Jeni Stolow1, Carl Kendall2, Francisco Marto Leal Pinheiro3, Mariana Campos da Rocha Feitosa3, Kelly Alves de Almeida Furtado3, Adriano Ferreira Martins3, Mayara Paz Albino Dos Santos3, Ana Ecilda Lima Ellery4, Livia Dias3, Ivana Cristina de Holanda Barreto5, Lina Moses6, Arachu Castro7, Christopher Dunn8, Ligia Kerr3. 1. Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, USA. Electronic address: jeni.stolow@temple.edu. 2. Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Department of Community Health, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil. 3. Department of Community Health, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil. 4. Post-doctoral Fellow, Graduate Course in Collective Health, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil. 5. Oswaldo Cruz Foundation, Fortaleza, Ceará, Brazil. 6. Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. 7. Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. 8. Department of Spanish and Portuguese, Tulane University School of Liberal Arts, New Orleans, LA, USA.
Abstract
BACKGROUND: In 2016, a Public Health Emergency of International Concern (PHEIC) was declared in response to the rise of microcephaly cases among newborns in Northeastern Brazil. A common reactionary measure by public health authorities was to recommend women postpone pregnancy to avoid the possible perinatal transmission of Zika virus (ZIKV). METHODS: The purpose of this study was to assess how women in Fortaleza, Brazil conceptualize pregnancy; experience facilitators and barriers to pregnancy avoidance; perceive the authorities' recommendation to postpone pregnancy due to the ZIKV outbreak; and recall their experiences during the ZIKV epidemic. Qualitative methods, specifically a Rapid Anthropological Assessment (RAA), were utilized in this study. Data collection included semi-structured interviews, triangulated with observations and informal interviews with community members. RESULTS: The sample included 35 women (18-39 years old) who exclusively utilized the national public health care system. Findings indicated that all participants perceived the ZIKV pregnancy-postponement recommendation to be counter-cultural to Brazilian social norms. Overall women's self-perceived agency to prevent pregnancy was low due to social expectations and lack of trust for contraceptives. ZIKV prevention was not seen as a reason to utilize contraceptives. Interestingly, only women who self-perceived as more affluent were willing to attempt pregnancy prevention for educational, occupational, or financial opportunity. CONCLUSION: Pregnancy postponement as a response to a ZIKV epidemic ignores gaps in reproductive agency and defies social norms, making it unrealistic and counter-cultural. Future ZIKV health recommendations must be culturally aligned with the population, and address barriers and motivators for family planning.
BACKGROUND: In 2016, a Public Health Emergency of International Concern (PHEIC) was declared in response to the rise of microcephaly cases among newborns in Northeastern Brazil. A common reactionary measure by public health authorities was to recommend women postpone pregnancy to avoid the possible perinatal transmission of Zika virus (ZIKV). METHODS: The purpose of this study was to assess how women in Fortaleza, Brazil conceptualize pregnancy; experience facilitators and barriers to pregnancy avoidance; perceive the authorities' recommendation to postpone pregnancy due to the ZIKV outbreak; and recall their experiences during the ZIKV epidemic. Qualitative methods, specifically a Rapid Anthropological Assessment (RAA), were utilized in this study. Data collection included semi-structured interviews, triangulated with observations and informal interviews with community members. RESULTS: The sample included 35 women (18-39 years old) who exclusively utilized the national public health care system. Findings indicated that all participants perceived the ZIKV pregnancy-postponement recommendation to be counter-cultural to Brazilian social norms. Overall women's self-perceived agency to prevent pregnancy was low due to social expectations and lack of trust for contraceptives. ZIKV prevention was not seen as a reason to utilize contraceptives. Interestingly, only women who self-perceived as more affluent were willing to attempt pregnancy prevention for educational, occupational, or financial opportunity. CONCLUSION: Pregnancy postponement as a response to a ZIKV epidemic ignores gaps in reproductive agency and defies social norms, making it unrealistic and counter-cultural. Future ZIKV health recommendations must be culturally aligned with the population, and address barriers and motivators for family planning.
Authors: Kun Chu; Ronghui Zhu; Yi Zhang; Wenjuan Pang; Xu Feng; Xiang Wang; Cheng Wu; Ningxia Sun; Wen Li Journal: Front Public Health Date: 2022-06-21