American Journal of Bioethics.

The Paradigm of the Paradox: Women, Pregnant Women, and the Unequal Burdens of the Zika Virus Pandemic

The inequalities of outcome are, by and large, biological reflections of social fault lines (Paul Farmer, 1999, 5)
Three paradoxes characterize the Zika virus pandemic and clinical and policy responses to it:
  1. Zika virus has been shown to cause severe developmental anomalies in the fetuses of infected women. As a result, both women and men in endemic areas are asked to avoid or delay pregnancy. However, access to effective contraception and safe pregnancy termination is either not available (especially for those living below the poverty line) or a crime for many women in Zika-endemic regions. The Brazilian government is confiscating international shipments of pills for medical abortion and is reportedly aiming to increase sentencing minimums for women who obtain abortions for fetal anomalies linked to Zika infection.

  2. Global approaches to pandemic planning and response, including those for the current Zika outbreak, are generally concerned with nominal fairness and the neutrality of procedural justice (i.e., response and allocation strategies equalize chances for those among the general population to receive benefits [or experience burdens]). Pandemic planners strive for systematic fairness by using (ostensibly) random processes (such as first-come, first-served or a lottery) to allocate resources for those who are similarly prioritized. However, pandemics disproportionately affect the disadvantaged, meaning that neutral approaches to global Zika virus pandemic planning and resource allocation will perpetuate and in fact increase existing gender, social, and health disparities.

  3. Historically, concerns for the “vulnerability” of pregnant women and fetuses have resulted in the systematic exclusion of pregnant women from research. In addition, political opposition to abortion has made it increasingly difficult to conduct research using fetal tissue. However, research on Zika virus in fetal tissue collected at the time of pregnancy termination or loss could potentially help many pregnant women and their fetuses. Reluctance to engage in such research potentially exposes all pregnant women and their fetuses to unquantifiable risk. […]

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Volume 16, Issue 5
May 2016