By Dr. Laura Lima and Lea Spörcke
[8 July 2016] -- ‘Zika is coming’, wrote pediatrician Peter Hotez in a New York Times op-ed on 8 April 2016. By the end of June, his opening sentence read more like a somber prediction than a warning: “If I were a pregnant woman living on the Gulf Coast or in Florida, in an impoverished neighborhood in a city, I would be nervous right now”.
Less than three months after the publication of Hotez’s op-ed, the states of New Jersey and Florida announced their first Zika-related microcephaly births, on the 1st and 28th of June, respectively.
The spread of Zika comes as no surprise to those following the coverage of the health crisis. Reports of an accelerated geographic expansion had been confirmed over the past few years, with accounts of the virus spreading the globe, including to over a dozen countries in the Americas.
Benefiting from climate change, especially warmer winters in the Northern Hemisphere, the Aedes mosquitoes that transmit the virus are now found in every continent except Antarctica. They are vectors for a plethora of diseases that are perversely known to be ‘diseases of the poor’ – Zika, dengue, yellow fever, chikungunya, and eastern equine encephalitis, among others.
They have adapted to live and breed around human dwellings, and their principal breeding grounds are untreated waters and sewages, uncollected waste and stored water within households – all of which are frequently found in slums. As a result, poor neighbourhoods overcrowded with shacks, surrounded by rubbish, and without access to running water are the main sites of outbreaks around the world.
And because female slum dwellers spend most of their day occupied with household work in the slum area, they are much more likely to contract the Zika virus.
Currently, there is no vaccine for Zika. Making the situation worse, financially-strapped national and local governments have prevention policies that are not responsive to slum dwellers’ lack of financial means or the gendered aspect of the virus. During the current outbreak, health authorities in some countries ordered the spraying of insecticides to annihilate the mosquitoes and their larva, but spraying has not been carried out in slums.
In places where governments could not remove breeding sites, the general instruction has been to wear insect repellent, light-coloured clothes that would cover most body parts, use air-conditioning, and sleep under mosquito nets. Families living in slums can rarely afford the financial cost of following this advice.
Even more concerning is the plea for women not to get pregnant and abstain from sexual intercourse over the next two years in Zika-affected countries. Avoiding a pregnancy is no easy task when most women lack access to health facilities, contraceptives and family planning methods. Gendered social status further leaves women and girls with less knowledge about contraception, less negotiating power on the use of contraception, and at risk of sexual violence.
Women should not bear the cost and weight of prevention for two reasons. First, it puts the burden of prevention on them when it should be shared. Second, it does so without empowering women to make their own choices in regards to family planning, the use of condoms, and their traditional roles as caretakers.
Effective long-term prevention must go beyond the confines of health policy and into the realm of gender-responsive urban planning.
To put it bluntly, climate change, rapid changes in land use, and the lack of long-term gender-responsive planning in public health have left the most vulnerable people on the planet most susceptible to epidemics like Zika.
In order to develop effective measures and incorporate them into city and local policies, it will be necessary to venture beyond the disciplinary confines that divide public health and urban planning. As a guiding principle, a gender-responsive approach that incorporates the needs of both men and women, as well as their priorities and roles, into all levels of urban planning is required to mitigate the risk of further Zika virus spread:
Adequate access to water and sanitation. Water collection and storage is regarded as women’s work, and its impact on the spread of diseases largely underestimated. Adequate access to potable water, water for washing and cleaning supersedes the need to store water in the property. Improved sanitation and covered sewages will further reduce breeding grounds. These measures reduce the likelihood of women being infected by improving the conditions for them to fulfill their traditional role as caretakers.
Waste disposal. Systematic disposal of waste will also contribute to the reduction of breeding sites. Gender-responsive approaches take into account women’s responsibility for cleaning and waste, and their disadvantage in the household’s decision-making structure when it comes to paying for waste disposal.
Education. Providing gender-equal access to education and including adequate information on health, rubbish disposal, water storage and sewage maintenance will be instrumental in diminishing the Aedes larvae.
Access to family planning. Since the question of family planning has gained momentum in the Zika crisis, women’s sexual and reproductive rights and health must be strengthened. This includes access family planning and contraception, as well as greater negotiating power for women in these areas.
Lesson learned from the Ebola crisis: Collaboration and coordination are key
In both long-term planning and ad-hoc action, a key issue is the collaboration, coordination and information sharing between national and local governments and community groups. Providing direct, accurate information and long-term urban planning is only successful in multi-level partnerships. This includes community and religious leaders who guide people’s behaviour, as well as the international community for emergency relief and setting the framework and resources for long-term, gender-responsive urban planning.
One important step the international community can take is to make a case for effective long-term planning in the New Urban Agenda. Overall, the link between gender-responsive urban planning, especially in slums, and global health is missing in the revised draft of the Agenda. Provisions on urban health and the link between education and urban development remain superficial, and the role of reproductive health has been completely excluded. Furthermore, how gender-responsive planning will be applied remains unclear.
Unless the international community acknowledges the connection between, health, urban planning and gender-responsiveness, women around the world will continue to be more susceptible to viruses such as Zika.
Dr. Laura Lima is an Urban Specialist at Cities Alliance, and Lea Spörcke holds the Carlo Schmid Fellowship at Cities Alliance. Both specialise in gender and urban development. The views in this article are their own and do not represent the views of Cities Alliance.
The Cities Alliance supported an Ebola advocacy campaign in Monrovia, Liberia that offers valuable lessons for Zika. Photo: Susanna Henderson/Cities Alliance
Mitigating Ebola in Liberia
A good practice is the Cities Alliance Waste Collection Project in Monrovia, Liberia funded by the Bill & Melinda Gates Foundation
It promoted an overall awareness towards the importance of hygiene, and the community structures established by the programme led to awareness raising, hygiene promotion and education during the Ebola crisis.
Throughout the project, women’s groups were included to guarantee that the needs, priorities and knowledge of both genders were addressed.
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