Venezuela’s health systems are crumbling – and harming women in particular

By Pia Riggirozzi, Professor of Global Politics at the University of Southampton

Venezuela sits on the world’s biggest oil reserves, but in terms of GDP growth per capita, it’s now South America’s poorest economy. It is mired the worst economic crisis in its history, with an inflation rate in the region of 500%, a volatile exchange rate, and crippling debts that have increased fivefold since 2006.

The economic crisis is inflaming a longstanding “economic war” between the government and the business sector – and a dangerous cycle of protest and repression is further polarising Venezuela’s already divided society.

In this scenario, violence of all sorts is approaching what could be a point of no return. The very ability of democracy to combine forces of transformation and resistance is at stake.

The crisis in Venezuela has also taken centre stage in regional organisations. The Union of South American Nations and the Organisation of American States are gravely concerned with the weakness of Venezuela’s democratic institutions, its culture of impunity, and the criminalisation of dissent. But they’re overlooking one of the biggest tragedies of the crisis: the crumbling of Venezuela’s health and welfare systems, which not long ago were beacons of hope. This collapse is truly dangerous and is affecting Venezuela’s women particularly badly.

Venezuela’s promise

For more than a decade, Venezuela was a focal point in the continental promise of a more direct and inclusive alternative to dominant marketised approaches to development and democracy. At the end of the 1990s, governments across South America began embarking on various “post-neoliberal” experiments – and for more than a decade, those experiments seemed to work.

Between 2000 and 2014, the region nearly halved the proportion of its people who lived in poverty, and the bottom 40% of its the population saw their incomes rise dramatically. In Venezuela, social, political and economic reforms between 1998 and 2012 helped cut poverty by a spectacular 50%, and extreme poverty by 65%.

Venezuela also became a regional health and welfare pioneer, greatly expanding the number of primary care physicians in the public sector and offering millions of poor citizens better access to healthcare than ever. Under a flagship programme titled Oil for Doctors, Venezuela subsidised oil exports to Cuba in exchange for deployments of Cuban medics and medical training programmes. The Barrio Adentro programme was set up to provide free basic medical care; Mission Miracle provides free eye care to people across the region, and other Venezuelan initiatives tackle the needs of people with disabilities across Central and South America.

But these remarkable projects all depended on revenue from Venezuela’s oil bonanza and accumulated reserves. Once the country was hit by an international oil industry downturn, the result was a string of shortages, outbreaks and widespread social deprivation – and a spiralling socio-political crisis.

Today, thousands of patients cannot receive essential medical treatments – and thousands more are on the waiting list to undergo vital surgery because doctors do not have the necessary resources. Likewise, diseases such as malaria and diphtheria – previously eliminated or controlled – are now on the rise, with disastrous results.

These assorted crises have implications for all Venezuelans, but women in particular. Their rights and choices are affected in distinctive ways, especially when it comes to reproductive rights, sexual health, and gender-based violence.

Women’s rights and dignity

Even before the economic collapse, Venezuela had one of the highest teenage pregnancy rates in the world. To tackle the problem, the socialist government rolled out entitlements to contraception – but the Venezuelan Pharmaceutical Federation estimates that since 2005, the country’s stocks of contraceptives have fallen by 90%. This is fuelling a rise of sexually transmitted diseases, particularly HIV, and more and more women are seeking out illegal abortions and even sterilisations.

According to Amnesty International, between 2015 and 2016 maternal mortality increased by 65% in Venezuela – wiping out recent advances and returning to the situation that prevailed 25 years ago. Among the main causes are the lack of medicines and basic medical tools and equipment, and the ever-falling number of medical personnel, many of whom are either emigrating or simply unable to work without equipment or pay.

Women find themselves in desperate situations and who fear dying in childbirth are fleeing to give birth in neighbouring Brazil and Colombia. According to the United Nations High Commissioner for Refugees, the overall number of arrivals in neighbouring states steadily increased to 5,000 a day as of early 2018. More than 56,000 Venezuelans crossed the borders in January alone – 40% of them were women.

