A report released this week by the Human Rights Watch documents the ongoing tragedy of Zika in Brazil. The Brazilian government has declared an end to the national public health emergency. Yet pregnant women are still becoming infected with the Zika virus, babies are coming into the world carrying the effects of Zika, and families will continue to care for their Zika-affected children for years to come. More broadly, the social, economic and environmental conditions that gave rise to and then exacerbated the Zika outbreak in Brazil have not changed. Sadly, many of these conditions are present in the United States as well. And while Zika has not wrecked havoc in the continental US (Puerto Rico has experienced significant Zika outbreaks), these same conditions are fertile ground for a multitude of public health disasters.

Environment and Infrastructure

I spoke with Margaret Wurth, a children’s rights researcher who spent a year interviewing nearly fifty women and girls who were pregnant or gave birth in two of the states most affected by Zika. She learned that Brazilian authorities warned women to spray their homes with insect repellant and to cover open water jars, “but there is only so much as individual can do.” In communities with erratic water supplies, people have no choice other than to fill tanks with drinking water. But these same tanks can quickly become breeding grounds for mosquitoes. The Human Rights Watch report also describes, “Untreated sewage flowing into open, uncovered channels, storm drains, roads, or waterways.”

Wurth recalls meeting a pregnant sixteen year old who did everything she could to protect herself and her fetus. She wore long sleeves, doused herself and her home with insect repellent and covered water jars in and near her house. She did not know, however, that Zika can be transmitted sexually. And she could not, of course, single-handedly clean up the standing water and sewage in her favela.

In the United States most communities have covered sewage disposal systems and household running water. Yet the American Society of Civil Engineers graded the country with a D+ in wastewater management in 2017. Their assessment is that more than $105 billion is needed for wastewater funding. With Congress stalled and no real plan for investing in infrastructure, this kind of funding seems unlikely. And while some states have reasonably good water and sewage systems, in other states – most notably Alaska and Mississippi – significant numbers of households lack both.

Reproductive Health and Rights

One in five of Brazilian mothers raising children with Zika syndrome are under the age of twenty. These young women were unlikely to have access to birth control. Given Brazil’s prohibition on abortion, women may turn to dangerous “backstreet” abortions. A young woman who especially touched Wurth’s heart underwent a clandestine abortion at the age of thirteen; she had become pregnant as a consequence of rape. Wurth met women who had used caustic acid to induce abortion. Facing the terror and the stigma of bearing a child with Zika-syndrome, these women risked their lives. Not all survived.
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In the United States access to contraception and abortion are increasingly under attack. The Republican health care bills would further reduce access to reproductive health care through defunding Planned Parenthood and removing birth control from the list of basic services insurance must cover.

In Brazil, government efforts to educate about Zika are disproportionately aimed at women, implicitly absolving men of the responsibility to prevent transmission or to help raise children living with Zika-syndrome. “Mothers are overwhelmingly the primary carers for kids with Zika syndrome. It’s very challenging. They can’t continue working or going to school. They often need to travel long distances and fight with agencies and officials to get the services they are entitled to,” according to Wurth.

In the United States family planning is similarly delegated to women, especially in communities that do not allow comprehensive sex education in schools. An abstinence-only curriculum does not prepare young men to be responsible sexual partners. And, like in Brazil, American mothers – especially low income mothers – face suspicion when they request government services. Republican demands that food stamp and Medicaid recipients work at paying jobs will hit hard at mothers of disabled children.

The Way Forward

There are measures that should be taken in the short and long terms to prevent future outbreaks of diseases like Zika, and to support those who are most affected. Developing and maintaining safe water distribution and sewage systems in all communities is crucial. Women and girls need access to the full range of medical services, including contraception and abortion. Men must be educated to shoulder their share of the responsibility for sexual safety, family planning and child rearing. And families and communities must be able to rely on ongoing support to care for ill and disabled individuals.

It’s unclear if the Brazilian government’s declaring the Zika crisis over was naively optimistic or blatantly political. In any case, it is eerily reminiscent of the declaration that “America has the best health care system in the world” when all data show health care in the US ranking last among developed nations. There are important lessons for the US both in the underlying causes of the Zika disaster in Brazil and in the Brazilian government’s response. We ignore them at our own peril.