For a woman who wants to safeguard against fetal brain damage from Zika, the surest protection may be a Zika infection that begins and ends prior to pregnancy—but questions remain about possible risks.
Months ago, CDC epidemiologists predicted that the Zika virus would land on American shores this summer; and right on schedule, the first mosquito-borne illness appeared in a Miami neighborhood at the end of July. Local health officials scrambled to isolate the neighborhood and kill mosquitos, and the CDC sent an emergency response team to Florida.
How to reduce infection risk
What should people in affected areas do to protect themselves against Zika?
The standard advice has three parts:
- Reduce mosquito populations. Get rid of standing water that serves as breeding grounds.
- Protect against bites. Put screens in windows, wear long sleeves, sleep with AC or a bed net, and use insect repellant. Delay travel to endemic areas.
- Avoid sexual transmission. Use condoms.
These measures will help to slow the spread of the disease, both from mosquito to person and person to person, while researchers work to formulate a vaccine. However, the attempt to prevent infections by eradicating mosquitos and reducing bites may be a fool’s errand—an impossibly expensive campaign that requires us to saturate our families with DEET and our environment with pesticides that are toxic to humans and other animals. Despite best efforts, experts expect the virus to spread across the southern half of the U.S. and as far north as Washington D.C.
The focus on reducing mosquitos and mosquito bites distracts from the much more urgent and achievable goal of preventing birth defects caused by Zika infection during pregnancy. What we know about fetal harm from Zika is so horrifying that it raises serious ethical questions about the failure of public health agencies to put contraceptive access and information at the top of the Zika emergency response.
Top priority: Prevent damage to fetal nervous system
Although the full long term effects of Zika virus won’t be fully understood for some time, it appears that with rare exceptions, Zika infection of children or adults causes either transient flu-like symptoms or none at all. In fact, four out of five adults who contract Zika have no symptoms. By contrast, Zika during pregnancy can attack the fetal nervous system, leading to lifelong deficits ranging from mild to lethal.
In the most extreme cases, the virus destroys budding brain structures or blocks them from developing, producing a baby with a small deformed cranium—microcephaly—and severe cognitive, motor, and sensory impairments. These can include blindness, deafness, and immobile joints. But for each case of microcephaly and obvious brain damage, pediatric neurologists fear that hundreds of infants who looked normal in utero will be born with invisible defects that appear over time as behavioral and learning deficits. Damage won’t be fully known until babies born following Zika infection develop through childhood.
CDC recommends delaying pregnancy
In the near term, the most reliable and cost effective way to prevent lifetimes of neurological damage is to empower couples so they can prevent unwanted pregnancy or delay wanted pregnancy until a time of high infection risk has passed.
As the Zika case count grows, the CDC is asking doctors to step up birth control conversations and services so that every couple who wants to prevent or delay pregnancy has the knowledge and the means to do so. In particular, they recommend better access to IUDs and contraceptive implants. This is because modern contraceptive devices are more than 20 times as effective as the Pill and almost 40 times as effective as condoms, with a rapid return to normal rates of fertility once they are removed.
Because misinformation is so widespread, experts want the public to know that each of the available contraceptive devices operates by preventing conception, not by causing abortion:
- A copper IUD functions as an internal spermicide, affecting how fast and far sperm can swim.
- A hormonal IUD prompts the opening to the cervix to seal itself off (as during pregnancy), operating as an internal barrier method.
- An implant prevents the maturation and release of eggs.
When birth control fails, abortion can provide the mercy of a fresh start. But in most cases the need for abortion can be prevented with better birth control and pregnancy timing.
Two to six months can make all the difference
With mosquito transmission just beginning in the U.S, public health experts are monitoring patterns of infection and working on a vaccination, so recommendations may change over time. Currently, the CDC recommends that both male and female travelers delay pregnancy for 8 weeks after a possible Zika exposure. If a person actually contracts Zika, different recommendations apply: women should wait 8 weeks after the first symptoms, but men should wait 6 months because Zika appears to linger in sperm. If a person living in a Zika area wants to get pregnant but hasn’t been sick, CDC’s advice is to talk with a medical provider who can help to assess risks and weigh options.
If this all sounds dire, here is some good news: Once a person has recovered from Zika, there is no reason to believe that future pregnancies will be affected. Also, Zika causes your body to produce antibodies that protect against future infections. So, for a woman living in an area where Zika is common, the most assured safeguard against contracting Zika during pregnancy may be contracting (and healing from) Zika before pregnancy.
“In Africa, where the virus has been circulating for an extended period of time, they haven’t seen these adverse outcomes in pregnancy,” says research scientist Matthew Aliota at the University of Wisconsin. “That seems to be because people are primarily exposed early in life, develop immunity, and then are protected later in life when they have children.”
In the absence of a vaccine, some women may even choose to expose themselves in the hope of developing immunity before seeking pregnancy. However, not enough is known yet about possible long term effects of Zika on adults to recommend this approach.
Over time, as the virus becomes established and “herd immunity” grows, the rate of new infections will drop off. Puerto Rico identified over 5000 cases of Zika between December and August, with almost a quarter of those in a single week of July as cases soared. As many as 20% of Puerto Ricans may ultimately contract the virus. But the epidemic is expected to peak this summer or fall, and next spring will bring better odds for a couple seeking a healthy child.
The other good news is this: Those state-of-the-art contraceptive devices are more than 99 percent effective, and under Obamacare they are free of charge. This means that in the continental U.S., even couples who are financially strapped can avoid fetal harm by timing pregnancy to stack the odds in favor of health.
Valerie Tarico is a psychologist and writer in Seattle, Washington. She is the author of Trusting Doubt: A Former Evangelical Looks at Old Beliefs in a New Light and Deas and Other Imaginings, and the founder of www.WisdomCommons.org. Her articles about religion, reproductive health, and the role of women in society have been featured at sites including AlterNet, Salon, the Huffington Post, Grist, and Jezebel. Subscribe at ValerieTarico.com.