Ganguli Mitra, Agomoni

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     Edinburgh Research Explorer                                      Zika, Gandhi and the CDCCitation for published version:Ganguli Mitra, A, Zika, Gandhi and the CDC, 2016, Web publication/site.Link:Link to publication record in Edinburgh Research ExplorerDocument Version:Publisher's PDF, also known as Version of recordGeneral rightsCopyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s)and / or other copyright owners and it is a condition of accessing these publications that users recognise andabide by the legal requirements associated with these rights.Take down policyThe University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorercontent complies with UK legislation. If you believe that the public display of this file breaches copyright pleasecontact openaccess@ed.ac.uk providing details, and we will remove access to the work immediately andinvestigate your claim.Download date: 05. Apr. 2019BMJ Group blogsZika, Gandhi and the CDC11 Feb, 16 | by BMJGuest Post by Agomoni Ganguli MitraThree pieces of news over the last weeks particularly troubled me.  In the first, and perhapsmost radical of them all, Latin American governments began to urge women not to becomepregnant over the next couple of years, as a public health measure to restrict the number of children born with microcephaly,potentially caused by the Zika virus currently plaguing the region.  The second came from the Indian Minister of Women andChild Development, Maneka Gandhi, one of the highest ranking officials in the current Indian government.  For years, India hasstruggled with non-medical sex-selective abortion (and female infanticide) in such significant numbers, that the sex-ratio forinfants in certain regions has become heavily skewed.  Despite sex-determination being illegal since 1994, the practice hascontinued with the complicity of physicians and clinics, and in some cases without the consent of the pregnant womenthemselves.  At a conference in early February, Gandhi suggested that an alternative to the current, ineffective policy ofcriminalising those who provide ultrasounds and sex-selective abortions, would be to register and monitor every pregnantwoman in the country to ensure that female foetuses are brought to term and female infants are not killed shortly after birth.  Thelast and most recent piece is perhaps the least shocking of them all, if only because we almost take it for granted that women’shealth and lifestyles choices are seen to be closely related to their ability and inclination to produce babies.  The USgovernment’s Centre for Disease Control and Prevention (CDC), in a bulletin patronisingly subtitled Why Take the Chance?, hassuggested that women should think carefully before mixing sex and alcohol intake, if they are trying to get pregnant, or (and thisis what makes it particularly problematic) could unknowingly be pregnant.On the face of it, these are three very different sets of circumstances, geographical, political and social contexts, and in appliedethics, context is crucial to rigorous analysis.  And yet I am struck by how, ironically, these policies and policy proposal fail to becontextualised within broader considerations of reproductive rights and justice by policy makers.  Underlying all three events is ablatant naivety, if not wilful ignorance about the circumstances in which women make reproductive choices (when they makethem at all), and a nonchalant paternalism about controlling women’s rights and freedoms, as if it is evident that such “publichealth” measures can be suggested with full impunity, as long as they come under the cloak of protecting the health andwell-being of (potential) children.  Plus ça change…Never mind that the link between Zika and microcephaly hasn’t been conclusively established.  Never mind the mind-bogglinglogistical implications of registering and monitoring each and every pregnancy in a country of 1.3 billion people, where the Stateis currently unable to bring to justice those who are currently flouting the ban on sex-determination.  Never mind that theimplications of what the CDC recommends seems to be that women of reproductive age should consider either giving up alcoholaltogether (since according to the same bulletin, half of the pregnancies in the US are unplanned) or that all women ofreproductive age should consider serious measures not be become pregnant if they wish to drink – especially in a country whereaccess to affordable contraception and healthcare remains politically fraught.There seems to be, on the part of state officials, a staggering lack of recognition and humility with respect to the role publicpolicies currently play in impeding women’s reproductive freedoms and wellbeing.  The Latin American governments could havepossibly responded to the Zika emergency by taking a hard look at current regulations around access to contraception andabortion in this (predominantly Catholic) region, and by opening a dialogue with the Church in order to revisit political and socialnorms around access to contraception and abortion.  The CDC could have separated their concern about alcohol abuse inpregnancy as part of a wider debate on alcohol abuse by men and women and its potential dangers, including intimate partnerviolence, or as one commentator has suggested, contextualised it along with recommendations about men’s reproductivehealth.  The Indian government Ministry of Women and Child Development could have taken this opportunity to revisit corruptionin the judiciary and law enforcement, or its recent failure to bring those responsible to justice on the matter of sex-selection.None one of these proposals came with suggestions to ensure that women are not further criminalised for their reproductivechoices, measures to increase women’s reproductive freedoms and wellbeing in general, or steps towards conferring additionalresponsibility to actors who happen to be involved, and sometimes in more privileged positions with regards to these choices(religious leaders, partners, families, health care providers, law enforcement officials).  The UN has now asked the LatinAmerican governments to revisit their laws on contraception and abortion, Gandhi and her ministry were forced to do somepolitical backtracking in response to the outrage from activists, and the internet backlash to the CDC proposal has been swift(see this, this, and this, for example). However, it seems unlikely that in the wake of these events, there will be a wider debate56BMJ Blogs: Journal of Medical Ethics blog » Blog Archive » Zika, G... http://blogs.bmj.com/medical-ethics/2016/02/11/zika-gandhi-and-the-cdc/1 of 3 30/03/2016 10:02regarding reproductive health and freedom in any of these contexts.What should the response be from the bioethics community?  Firstly, a trend that I particularly welcome as an early careerresearcher in medical ethics and bioethics is the increased popularity and understanding of social justice issues in health andhealthcare debates, and a recognition that women and girls’ health, flourishing and wellbeing are heavily influenced by policiesin other areas.  But often, these approaches remain confined to those who are particularly concerned with social and healthjustice topics.  I would welcome further academic attention to cultures – professional, institutional, societal, economic – toensure that policy changes are eventually translated into practice and social norms.  Finally, for those of us who tend to be keptawake at night worrying about global justice concerns, the cases above further show that the global bioethics discourse does notnecessarily need a final answer to the statist-cosmopolitan divide before we can consider whether bioethics concerns are trulyglobal, nor does it require a breakdown of borders through trade, mass exodus, pandemics, and climate change in order to berelevant.  In bioethics, more than ever, the local, is also the global.By submitting your comment you agree to adhere to these terms and conditions0 Comments 1You can follow any responses to this entry through the RSS 2.0 feed.We recommendPowered by Zika virus: management of infection and riskShazaad S Y Ahmad et al., BMJ Support PalliatCare, 2016Primary Care Corner with Geoffrey Modest MD: ZikaGuidelines/Updates from CDCrsaitz, EBM blog, 2016Primary Care Corner with Geoffrey Modest MD: ZikaVirusrsaitz, EBM blog, 2016New Guidance From DoH On Abortion ProvisionJFPRHC blogControversial Views on “FGM”bearp, JME blog, 2016Zika: should I be worried about it?James McIntosh, Medical News TodayZika Virus: Treatment and PreventionLori Smith BSN MSN CRNP, Medical News TodayMosquitos and Zika: the insect behind the outbreakJames McIntosh, Medical News TodayWHO: Zika epidemic requires ‘research-guided’public health interventionsNeil Osterweil, Family Practice News, 2016Zika virus: CDC investigating more possible casesof sexual transmissionCatharine Paddock PhD, Medical News TodayBMJ Blogs: Journal of Medical Ethics blog » Blog Archive » Zika, G... http://blogs.bmj.com/medical-ethics/2016/02/11/zika-gandhi-and-the-cdc/2 of 3 30/03/2016 10:02

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Zika, Gandhi and the CDC

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