Zika virus can be found as far north as Minnesota and Maine. As of April 30, 2016, more than 400 cases of Zika had been reported in the U.S., and mosquito transmission may reach 40 states, beginning this summer.
The more developmental specialists learn about Zika during pregnancy, the more grave public health concerns have become. In mid-April, after months of uncertainty, medical researchers announced that all reasonable doubt was gone: Zika causes birth defects. The virus attacks neural progenitor cells that produce neurons in the developing brain. It attacks many brain lobes including those that control thought, movement and vision, eating away parts of the brain that already are developed and preventing new structures from developing. It is not clear that any point in pregnancy is safe.
Experts in developmental pediatrics and neurology who study microcephaly say that the damage in Zika infants is particularly severe. Neurologist William Dobyns at the Seattle Children’s Center for Integrative Brain Research says it is the worst he’s seen in 30 years of practice. “In these kids with Zika you see really severe microcephaly. The heads are probably minus five to six standard deviations below the norm, and that’s really small. If the appearance of the head seems problematic, the brain is worse. ... The idea that these children are mildly handicapped is a fantasy.”
On top of that, microcephaly is likely just the most dramatic and visible form of brain damage from Zika. Pathogens that impair fetal development produce a range of defects that depend on the severity and timing of infection, and the extent of invisible brain and nervous system defects will become apparent only as babies from Zika-infected pregnancies grow up. Marco Safadi of the Santa Casa Medical School in Sao Paulo, Brazil, saw a baby who looked normal at birth but whose mother had Zika-type symptoms during the second trimester. Two months after birth, CT and MRI scans showed hardened areas of “calcification” in the baby’s brain. His developmental trajectory remains to be seen. In the words of Sonja Rasmussen from the U.S. Centers for Disease Control, “The microcephaly and other birth defects we have been seeing could be the tip of the iceberg.”
Timing Pregnancy Is Key to Avoiding Birth Defects
It appears that Zika, like some other pathogens, damages fetal development only when a mother has a new or "acute" infection during pregnancy. Unfortunately, the most critical period of brain damage is likely the first part of pregnancy, before most women know they are pregnant. Safeguarding against Zika after a positive pregnancy test is important, but may be too late.
With Zika and pregnancy, timing is everything. Although data are still coming in, once a person has contracted and recovered from Zika, pregnancy is thought to be safe and a second acute infection less likely. For a woman who wants a child, one of the most powerful ways to stack the odds in favor of healthy babies may be to delay or time pregnancy so as to minimize the risk of in utero exposure. A woman might choose to safeguard against pregnancy because of expected travel or because she knows that people around her are infected, or because mosquito season is coming. And of course, for a person who would rather not be pregnant or can't decide, Zika offers up a good reason to step up precautions.
Similarly, one of the most powerful ways a government can protect families and communities against a tidal wave of trauma and suffering is by quickly ramping up access to reproductive information and better birth control.
That means better than the Pill. Half of U.S. pregnancies are unplanned, and half of these occur when a couple is using some form of birth control. Relying on the Pill, 1 in 11 couples gets pregnant each year. With condoms, that’s almost 1 in 5. And, no matter what anyone tries to tell you, in the real world, pregnancy rates for withdrawal, barrier methods, or periodic abstinence are far, far worse. (Unprotected, about 85 percent of sexually active couples will experience a pregnancy within a year.)
By contrast three state-of-the-art “get it and forget it” contraceptives for women work 20 times better than the Pill. Each has a failure rate below 1 in 500, with a rapid return to normal rates of fertility when a woman feels ready. Each has a different appeal: The copper IUD is completely hormone-free, the hormonal IUD offers lighter and less frequent periods, and the implant is as easy as getting a shot. But among the 61 million American women of childbearing age, 90 percent are playing reproductive roulette (soon to be Zika roulette) by using a far less effective family planning method.
Delaware’s Simple Solution Could Radically Reduce Harms
Most American couples are not rolling the dice because they prefer to; when women are offered the full range of options with no barriers, the vast majority choose a top-tier get-it-and-forget-it contraceptive. The problem is that when it comes to family planning services, our medical system is out of date. Right now, scheduling, billing, counseling, clinician habits, and consumer misinformation all erect barriers against women getting truly excellent modern care, the kind that could protect American families from Zika trauma.
The good news is that this is easy to fix.
