The Zika virus and sexual and reproductive health in Malaysia — John Teo

SEPT 1 — As the first case of Zika virus infection is reported in Malaysia today, 1st September, 2016, here are the worrying facts awaiting us.

I am of course referring to the already known link that pregnant women infected with Zika virus may suffer the most serious sequelae of the infection resulting in mothers potentially delivering babies with the severe congenital abnormalities of microcephaly and related neurological disabilities.

Other complications such as miscarriages and stillbirths can also occur.

The fact that many individuals can be infected and remain asymptomatic or having only mild symptoms makes it difficult to detect and the risks of these pregnancy complications potentially significant with escalating numbers.

No vaccine is currently available to protect against the infection. 

The Zika virus is transmitted by Aedes mosquito bites and the main strategy is to prevent mosquito bites as well as eradication of mosquito breeding sites similar to dengue prevention. 

Unlike dengue, in addition, Zika virus have been shown to be transmitted sexually and the use of barrier protection is recommended.

The statistics on unintended pregnancies and use of contraception in Malaysia are clearly depressing. 

It has been estimated that 40 per cent of pregnancies were unintended.

The Malaysian contraceptive prevalence rate since 1988 till to date has never shown any improvement, hovering between 50 to 55 per cent. The use of highly effective modern contraception is only approximately 35 per cent with many sexually active women choosing not use any or low effectiveness contraceptive methods despite having no intention to be pregnant.

The unmet contraceptive needs of married Malaysian women have widened over the years, signifying that more women are not using contraception despite their intention was not to get pregnant. 

It was reported that the unmet needs was 16 per cent in 1988 and 24 per cent in 2004.

The unmet contraceptive needs for unmarried women would have been even more.

The data from Teenage pregnancy was indeed alarming with 19,000 births each year to teenage mothers between 2009 to 2011. Many of these pregnancies were unintended.

The high rate of unintended pregnancies with the low contraceptive use rate is a potential time bomb waiting to explode with the Zika virus outbreak resulting in many infected pregnant women and potentially many babies born with severe abnormalities.

In response to the outbreak and the potential link to severe complications in pregnancy, several governments in Zika-affected-countries, such as in Latin America, had advised women not to get pregnant in the next two years and others have advised pregnant women not to travel to countries with Zika outbreak.

The World Health Organisation has called for aggressive measures to reduce infection with Zika virus, particularly among pregnant women and women of child bearing age.

Poor women are particularly vulnerable with more likelihood of their surroundings having stagnant water, less ability to have personal protection against mosquito bites, less likely to access contraception, sexual & reproductive health services. 

Young women are also especially at risk of unintended pregnancies with lack of sexuality education and taboos that surround talking about their sexuality and exercising their sexual rights.

We need to actively engage in Zika prevention and control by creating awareness, providing facts and dispelling myths about the Zika virus.

We also need to provide public information and services in vector control measures as what had been instituted globally with renewed intensity.

Critically for women who do not intend to get pregnant and all others who are at risk of unintended pregnancies, we need to redouble and strengthen our contraceptive counselling, provide contraception including emergency and barrier contraception.

Contraceptive service delivery points nationwide needs to be strengthened, widened and enhanced.

Safe abortion and post abortion services need to be provided in cases where it's legally permissible to vulnerable women with unintended pregnancies and Zika virus infection.

For women who are infected and want to continue their pregnancies and for those families with babies born with microcephaly and other complications, enhanced care, counselling and support need to be provided.

The Zika virus outbreak globally calls into sharp focus the potential catastrophe that may befall our women and children in an unprecedented magnitude if we do not act now with the greatest of urgency and purpose in enhancing and redoubling our efforts in sexual and reproductive healthcare in this country. 

Decreasing incidences of unintended pregnancies and increasing contraceptive usage for women who do not intend to get pregnant will go a long way towards prevention of severe abnormalities in babies and decreasing the numbers of families affected.

This response must be part of our global response towards the Zika outbreak.

* Dr John Teo is a consultant obstetrician and gynaecologist in Kota Kinabalu, Sabah.

** This is the personal opinion of the writer and does not necessarily reflect the views of Malay Mail Online.