Integrated reproductive health: the Zika virus

In February 2016, the World Health Organisation (WHO) announced a Public Health Emergency of International Concern following the identification of a cluster of cases of microcephaly reported in Brazil, which was suspected to be related to fetal exposure to the Zika virus (World Health Organization (WHO), 2016a). As concerns about the Zika virus and its potential consequences for pregnant women and their babies continued to grow, WHO produced brief, interim guidance for health-care providers on how to provide psychosocial support for pregnant women and for families with microcephaly and other neurological complications in the context of the Zika virus (World Health Organization (WHO), 2016b). A rapid-response, international research agenda was established focusing on understanding and managing the transmission of the virus and its physical symptoms. The psychological impact on women in this emergency has been relatively neglected. Yet both virus transmission and physical symptoms in women and their babies have significant implications for the psychological well-being of women who are pregnant or who are thinking about getting pregnant; thus, an integrated health approach would better serve the women and their families exposed to this virus.

An integrated health approach acknowledges parity of esteem between physical and mental health and, as there is a high level of comorbidity between physical and mental health conditions, there should be greater benefit from an integrated care approach. For example, randomised clinical trials of cancer patients who were provided with collaborative care, which integrated depression treatment with medical care, demonstrated that paying the same systematic attention to the management of comorbid major depression as is currently given to the associated medical condition achieves much better outcomes for patients in comparison to standard care (Sharpe et al., 2014). There is recognition that diagnosis with the Zika virus could exacerbate maternal and paternal stress, anxiety or depression and lead to an increase in unhealthy risk behaviours such as tobacco and alcohol use. These psychological symptoms, along with the social deprivation in which the Zika virus thrives, have the potential to add significantly to the short- and long-term health consequences for the women and their families who have experienced the Zika virus and in particular those families whose babies have neurologic complications.

The British Council Researcher Links Workshop on Social Technology Solutions for Postnatal Care in Brazil was held on 7–10 March 2016 in Federal University of Santa Catarina (http://repensul.ufsc.br/poster/). While the workshop had broader objectives about how to improve postnatal care in Brazil through social technology solutions, the timing was such that Zika was high on the discussion agenda. During the workshop, we met with women and their partners who had recently had babies, and also health professionals. Dr Alan Indio Serrano gave a presentation that reinforced the importance of specific public-health initiatives using the Zika virus as an example. The parents talked about their fear of the Zika virus throughout pregnancy and the need for good, clear communication on the Zika virus. We were struck by the importance of good health surveillance in a country as large and multi-cultured as Brazil and the need to merge data systems (i.e. primary and secondary care systems, health and social care systems) to help improve communication between health-care professionals looking after women. Most of all, we were aware of the support needs of parents and parents-to-be.

Anecdotal evidence in the media suggests that women in Brazil and their families are experiencing high levels of stress and much more needs to be done to support them. In January 2016, reports of the need for support were highlighted in the media (www.independent.co.uk/news/world/americas/zika-virus-mothers-tell-their-stories-the-legacy-will-shame-brazil-for-years-to-come-a6842441.html). The example given in this article was of a support group, Maes de Anjos Unidas (United Mothers of Angels), which was established to give mothers of children with microcephaly a voice. The support group highlighted numerous problems around diagnosis of Zika, diagnosis of microcephaly, understanding the severity of microcephaly and what can be done to help not only babies but the wider family in living with Zika and microcephaly. There was urgent demand for developmental support for their children and psychological help for their families.

Much has happened in the intervening months and the virus has received much media attention because of the Olympic Games. The Rio Olympics are now over and the worldwide attention on the Zika virus may die down (Bogoch et al., 2016); however, the virus may continue to spread. In the USA, where cases have already been reported, guidelines on ‘stress management for pregnant women during the Zika virus outbreak’ have been released (www.phe.gov/Preparedness/planning/abc/Pages/zika-stress.aspx). What will happen next with the Zika virus is unclear, but a lot of damage has already been done to the health and well-being of women and their families in Brazil (Brasil et al., 2016; Schuler-Faccini et al., 2016). We urgently need integration of more psychological health awareness, information and interventions into public health programmes on the Zika virus. We need research into the most effective way to achieve large-scale communication and support for women and their families. A number of information-based Zika virus Apps already exist, including one from the WHO; however, rigorous research exploring the integrated health needs of those women who could and have been affected by Zika would greatly inform the development of future information and support interventions.

Fiona Alderdice
Chair in Perinatal Health and Well-being, School of Nursing and Midwifery,
Queens University Belfast, UK
[email protected]
Maria de Lourdes de Souza
Chair in Woman Health and Public Health, President of Repensul Institute,
Federal University of Santa Catarina, Brazil
[email protected]
On behalf of the Brazil–UK Research Network on Social Technology Solutions to Postnatal Care in Brazil.