The ConversationSo far, Venezuela’s South American neighbours and the regional multinational organisations have responded to the crisis principally as an economic and fundamentally a constitutional problem, justifiably worried as they are by the Maduro’s rapidly expanding authoritarianism. They have focused on isolating his government, condemning Venezuela’s farcical elections, recalling their ambassadors and even moving to suspend the country from organisations such as the Organisation of American States. But this is a humanitarian disaster, not just a democratic one. It’s time for other countries to step up and address the crisis’s disastrous effects on women, their rights, and their dignity.

This article was originally published on The Conversation. Read the original article.

Europe’s Russia Dilemma Is Older and Deeper Than It Seems

Kamil Zwolski, University of Southampton

The conflict in Ukraine effectively began between 6.30pm and 8.30pm on November 28 2013. This is when Ukraine’s then president, Viktor Yanukovych, confirmed that he was not going to sign an association agreement with the EU – a deal that the Russian government held in contempt. The result is well-known: mass pro-European protests in Ukraine, the ousting of Yanukovych, the annexation of Crimea by Russia, and the protracted war in eastern Ukraine. But why did this happen, and why did it unfold in the way it did?

People have been asking these questions since the Ukrainian conflict began. When Yanukovych made his decision, Herman Van Rompuy, then president of the European Council, reportedly vented his frustration: “You are acting shortsightedly. Ukraine has been negotiating [the EU Association Agreement] for seven years because it thought that it was advantageous. Why should that no longer be the case?” Despite the years of political upheaval, revolution and war that followed Yanukovych’s decision, no single clear answer is forthcoming.

For anyone interested in the future of Europe’s relationship with Russia, grappling with the question of why Ukraine changed course is a crucial part of understanding not just the roots of the Ukrainian conflict, but the deeper geopolitical dynamics that have played out in Central and Eastern Europe for centuries.

As always, in 2013, Russia was worried about the future of its influence in its “near abroad” – the term used in Russian political language to denote former Soviet republics. Towards the end of the year, Russia went out of its way to discourage Yanukovych from signing the agreement with the EU, even resorting to threats; Vladimir Putin’s representative, Ukrainian-born Sergey Glazyev, explained to Yanukovych that “the association agreement is suicide for Ukraine”.

The EU, meanwhile, faced a fiendish dilemma. The situation was neatly summarised by Alexander Kliment of the Eurasia Group during a 2015 House of Lords hearing on the future of EU-Russia relations: the question was whether it was “more important for the European Union to expand its political and economic influence in the former Eastern bloc countries” or “to have a functional, stable and growing relationship with Russia”.

In other words, the EU had two options: to stay as unified and assertive as possible while pressuring Russia to stop its arguably expansionist behaviour, or to accept that Russia was just “different” and try to influence its foreign policy by forging links where possible. And despite the events that followed in Ukraine, the EU has yet to make a choice.

As I argue in my recent book, European Security in Integration Theory, this dilemma has deep roots; in fact, it dates back at least to the period after World War I.

Friends and foes

In 1918, the severely weakened European powers had to face a new, potentially mortal threat in the east: Soviet Russia. As they tried to figure out how to safeguard European security in this new environment, they had two options almost identical to the ones Europe has today.

One idea is associated with the approach called European federalism; the other idea is associated with the approach called international functionalism. The ideas behind these two approaches are quite simple: whether the best way to face down an external threat is to unite Europe as closely as possible in opposition, or to engage the threatening power (namely Russia) openly, through forging functional links where possible – on trade, say, or culture – in hopes of changing its behaviour.

One of the most famous advocates of European federalism was Richard von Coudenhove-Kalergi, a Japanese-born Austrian aristocrat and politician. Between the two world wars, he promoted a close integration of European countries, just as the staunchest advocates of the EU’s “ever closer union” do today. What’s interesting is how he justified it. Writing in 1926, he painted a dark picture of a Europe under threat:

The world hegemony of Europe is overthrown for all time. Once feared, Europe is now pitied. From its dominating position, it has been thrown back upon the defensive. Threatened in a military way by a Russian invasion; threatened economically by American competition.