If we wanted to reduce the number of Zika-damaged children by as much as 75-90 percent, we know how to do it. All it would take is a simple upgrade of America’s health-care system so that state-of-the-art family planning (already free under Obama's Affordable Care Act) is available in every clinic that serves women of reproductive age. This kind of system upgrade is underway in Delaware right now thanks to the foresight of Governor Jack Markell, and thanks to research in parts of Colorado and Missouri, we know it’s a radical game-changer. Unexpected and unwanted pregnancy—the kind that would drive an epidemic of brain damage—plummets.
Religious Conservatives Have Committed to Obstruction
So, has the U.S. government stepped up a massive public health campaign aimed at educating the public and getting top-notch birth control to everyone who wants it? Nope. Instead, some conservative politicians have thrown their weight behind banning abortion of defective fetuses. In March, following North Dakota’s lead, Indiana’s Republican Governor Mike Pence signed such a bill, based on a model being promoted across the country.
The United States Centers for Disease Control has assembled hundreds of experts and created an emergency operations center to deal with the Zika pandemic in real time. Yet, ironically, the simple health-care upgrade that would allow American couples to time their pregnancies and prevent devastating birth defects is inching forward at a pace that will take years rather than months.
Nationally, Republicans in both the Senate and House have refused to fund a fight against Zika, perhaps hoping that pandemic anxiety will tilt elections in their favor as it did during the 2014 Ebola epidemic. But even when they do at last fund all or part of the administration’s emergency offensive, it’s not clear how much of the money will go to upgrading family planning services and education so that at-risk families can delay pregnancy.
In contrast to rhetoric about family values, religious and political conservatives continue to obstruct every aspect of reproductive services that might help prospective parents deal with Zika: sexual education, funding for public health campaigns, contraceptive access, and—of course—the abortion care that families rely on as their last defense against ill-timed and unhealthy pregnancy. As a consequence, even though Zika poses little risk except during pregnancy, the vast majority of $743 million requested by the CDC to fight Zika is slated for the much more costly—and perhaps quixotic—project of stopping mosquitos from getting infected and biting people.
Lest there be any doubt, resistance to better family planning—even in the midst of a preventable crisis—is driven almost wholly by archaic theologies. This spring, as Zika and heartbreak spread across Latin America and pictures of malformed babies began appearing in the news, devout Catholics cruelly condemned the souls of women who sought abortions or even contraception. “Contraceptives are not a solution. There is not a single change in the church’s position,” proclaimed Bishop Leonardo Ulrich Steiner, secretary-general in Brazil’s National Council of Bishops. Pope Francis informally offered some wiggle room to desperate families, but later pontificated against even sexual education:
Frequently, sex education deals primarily with “protection” through the practice of “safe sex.” Such expressions convey a negative attitude towards the natural procreative finality of sexuality, as if an eventual child were an enemy to be protected against. This way of thinking promotes narcissism and aggressivity.
Catholic priests, ignoring the lessons of “Spotlight,” and Protestant leaders, ignoring their own scandalous inability to keep their pants zipped or their hands off of children, loudly promote their own failed solution for singles in the age of Zika: chastity. Some exhort married couples to rely on prayer or “let go and let God,” or the rhythm method, which has a 1 in 4 chance of pregnancy and is impossible for women who lack the power to say no to sex.
All Families Are at Risk, but Lack of Care Hits the Poor Hardest
Most people, including lay Catholics, look to their own conscience in family planning decisions—especially now that resource scarcity and epidemics like Zika have put the cruelty of the Church’s anti-contraception stance on display. As one pained Catholic put it, “How can being responsible be a sin?”
But church leaders have enormous influence over people who lack the education or confidence to question religious authority. This means that Vatican opposition to family planning hits young, poor, and psychologically vulnerable women the hardest. It widens economic disparities and puts the burden of ill health on those least able to absorb it. All families are at risk, but as in Latin America, most Zika-damaged babies in the U.S. will be born to poor or working-class women under the age of 30—the prime demographic for unplanned pregnancy.
The good news is that the Zika pandemic will sweep over us. And mercifully, lasting symptoms will be rare save for children born from infected pregnancies. At some point in the future, once widespread immunity is established, acute Zika during pregnancy likely will be rare. But with globalization and climate change, other pandemics are sure to follow, crises when parents will want to delay pregnancies in order to give their kids the best starts in life. If ever there was a time to ensure that families have unobstructed access to the state-of-the-art family planning information and services, that time is now.