Here’s what we (probably) know: There’s a bad virus circulating around called Zika. If you’re not pregnant, it’s not actually that terrible. If you get it, you’ll be fine, although we should tell you that there’s a chance you may have the bad luck to get a tiny bit paralyzed. If you did get paralyzed, it would probably be reversible, so don’t worry too much about that.
However, if you are thinking of getting pregnant or have unfortunately already become pregnant, then Zika is very bad. You probably won’t get very sick yourself, at least not in any obvious way, so you shouldn’t panic about that. But also, just so you know, the virus might get into the fetus and, like a very tiny zombie, devour its developing brain and produce microcephaly—an abnormally small head—in the baby. You might not even know this is happening! So you should delay pregnancy. Or you can not. Other options include “panic.” Totally your call.
We hope that was clear.
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Zika is so new to much of the world and we have so little information about it that our advice is jumbled. Here’s what we don’t know about the Zika virus: pretty much everything. We don’t know how long the virus can really live in a human body or how long someone might be contagious. We don’t know what the rate of brain damage in pregnancies is, if someone does happen to get infected while pregnant. We don’t know if other pregnancies without obvious signs of microcephaly might have other levels of neurodevelopmental damage. We don’t know if we should be testing sexual partners; some regions are, some aren’t. We’re not completely sure if condoms can protect a woman from getting infected—based on what we know about other similar sexually transmitted diseases, it seems to be the case but there is no conclusive evidence. We don’t know if we’ll all be immune by next year, or ever, or, if we do become immune, how protective that may or may not be for our pregnancies. We don’t know what drugs, if any, will help. We don’t know how to make a vaccine. Yet.
Because of this, many of the Zika updates I get as an obstetric provider are comprised largely of sentences like this:
Because currently available data are limited, providing preconception counseling following possible Zika virus exposure is challenging.
And if the situation is confusing on a personal level, the level of difficulty only increases when Zika starts to intersect with large international events such as the Olympic Games. Some organizations are saying one thing; some are saying another, and the messages are constantly evolving. And if there’s anything I know about public health, it’s that discrepant and vague advice isn’t a terribly helpful way to go.
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Why is this so hard? Some of the confusing guidance being offered is a reflection of the sheer lack of information at hand. Even the fact that Zika causes microcephaly is something we have had to arrive at inductively; lab data is still not quite there. The world’s attention has been turning to Zika, and scientific resources mean that we know a little bit more every day; trying to keep the public updated has meant rolling that new knowledge into recommendations quickly. That iterative process and quick translation has meant a fair number of errors, corrections, and restatements
As a long-time provider of women’s health, I think that another important factor to acknowledge is the frank discomfort that results whenever public health interacts with pregnancy care. We see it in recommendations about alcohol use, about folate supplementation, and others. There’s the real desire of the medical world to acknowledge autonomy of women over their own bodies; science also does generally notice that most women age 15–45 are not, statistically speaking, pregnant most of the time. However, in direct conflict with those observations is the protectiveness we as a society feel—not inappropriately—toward the itty-bitty babies those 15–45-year-olds might be growing (even if they’re not, right this second). And from a public health perspective, pregnancy is a tremendous opportunity for high-yield interventions; appropriately timed action can save a lifetime of pain, suffering, and health dollars. Put all that together, and much of the time we end up with confused public health policy that infringes on women’s bodily independence but feels really tortured about it. It’s hard for everyone.
But let’s admit this: It’s harder for women. Public health officials, attempting to do their jobs and keep the population calm, can say things like, “Zika doesn’t cause symptoms in 80 percent of people who contract it.” For a woman who is pregnant, or wants to become so, this reassuring statement is anything but. It leads to thoughts of “What will happen if I get it but don’t know?”; “What will become of my life?”; and “What will become of my child?”—questions that current science doesn’t have great answers for. And not addressing the emotional aspect of this crisis increases the disconnect between the public health statements issued and the reality the rest of us live in.
This is what I see before us today: a dearth of information about the Zika virus in humans, interacting with the minefield that is our societal relationship with women’s reproductive lives. Which is it—should we consider delaying pregnancy, as the World Health Organization recommends? Should we leave that decision as a personal one best made by women and their partners, as the Centers for Disease Control suggests? Who is addressing the exhausting emotional reality of this crisis? You can almost see the organizations wrestling it out, autonomy vs. public good; women’s independence vs. babies. The discomfort radiates out from these statements like stress lines from a comic strip character’s forehead. And as usual, this creates a muddy environment for health policy creation; we’re in the weeds before we can even decide what’s important.
Here’s what I will tell you, from the luxury of working with one patient at a time. Zika is scary. So are other infections that affect babies in utero. (People don’t know about them, but they’re real, and relatively common.) You know what else is scary? Car accidents, and schizophrenia, and terrorism, and bullying. The fact that my kid may grow up to be unkind, or unloved.
Let’s acknowledge that the decision to get pregnant and then raise a child is, frankly, terrifying. And regardless of what the actual risk ends up being, let’s acknowledge that it is reasonable to feel scared by this disease that is making headlines daily. But let’s also remind ourselves that most of the time, the system works. Most of the time, your body works to make another body; and most of the time, everything really does go just fine.
And let’s remind ourselves that we will continue to learn everything we can about the Zika virus. We should try to find a Zika vaccine, and I bet we will. And maybe, just maybe, we’ll start to be able to acknowledge the discomfort we have when talking about women’s health and the unaddressed emotional cost that this kind of crisis includes. And then, panic or not, we might actually be able to start to get somewhere where we can make a whole lot more issues surrounding women’s health finally clear.