Today, calls for further European integration are often justified not in hopeful terms, but by references to the threatening “external environment”.

The current president of the European Council, Donald Tusk, has warned that “the challenges currently facing the European Union are more dangerous than ever before in the time since the signature of the Treaty of Rome” – and pointed out that whereas European countries can’t on their own do much to counter Russia and China, a properly united EU is “a partner equal to the largest powers”.

But today as in decades past, there are many who take the opposite view. Back in the 1930s, one alternative was advanced by the Romanian-born British thinker David Mitrany.

Mitrany argued that international relations should not be organised around regional integration blocs, but based on the functional idea of “binding together those interests which are common, where they are common, and to the extent to which they are common”.

According to this mindset, Europe would be better off engaging Russia on matters such as counterterrorism co-operation, hoping that the cumulative effect would make Russia more accountable and peaceful. One modern organisation taking this approach is the EU’s CBRN Centres of Excellence, a worldwide network of local experts and collaborating partners concerned with addressing chemical, biological radiological and nuclear risks. Also choosing the co-operative style are the specialised agencies of the United Nations, such as the International Labour Organisation.

The ConversationFor all that the last 100 years have transformed the continent, Europe is still in the same Russian bind. Its thinkers and politicians have spent nearly a century debating Russia’s proper place and different ways of co-operating with it. If the 21st-century’s European players re-examined these old arguments over the limits of integration with their eastern neighbour, they would be better equipped to deal with the problems they face today.

Kamil Zwolski, Associate Professor in International Politics, University of Southampton

This article was originally published on The Conversation. Read the original article.

Latin American Studies Around the World: Southampton Hosted the 2018 SLAS Conference

Last week the University of Southampton hosted around 200 experts on Latin American Studies from all over the world who gathered at the 2018 Society of Latin American Studies’ Annual Conference to reflect on the history and current state of Latin American Studies in the UK and around the world.

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A team of ten students from Social Sciences and Humanities were part of the organising team, based at PAIR, and efficiently run this two-day event at the Winchester campus. For most of these students, it was their first experience on a professional academic event of this size and prestige. They enthusiastically combined work experience with attendance to panels and networking with the experts in their favourite topics.

Full information about the conference programme, keynote lecture, closing plenary and more pictures can be found at http://generic.wordpress.soton.ac.uk/slas2018/.

 

Argentina’s Foreign Policy: In the Path to Change?

By Dr. Ana Margheritis, Reader in International Relations at University of Southampton (Twitter, Academia.edu). You can find more posts by Ana here.


Next 1st December, Argentina is going to take over the presidency of the G-20. In late 2018, it will host the summit of the International Trade Organization. The Macri administration argues that this role is an ‘acknowledgment to the change’ the country is undergoing. How much changed has happened since Mauricio Macri took office in December 2015? The recent mid-term elections (on 22 October 2017) offer an opportunity to assess the records.

cumbre-del-g-20-2263999w620.jpgIn an effort to highlight contrasts with the predecessor and expand its base of support, change has been the key slogan of the coalition in government called, indeed, Cambiemos (let’s change). In foreign policy, two ideas summarised this proposal: ‘re-joining the international community’ (volver al mundo) and adopting pragmatism (des-ideologizar). In other words, Argentina now attempts to resume its historical goals, principles and roles, open and integrate itself to the world, and pursue what officials call an ‘intelligent’ and ‘mature’ positioning in world affairs. The underlying goal is to re-establish other countries’ confidence, presumably lost in the past decade due to a confrontational rhetoric and conflictive actions mostly inspired by economic and political nationalism.

