‘Hey everybody, don't get pregnant’: Zika, WHO and an ethical framework for advising

Abstract

WHO recently issued new guidance on the prevention of sexual transmission of Zika virus. The updated guidance states that '[c]ountry health programmes should ensure that… [i]n order to prevent adverse pregnancy and fetal outcomes, men and women of reproductive age, living in areas where local transmission of Zika virus is known to occur, be correctly informed and oriented to consider delaying pregnancy'. While the media has reported this advice as WHO telling couples in Zika-affected regions to avoid pregnancy, WHO states that they are not doing that. In an interview with the New York Times, a spokesperson from WHO stated, 'it's important to understand that this is not WHO saying, "Hey everybody, don't get pregnant." It's that they should be advised about this, so they themselves can make the final decision'. In this statement, the WHO's spokesperson distinguishes between actively directing individuals to delay pregnancy and advising them, which is portrayed as a merely informative act that facilitates but does not direct an individual's final decision. This paper proposes that advising should not be understood as a purely informational and non-directive act. The choices that agencies make in what advice to offer and to whom to offer the advice are ethical choices with practical implications. We will thus lay out a framework for considering the ethical issues that arise in the context of advising and demonstrate how it can be used to evaluate the WHO guidance.

Perceptions of Zika Virus Risk during 2016 Outbreak, Miami-Dade County, Florida, USA

“…To use the HBM, participants must have the ability to implement a desired behavior, self-efficacy (i.e., confidence in their ability to implement that action), and cues to action (which could lead to health behavior changes) ( 7 ). Because Zika virus infection mainly affects pregnant women ( 8 , 9 ), we report differences in perception and behavior by sex. Our target sample size was 421, with a power of 0.90 and margin of error of 0.4.…”

Research Ethics Committees (RECs) and epidemic response in low and middle income countries

“…The care and research gaps noticed during the Haiti Cholera outbreaks and the recent deadly Ebola crisis depict the fact that much has not been learned, nor proposed to improve community engagement in these settings. Byron and Howard have exemplified how the strength of appropriate communication techniques, when it comes to making pregnancy decisions in Zika virus, affected countries [17]. A research ethics committee is important to categorize the level of risk with regards to the characteristics of the women in question.…”

Rapid qualitative review of ethical issues surrounding healthcare for pregnant women or women of reproductive age in epidemic outbreaks

“…Moreover, a paper noted that recommendations on reproductive choices during an outbreak could be too directive and infringe upon individuals’ autonomy (in our review: [ 18 ]). Indeed, some have argued that the June 2016 recommendation of the WHO that individuals in affected areas “be correctly informed and oriented to consider delaying pregnancy” [ 28 ] is more than a merely descriptive and non-directional piece of information, but actually directs individuals to an ethically relevant extent [ 29 ]. This is not to say that the recommendation is indeed ethically problematic, only that its justifiability has been drawn into question and might require further ethical reflection.…”