Zika Unintended pregnancies in Brazil A challenge for the recommendation to delay pregnancy due to Zika

Because of the potential link between the ongoing Zika virus outbreak and a surge in the number of cases of congenital microcephaly, officials in Latin America have recommended that women postpone pregnancy until this association is firmly established or the outbreak subsides. However, in all these countries a large proportion of babies are still born out of unplanned pregnancies. Teenage girls are particularly at high risk, as they often lack access to preventive contraception methods, or the knowledge to use them appropriately. To gauge the magnitude of the barriers preventing the implementation of such a recommendation in Brazil, the country so far most affected by the Zika epidemic, we evaluated pregnancy rates in teenage girls, and their spatial heterogeneity in the country, in recent years (2012­2014). Nearly 20% of children born in Brazil today (~560,000 live births) are by teenage mothers. Birth incidence is far higher in the tropical and poorer northern states. However, in absolute terms most births occur in the populous southeastern states, matching to a large extent the geographic distribution of dengue (an indicator of suitable climatic and sociodemographic conditions for the circulation of Aedes mosquitoes). These findings indicate that recommendation to delay * 5/18/2017 Unintended Pregnancies in Brazil ­ A Challenge for the Recommendation to Delay Pregnancy Due to Zika https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866532/?report=printable 2/9 pregnancy will leave over half a million pregnant adolescents in Brazil vulnerable to infection every year if not accompanied by effective education and real access to prevention.


Unintended pregnancies in Brazil A challenge for the recom pregnancy due to Zika
The World Health Organization has recently declared the emerging Zika virus an i emergency .The virus, which reached Brazil to cause a major epidemic starting in spread to over 28 countries and may still reach many more considering the wides vector species (Aedes aegypti mosquitoes) and the high transmission rates observe involve the possibility of a second vector of Zika transmission, Aedes albopictus expanding its ecological niche globally .
However, the biggest concern about the Zika outbreak is the potential link with the microcephaly and other malformations of the central nervous system in newborns the virus during pregnancy .The proposed link between Zika infection and conge conclusive , but given the longterm consequences of this birth defect (which c developmental delays to severe, lifelong motor and cognitive impairment), a numb America have recommended that women avoid or defer pregnancy, giving time fo and therapies to develop .Among these were representatives of the Health Ministr Jamaica and El Salvador.In Brazil the recommendation to postpone pregnancy ha yet the director of the Surveillance Department at the Ministry of Health Cláudio that women from highrisk areas who can wait to conceive should do so .
The implementation of such a recommendation requires, however, that women in clearly informed about the risks posed by infection, but also have control over thei There are few reasons to doubt that most women will be aware and informed abou consequences through the widespread media.Yet ensuring control over the timing daunting challenge, especially considering that many babies are born out of unplan when strong motives for avoiding them exist (e.g.age, economic, social, professio In Brazil, the country most affected by the Zika outbreak so far, data from a demog indicate that approximately half of all births that happened five years prior to the su demographic group at particularly high risk is that of adolescents (defined as the pe old, following the World Health Organization definition ).Pregnancies in adolesce to be unplanned because this group often lacks access to contraception and family knowledge to use them appropriately.In such circumstances, the risk of conceiving anomalies might not affect the likelihood of a pregnancy.
To gauge the magnitude of the barriers preventing the postponement of parenthood pregnancy rates in adolescent groups, and their spatial heterogeneity in the country data are available (20122014).Data on live births were obtained from the Informa Births (SINASC ).Population estimates for each state and age group were obtaine Institute of Geography and Statistics and annual population data were calculated census data.Analyses were conducted using the freely available analytical softwar Although Brazil has experienced a substantial decline in fertility rate and a corresp reproduction towards older ages over the last decades, nearly 20% of children born teenage mothers, a proportion nearly twice as high as the world average (11%) in t year, over 560,000 children are born to adolescent mothers in Brazil (Fig. 1).
The states with the highest incidence of births from adolescents in Brazil are those (coinciding with a large part of the Amazon area) and Mato Grosso do Sul (Fig. 2 mothers aged 1014 years (Fig. 2a) and 1519 years (Fig. 2b).When birth incidence mothers (1019y) is plotted against latitude (Fig. 3), it is clear that it increases with far higher in the tropical northern states.In absolute terms, however, most births oc southeastern states, most notably São Paulo (Fig. 1).The distribution of dengue cas shown in Figure 1, as an indicator of those states with climatological and sociodem conditions for the circulation of Aedes mosquitoes.As shown in Fig. 1, the highest also occur in populous states in the southeast (predominantly São Paulo), matching spatial distribution of the absolute number of births from adolescent mothers.
The preexisting high incidence of what are most likely unplanned births by adoles areas emphasizes that the recommendation to delay pregnancy during the current c solution to protect babies from the putative effects of infection.Unless accompanie accessibility to contraception methods and a drastic change in health education, ac towards family planning, the recommendation to delay pregnancy will leave over h adolescents vulnerable every year until effective interventions (including vaccines) are not available .

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More complicated yet is the communication of risk at a time when microcephaly h to Zika infection.While we await the final verdict of the magnitude of risk and stre recommendations related to conception in the time of Zika should be approached w and real access to prevention.

Figures and Tables
Mean number of live births per year (20122014) from adolescent mot state (source: Datasus: SINASC) and number of dengue cases in 201 Brazlian Ministry of Health).