Two years down the road, there are some signs of changes, although these are still a work in progress. First, efforts to mend relations with the US led to establishing a good rapport at the presidential level during the Obama administration. This continues under Trump’s term as trade negotiations progressed and changes in Argentina’s policy orientation and discourse are welcome in Washington.

Second, expanding and diversifying partnerships follows from an aggressive trade and investment strategy. These include reviving MERCOSUR (the regional trade bloc of which Argentina is founding member), pursuing trade agreements with the European Union, and joining as observer the Alliance of the Pacific in June last year (another regional organization formed by Mexico, Peru, Colombia and Chile). This last move is consistent with increasing economic links with China and Asia more broadly –where four of the ten main destinations of Argentina’s exports are (i.e., China, Vietnam, India and Indonesia, in that order). In other regions of the world, redefining relations has proved to be more controversial at the domestic level: the agreement with Iran (signed during the previous administration) has been declared non-constitutional. The President accepted this judicial decision and did not use his veto power in this case. Iranians have been linked to the 1990s terrorist attacks to Israeli institutions in Buenos Aires. Former president Cristina de Kirchner and other high officials were to be prosecuted when a federal judge died the day before presenting the evidence. Both legal cases are still open in the context of increasing efforts of the Judicial power to re-gain autonomy and enhance transparency.

Third, relations with regional partners deserved special attention in the last two years because of the ongoing crisis in Venezuela. In clear contrast with the Kirchners’ alliance with Chavez and Maduro, Macri forcefully requested the liberation of political prisoners, denounced violations to human rights, and was in favour of not allowing Venezuela to take over the pro-tempore presidency in July 2016. He was keen on ‘passing from rhetoric to action’ and even applying the Organization of American States’ Democratic Clause. This position finally prevailed within the bloc: on 5th August 2017 MERCOSUR finally applied the 1998 Ushuaia’s Protocol, suspending rights and obligations of Venezuela as member state for indefinite time (i.e., ‘until the democratic order is restored’).

Fourth, the bilateral relationship with the UK also shows some signs of change. Aware of the constrains posed by the long-standing dispute over the Malvinas/Falklands Islands, Argentina argued that this item should not be the focus of the relationship as it represents, at most, a figurative 20% of the links with the UK; instead, Macri’s government proposed to concentrate efforts on the remaining 80% which promises mutual benefits. This new approach led to a joint declaration in early 2016 and some progress afterwards. One of the goals in that document was achieved: clarifying the identity of Argentine soldiers who died during the war and were buried in the islands. The other two are still pending: resuming flights to/from the islands and ending sanctions to economic activities by islanders. Political, diplomatic and cultural relations improved and intensified in the last two years, in the spirit of ‘construction of empathy,’ as the British Ambassador to Buenos Aires called it, that is, setting a positive, mutually beneficial and long-term bilateral agenda.

These incipient changes are not exempt of pitfalls and criticisms. The 20/80 figure used to represent relations with the UK is questioned by the opposition, which also charges the government with a lukewarm approach in the defense of sovereign claims at international forums and an ambiguous approach to the case of Venezuela. Trade partnerships also represent a source of concern because of Argentina’s trade deficit and specialization in commodities. This is more of a continuity than a change between the current and the past administrations, and a pending issue in the governmental agenda. Another sign of continuity is to be found in the management of this area of public policy: as usual, presidential diplomacy is at the driver’s seat of most initiatives in foreign policy. Signs of dissent within the Cabinet (as the ones recorded between Macri and his former minister of Foreign Affairs over the issue of Venezuela) are seen as detrimental to the overall strategy. The replacement of Susana Malcorra by Jorge Faurie in that post (last June) was presented, in the official discourse, as a sign of ‘continuity and trust,’ presumably meaning that, from now on, no fundamental changes and disagreements in foreign policymaking are to be expected.

