On Tuesday, Kaiser Health News published a lengthy article about a potentially tragic piece of irony: that the U.S. states where the Zika virus will likely hit first, and hit hardest—Florida and Texas—are among the least prepared to minimize its impact. The virus, which generally produces symptoms comparable to a bad flu in adults, can cause severe birth defects or miscarriages if contracted by pregnant women. Texas and Florida, like many Southern states, have spent recent years systematically dismantling reproductive healthcare.
State governments will be the first line of defense against the Zika-infected mosquitoes that are expected to reach the U.S. this summer, especially since Congressional Republicans have so far refused to approve the funding that the Obama administration says it needs to mount an effective defense. Texas and Florida are so far emphasizing “mosquito surveillance and targeted spraying,” according to KHN, but public health experts say that simply won’t cut it:
[T]hose campaigns miss a key element, advocates say, given the heightened stakes for pregnant women. The states aren’t addressing the challenge low-income women face in getting birth control. And, for those who do get pregnant, there are still major barriers to accessing potentially helpful prenatal care.
“No amount of mosquito repellent is going to get us out of this,” said Christine Curry, an assistant professor of obstetrics and gynecology at the University of Miami Miller Medical School.
Officials preparing to combat Zika in Republican-held states such as Texas and Florida are trapped in an unfortunate double bind. On the one-hand, both states declined to participate in the Medicaid expansion under the Affordable Care Act, which means that many of their residents fall into a “coverage gap”: they’re too poor to buy insurance, even with subsidies, on the exchange, but not poor enough to qualify for Medicaid under their state’s highly limited eligibility requirements. For uninsured, low-income women, family planning clinics have long been the best places to seek out contraceptives, prenatal exams, and other forms of reproductive healthcare at manageable prices. But many of these facilities also provide abortions—or, as in the case of some Planned Parenthoods, are affiliated with others that do—and as state-level Republicans have accelerated their war on abortion, hundreds of clinics have been forced to scale back operations or close altogether.
A Supreme Court case has brought national attention to the situation in Texas, where a single omnibus law has reduced a landscape of more than 40 clinics to only 19, forcing many women to drive hundreds of miles for healthcare. Florida passed its own law this spring requiring that abortion providers have admitting privileges at local hospitals—a provision it borrowed straight from the Texas law, and which may have similarly ruinous consequences, unless the Supreme Court rules it an “undue burden” that states can longer impose on women. The Florida law also attempted to defund all clinics that perform abortions, though the federal government made it clear that, legally, the state could do no such thing.
Years of cuts to women’s healthcare may come back to haunt southern Republicans this mosquito season—especially since, as KHN points out, the poorest women are at the highest risk for contracting Zika. The women most likely to rely on clinics for their birth control and prenatal care “might live in housing that lacks air-conditioning, or that allows easy mosquito entry,” KHN reports. “Or they may not have the money for repellent or preventive clothing.” As states have shredded their safety nets for reproductive healthcare, many women have simply stopped seeing OB-GYNs. “It is a daily occurrence that someone who has lived in this state her entire pregnancy presents for delivery having not interfaced with the public health system,” Curry, the University of Miami professor, told KHN. If Zika reaches the U.S., prenatal visits will become “huge opportunities for preventive care” that many women will miss out on altogether.
Worrisome as it is that many women in Zika’s pathway rarely go to the doctor, public health officials are also worried about what will happen if they all try to seek medical attention at once. If “an avalanche of people” descends on affordable family planning facilities after the first few cases of Zika transmission, there’s no way the remaining, beleaguered clinics will be able to meet the demand, Linda Sutherland, executive director of Healthy Start Coalition of Orange County, a Florida maternal health nonprofit, warned KHN. Texas and Florida don’t seem to be doing much to prepare for that possibility. Instead, they’re warning residents to stock up on bug spray, hang some mosquito netting, and, if at all possible, avoid getting pregnant. Unfortunately, Republican lawmakers have made it ever harder for low-income women to follow that advice.