Zika in El Salvador

The world has woken up to the mosquito-borne Zika virus, and today the World Health Organization declared it a global health emergency.  El Salvador has already had 6310 suspected cases of the disease starting in 2015.

At the moment, there are no confirmed cases of Zika-related microcephaly in El Salvador, the birth defect producing abnormally small heads in babies, which has been tentativley linked to Zika in Brazil.   The advice of El Salvador’s health ministry that women postpone pregnancies until 2018 was widely reported.  

The advice on pregnancy, however, also highlights the question of how such advice could even be followed in El Salvador, where rape is common, teen pregnancy prevalent, and access to reproductive health services often limited.  As reported on the website of RH Reality Check:
The potential inability to plan for pregnancies—or prevent them—is exacerbated by El Salvador’s weak policies around sexual and reproductive health services. Both García and Salvadoran OB-GYN and specialist in women’s health, Dr. Aleida Marroquín, noted to RH Reality Check that comprehensive sexual education that includes contraception is not available in schools. 
Such barriers to access are not limited to education, however. Contraception is not legally restricted in the country. Even so, in a study-in-progress carried out by the feminist organization Organización de Mujeres Salvadoreñas por la Paz (Organization of Salvadoran Women for Peace, known as ORMUSA), which shared a preliminary draft with RHRC, early findings based on interviews indicate that although local health centers might prescribe contraceptives, centers can go for months at a time without actually having any in stock. Young women say they routinely encounter humiliating treatment or have their requests to purchase contraception denied at public clinics and private pharmacies.   
In addition, the study reports, although the country’s policies direct that there be specialized services and personnel trained to serve adolescents and young adults, in reality those services rarely exist. Gang violence and territoriality also impact clients’ ability to physically access clinics, and the reporting of rapes for fear of retribution.
Any discussion of reproductive health in El Salvador also requires mention of El Salvador’s absolute ban on abortion.   There are no exceptions, and the country will prosecute women who have abortions for murder. 

Pregnancies are going to happen in El Salvador in the coming months and years.   While we may see some reductions in birth rates among the small middle and upper classes, it seems unlikely in the many areas of the country where poverty is persistent.   From a Washington Post story titled The country with the world’s worst homicide rate now grapples with Zika:
In this web of slums, there are blocks where 8 in 10 houses are breeding sites for mosquitoes. The city is a patchwork of rival gang territories that are defended so fiercely that health authorities cannot enter some neighborhoods. In just the first three weeks of January, El Salvador recorded 2,474 new suspected Zika cases, nearly half of them here in the capital. Many infected pregnant women live in these densely packed southern neighborhoods. 
“It’s uncontrollable,” said Eli Leiva, 40, an elementary school teacher in San Jacinto who has several students with Zika. “It’s a problem that has gotten totally out of hand.” 
Doctors are worried that basic public-health messages are not reaching their audience. Many residents ignore the recommendation to destroy mosquito breeding grounds by disposing of standing water, even though El Salvador has suffered repeated outbreaks of dengue and chikungunya, fevers transmitted by the same type of mosquito that carries the Zika virus. Teen pregnancy is rampant, abortion is illegal and contraception is discouraged in the heavily Catholic country. Many women interviewed dismissed the advice not to become pregnant as unrealistic.
It is not a matter of lack of information being disseminated throughout the country.   The newspapers and airwaves are full of stories about the virus and public service announcements on avoiding mosquito bites.    But the country has been fighting dengue and chikunguya for years, two diseases carried by the same mosquito which carries Zika.  Unless that fight becomes more effective, we can expect to hear about Zika as a recurring public health problem in El Salvador.