In sum, foreign policy might not have been a top consideration for voters in the recent mid-term elections, but it certainly contributed to construct a narrative about the identity of the coalition in power and to suggest a path to the future, a projection of national interests in a certain direction that seeks social support. Macri won the recent elections, defeating the dominant political force (Peronism, in its multiple forms). However, a narrative based on contrasts with the predecessor inevitable has limits in the long-run. Interest groups and society at large are eager to see, for instance, if Argentina has the capacity to resume steady economic growth, capture foreign investments, or play a leadership role at the regional level. In other words, the challenge is now to show if slogans translate into concrete changes at both the domestic and international level.

Podcast on the Politics of Indignity and Refugees with David Owen

Here is a podcast of Dr. David Owen speaking at Oxford University, for the Refugee Studies Centre’s 2017 Public Seminar Series. His talk is entitled, “Refugees and the Politics of Indignity.” The series was convened by Matthew J. Gibney.

 

Research Reflections from an Outsider, cum Insider, during Field work in Uganda

By Eunice Akullo (Phd Candidate, University of Southampton). 


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(Visual art image by Rolands Tibirusya)

This article presents a narrative of my July and September 2016 data collection experience for research exploring the integration of children born in captivity in three sub-regions of Uganda. Following the end of the research, I was puzzled about my identity/position as a young, female researcher and decided to reflect upon the process. The narrative below provides an account of the research experience and explains the complex nature of my identity as crosscutting between insider and outsider. It also explains how gatekeepers were vital in accessing some of the respondents and in providing guidance on how to conduct the research.

The quotation below, captured in my diary, represents my thoughts after one of the weeks of the fieldwork. My PhD research explores the integration of children born in captivity to females abducted by the Lord’s Resistance Army (LRA).

Community members received me with pre-conceived expectations. I remember one elderly male voluntarily offering me advice as I embarked on my field travels. He advised me to mind what I said, what I wore and how I behaved among the fieldwork communities to avoid being misunderstood. I enjoyed dressing up in long skirts and long dresses, and interacting with participants according to culturally expected norms. Having grown up this way, not much was surprising though. What concerned me was the feedback. Some respondents appeared surprised by my gestures. Others clutched on to their high cultural standards! The idea that a number of highly educated women around here despised folks in their community also took me by surprise!

Captured thoughts such as these following a week of research activity, reflect more than simply a memory of my fieldwork experience. They allow me as a researcher, in hindsight, to consider the power relationships and unforeseen moments during fieldwork. These form part of what reflexivity involves.

There are various scholarly definitions of reflexivity. Some of the appropriate ones in my research context include; Mullings (1999), for whom reflexivity applies to data collection processes and power relationships during research. Feminists focus on “power distribution between the researcher and participants” (Finlay: 2002b). These relationships may position the researcher as either ‘insider’ or ‘outsider’ (Mullings: 1999). An “outsider” denotes a person conducting fieldwork in a community they do not belong.

Furthermore, young female researchers may experience power relations working in both directions while doing research in an overtly patriarchal field context (Sultana; 2007:380). While institutional ethical clearances aim at minimising harm, the positionality of the researcher (gender, class and ethnicity) shapes the nature of investigation (Dwyer and Buckle: 2009).

I embarked on fieldwork after obtaining institutional ethics approval both at the University and in Uganda.  Semi-structured interviews, focus group discussions and notes in a reflexive diary were sources of data. Gatekeeper role in research of this nature was very vital in enabling data collection from some key informants and the focus group participants. I discuss how my positionality (gender and social status) did not neatly fit within the dichotomy between ‘insider’ and ’outsider’. I concur with Etherington (2004) that reflexivity helps to bridge the gap between institutional ethics approval and the actual fieldwork.

My positionality: Insider? Outsider? Both?

Questions like, ‘why are you interested in this study?’ ‘Is this a topic of your choice or the University’s?’ ‘How will the children benefit?’ came up during data collection.

