Opinion: Without supplies, all the Zika headlines are but noise

The Zika virus has dominated the global conversation for several weeks. Coy messaging from the Vatican, rigid taboos around abortion and the devastation of microcephaly have all featured in the swirls and eddies of media discussion. Zika is the latest headline-grabber in a line of grim predecessors including HIV and Ebola. Spread by mosquitoes, it has been linked to severe birth defects in more than 4,000 babies in Brazil, is rapidly spreading in the Americas, and could infect up to four million people, health officials say.

Indeed, several governments, including those of Brazil, Colombia, Ecuador and El Salvador, are advising women to avoid getting pregnant. And as of last week, these governments have an unlikely ally: the Catholic Church. In the face of Zika, the Pope made a (somewhat grudging) admission that contraception was perhaps not as evil as it had been deemed to be for time immemorial.

So what now? Will the Pope’s decree make a significant impact on the region’s contraceptive uptake? Will government officials’ advice be heeded? In a word: No.

Those of us in the reproductive health community know that Latin America is notoriously underserved when it comes to contraceptives. According to the World Health Organization, 18 percent of births in Latin America are to teenage mothers, and Amnesty International estimates that up to 60 percent of pregnancies in the region are unplanned and unwanted. The international donor community has graduated most of the Latin American and Caribbean countries because they have been classified as “middle-income countries” and have achieved graduation criteria such as:

• Modern method contraceptive prevalence being greater than 55 percent of married women of reproductive age (MWRA);
• At least 80 percent of the population being able to access at least three FP methods within a reasonable distance;
• No more than 20 percent of family planning products, services, and programs offered in the public and private sectors are subsidized by external donors; and
• Major service providers (public sector, NGO, private commercial sector) meet and maintain standards of informed choice and quality of care. (Bertrand et al 2015).

Unfortunately, these figures are averages – averages which hide the huge disparities and inequities in the region. These same inequities make poor indigenous adolescent women more susceptible to unwanted pregnancies – and to Zika – because their access to supplies is severely limited by geography, culture, appropriate services, and gender-based violence.

The private sector could play a major role working with governments in helping reduce these inequities by implementing a total market approach, thus leaving government-subsidized services to focus on those populations living in the most vulnerable conditions. We are talking about a region where up to 23 million women would like to space or limit their pregnancies but are not using a contraceptive method.

The Latin America and Caribbean region also continues to have the highest rate of unsafe abortion in the world: 31 per 1000 live births. In most countries where the Zika epidemic is rampant, local abortion legislation is totally restricted, which increases the potential for unsafe clandestine abortions affecting the poorest of the poor. Even access to emergency contraception is limited by legal and administrative regulations in this region where 1.3 million sexually active adolescents live.

We at the Reproductive Health Supplies Coalition know that without supplies, all the speech-making, headlines and advocacy are but noise. The story only has a happy ending when the end-user holds in their hand the product of their choice, and this is contingent on healthy, sustainable supply chains being in place. And this holds true for all health products. In a blog post this week, JSI President Joel Lamstein writes, “the international commitment to universal health coverage by 2030 cannot be achieved if the medicines, vaccines, diagnostics, and other supplies required are not universally available.” 

He writes that today and tomorrow, African health and finance ministers convene at the African Union in Ethiopia to talk about immunization for the first time. Although supply chain is not on the official agenda, it's been fitted into the proceedings as a lunch-time discussion between select regional health ministers working to improve vaccine and medicine distribution.

In the tumultuous world of unmet need and its consequences, the Coalition continues to work to strengthen markets and supply chains, to push the lifesaving subject of supplies into agendas everywhere. These are urgent times, where the scourge of unmet need takes on an even more devastating implication than it usually carries. No supplies, no services.

John Skibiak, Director, Reproductive Health Supplies Coalition
Milka Dinev, Regional Facilitator, ForoLAC