I was neither a complete ‘insider’ nor ‘outsider’, and if the concepts of ‘insider’ and ‘outsider’ were located on a continuum, I occupied a middle ground. Dwyer and Buckle (2009:60) refer to the middle ground as the hyphen position, one characterised by “paradox, ambiguity and ambivalence, as well as conjunction and disjunction”. As a tribes mate in one of the research areas, some participants considered me an ‘insider’. I was an ‘insider’ prior to the fieldwork, given that I had lived and worked in Uganda, and had over time gained knowledge of the culture and context.

My need for gatekeepers (folks I had made contact with during my professional experience) for data collection however started to affect my perception of how much of an ‘insider’ I was. I was researching among communities where I had not lived while growing up. Sometimes, I felt like an ‘outsider’ among communities where I could not speak/ understand the native language. Given that I was a researcher from a university abroad, respondents asked what the interest of the University was in such a topic. Explaining that abduction in my village indirectly affected me was helpful, yet I still did not pass for a complete ‘insider’ because I never lived there during war. The explanations were however important for building trust.

The influence of my positionality as a researcher

As a female, I met social and moral discussions surrounding females in leadership roles, within politics and academia. Conflicting opinions regarding how some women in politics and academia defied culturally expected norms is prevalent in Ugandan society.

Some of my peers expressed similar sentiments, and wondered which side of the debate I would fall after the PhD. Unknown to me, these kinds of social discourse shaped the ‘silent expectations’ some respondents had from me as an unmarried female researcher from a university in a developed country. A fact I discovered later. It became common before, during or after some interview sessions, to receive advice on the expected role of a woman in marriage, despite her career achievements. During such moments, I would listen to the advice, and find ways of steering the discussion back to the research. The various encounters with advice of this nature, more than ever, shaped my awareness of the impact that the socio-cultural construction of marriage and expected gender norms have on inter-personal interactions like research.

My helpful gatekeepers

My Gatekeepers with whom I had been in touch for about 6-12 months prior to fieldwork, helped build trust among research participants, mobilised for focus group discussions, and offered guidance on security measures to consider while conducting research on sensitive topics among communities recovering from war trauma. They offered advice on the necessary precautions and actions in light of my personal security and that of my participants.

Gatekeepers were helpful in recruiting participants for ‘seeded focus group’ discussions- the ‘seeded focus group’ approach previously used in HIV/AIDS research (Busza et al., 2009)[1], allows for the inclusion of the perspectives of vulnerable people. While recruiting participants, I requested them to ensure a few people related to, or living in homesteads with children born in captivity, participated. I did not know who the seed was during focus group discussions. The intention was to allow them to participate freely.

Taking stock of my fieldwork experience, I agree that reflexivity helps to explore “ethically important moments” in fieldwork and responses to the same (Guillemin and Gillam: 2004). However, since qualitative research is a subjective process, I recognise that another researcher conducting the same research would have a different experience of the fieldwork. However, some issues raised herein, may be relevant to researchers who adopt a ‘seeded focus group’ approach for a research on children born in captivity without being a ‘complete insider’. In addition, researchers involved in any socially, ethnically and politically sensitive research could find these insights useful.

Zika and the political battle of rights

By Pia Riggirozzi, Associate Professor in Global Politics at the University of Southampton (@PRiggirozziAcademia.edu). You can find more posts by Pia here.


 

In recent years there has been growing global awareness of the interplay between rights and social development. In 1997, in an attempt to mainstream human rights as a central feature of all UN programmes, the UN Secretary-General Kofi Annan, called for a reorientation of the UN’s mission to reflect the realisation of human rights as the ultimate goal of the UN (UNDP 2005). Within this approach, the UNDP declared that human rights should not be regarded as the outcome of development but should rather be seen as the critical means to achieving it. With the signature of the Millennium Declaration and more recently the Sustainable Development Goals (SDG) there has been a renewed focus on the links between global poverty and human rights in development. As a consequence, protecting and promoting rights, and creating opportunities for individuals and groups to access, enjoy and reproduce those rights have increasingly been furthered in transnational campaigns promoting broader civil liberties, the ‘right to development’ (Grugel and Piper 2009) and ‘human right to health’ (Oslo Declaration).

However, as Easterly (2009) argues ‘which rights are realised is a political battle’ contingent on a political and economic reality often determined by what is considered (national and internationally) visible and urgent. The response to the outbreak of the Zika in South and Central America is manifestation of that battle.

Zika and systemic injustices

In February 2016, South America became, for the first time, the epicentre of a Public Health Emergency of International Importance when the World Health Organisation (WHO) declared that the Zika virus and its link to neurological disorders deserved global attention. After nine months Zika dropped from the international radar as the WHO declared it was no longer an international emergency. But the crisis is not over. The Zika outbreak that began in 2015 and has now spread across much of Central and South America has implications over the medium and long term on equity, health, education, gender and community relations. The challenges of managing the medium/long-term impact of outbreaks, as previously seen in the case of Ebola, are still poorly understood, and so are the prospects of safeguarding the right to health and the right to development in policies advanced by international and national health agencies addressing those amongst the most vulnerable.

The Zika virus, as with other insect-borne diseases such as Dengue and Chikungunya, is part and parcel of troubling inequities, amongst which health inequality is key, based on deprived living conditions. What raised international alarm in 2015 was the number of cases of microcephaly detected in countries affected by the Zika virus, particularly in Brazil. Microcephaly is a condition where babies are born with unusually small skulls. It is a developmental defect and is usually also associated with serious nervous system disorders – including deficiencies in mental functions and muscular weaknesses of varying degrees (WHO 2016). More than 1.5 million people in Brazil have been stricken with the mosquito-borne Zika virus, and since the outbreak began in 2015, the country has logged around 4,000 confirmed and suspected cases of microcephaly. This is alarming, particularly compared to 2014 when there were 147 cases.

Economically disadvantaged segments of the population are at higher risk of exposure to Zika, of being infected, and of their children of being born with microcephaly or other genetic conditions that require special care in the long term. The Zika crisis has also reinforced the socio-cultural expectations about the role of child-raising/caring that disproportionately fall on women, limiting even more opportunities to engage in education programmes or seek/obtain formal employment. Finally, promiscuity, lack of education and the simple fact that poor women might spend more time at home and thus are more exposed to dirty water, sewage, and mosquito breeding grounds than men, also means that women bear the burden of the prospect of infection. This drama typically unfolds in conditions where infrastructural deficiencies and lack of quality medical care and social services are the norm.

Consequently, poor women and their families are likely to be stigmatised as poor, as women, as sexually irresponsible, as families marked by disability. The Zika crisis is, in effect, a window that exposes systemic injustices related to poverty and marginalisation of poor women and children. It also a constitutive dimension of the ‘structural violence’ as global, regional and national responses to the Zika outbreak have disproportionately concentrated on prevention of infection and transmission which although necessary and urgent do not change the structural and related socio-cultural conditions that perpetuate injustice and inequality in these societies.

Which rights are right? 

The Zika crisis is not gender neutral and a focus on women is needed. Take Brazil, where there is a large proportion of single parent families, the majority of which are headed by women. These households are more likely to experience perpetual cycles of poverty as a result of the economic shock of disease. In addition, where children are born with potentially disabling impairments, they are often further isolated by limited support or social protection. The significant increase in the number of infants with microcephaly in the Northeast of Brazil which triggered of the WHO declaration of international emergency, highlights the centrality of the social determinants of health in the transmission chain, as well as issues such as the social division of care and debates on sexual and reproductive health.

During 2016, a roll out of official declarations put women at the centre: the High Commissioner for Human Rights and the WHO reinforced the importance of women’s human rights being central in the response to the Zika outbreak in many states (Gostin and Phelan 2016), while the US Center for Disease Control and Prevention advised pregnant women to refrain from travelling to countries affected by the Zika virus. Most dramatically, health officials in El Salvador urged women not to get pregnant until 2018; Colombia called on women to delay pregnancy for six to eight months.

This particular response focusing on behaviour is problematic for at least three reasons. First, implementing vector control programmes in the poorest areas is particularly challenged by more structural issues of lacking infrastructure, running water and access to healthcare. And even if such operations are conducted, mosquitoes have previously shown their capacity to quickly resurface whenever there is inadequate funding or surveillance. Second, shifting responsibility to women’s behaviour delinks the disease from its social determinants and their rights; not least because most pregnancies amongst poor and vulnerable women in the region are unplanned. As Davies and Bennett (2016: 1046) note, responses tend to focus on the ‘immediate’ health-care problem, while the status of gendered inequality that underpins the prevailing unhealthy conditions is considered ‘beyond’ the capacity of public health interventions. Add to this prevailing high rates of sexual violence, elusive contraception, teen pregnancies and the lack of sexual education prevalent in Zika-affected countries. According to a study published by the Guttmacher Institute in 2014, as many as 56 per cent of pregnancies in Latin American and the Caribbean are unintended, either because of lack of access to contraceptives or because of associated forms of gender violence.

Third, reducing the problem in this way to a few modifiable behaviours ignores factors of social determinants of health and poverty. Responses to communicable diseases such as Zika, and before Ebola, have so far tended to focus overwhelmingly on short-term-vector control and surveillance (Gostin and Hodge 2016; Davies and Bennet 2016). Such responses may be effective in terms of disease containment, effectively masking the precarious social conditions in which they live, in which many rights remain merely notional.

A final issue raised by the Zika crisis is that of reproductive rights. In a region where birth control is limited and sexual violence is widespread, the debate on legalising abortion has gained prominence. Last February, the Obama administration put under Congressional consideration $1.8 billion in emergency funding to help prepare for and respond to the threat posed by the Zika virus. But abortion politics sterilised these discussions as Republican lawmakers leading a congressional hearing on the Zika outbreak made funding conditional on anti-abortion policies in recipient countries. And while Pope Francis hinted at softening the rigid stance of the Catholic Church on contraception because of the threat posed by the Zika virus, it is the region’s restrictive abortion laws that remain a critical problem. In most Latin American countries affected by Zika, abortion is illegal or can only take place in exceptional situations. In El Salvador, for instance, where more than 7,000 cases of Zika were reported between December 2015 and January 2016, abortions are illegal under any circumstances and miscarriages could even lead to homicide convictions if proven to be self-induced.

Advocacy groups in Brazil are increasingly presenting legal cases to the Supreme Court to legalise abortion and secure reproductive rights for women under the principles of the 1988 National Constitution that guarantees the right to health. But the challenges ahead are many, not least in what a human rights-based approach to health may mean in addressing the long-term consequences of Zika (and other such health crises).

To be clear, vector control actions are imperative, but policies and recommendations based on behaviour, control and prevention are not only not enough to address women’s marginalisation in society and the effect this has on their health, they may further exacerbate this problem in addressing the immediate health risk. More academic and policy debate is needed on the scale and nature of future needs (health, social, economic, educational, welfare) of vulnerable communities particularly women and children, and how to calculate them. Government awareness of this issue is still low in Central/South America and although regional, global and expert/practitioner networks might be able to provide support in the future (Riggirozzi 2015; Riggirozzi and Yeates 2015) both in defining the scale of need and in providing support to governments in developing policies to address them, their roles over the medium/long term require greater definition.

Governments in South and Central America are in urgent need of a multi-policy approach – and funding- if they are to put in place effective responses to mitigate long-term effects and not derail progress in terms of meeting the SDGs targets on gender, childhood, disability and inclusive growth. Vector control and compliance could be seen as first step. The right to health needs to be delivered with a view that development in general and the delivery of health in particular should be anchored in an understanding of the inequalities, discriminations and power relations that prevent many people having access to good healthcare systems, care provisions and education and a view that states have legal and ethical obligations under international law to ensure the best possible provision of services for all.

 

Pia is currently involved in a funded project on regional organisations and access to medicines in South America.