It takes two to make a thing go right, or wrong

women powerAt the same time we have Hillary, 4 female astronauts graduating from the NASA space program, Samantha Bee on late night tv,  and actual dialogue about gender gaps in salary and management,  it’s still been a rough start to 2016 for women.  

As you are all well-aware, Zika virus infections have swept through much of Central and South America.  Large outbreaks in Brazil have been linked to birth defects in babies born to mothers infected with Zika virus.

The most common defect is called microcephaly, which is when a baby is born with an unusually small head.  Babies with microcephaly may have a range of problems including developmental delays, intellectual deficiencies, and vision or hearing loss.

Microcephaly can occur because of genetic mutations, severe malnutrition or exposure to harmful substances such as alcohol during pregnancy (more on that below).  Microcephaly may also happen because of infections experienced by women during pregnancy.  Some of these infections include rubella, toxoplasmosis, cytomegalovirus, and the more recently-hypothesized Zika virus.

A study recently published in Science showed that viral infections in pregnant mice cause inflammatory reactions that may lead to autistic behaviors in the pups.  This study really highlights the urgency for more research to understand how infections during pregnancy impact fetal and child development.

But to be honest, it is not all that surprising that infections during pregnancy can impact a developing baby.  An immune response can be a vigorous body-wide reaction that causes fever, chills, and muscle aches, not to mention the potential of the pathogen to cross the placenta and cause direct damage to a growing fetus.

While it’s nearly impossible to avoid something you can’t see, there are many things that can be done to reduce the risks of infection during pregnancy.  First, ensuring that all family members (not just the pregnant moms) are updated on their vaccines will help protect the whole family, including the new baby.  Second, simply paying attention to what’s going on around you can be helpful.  For example, you can track flu infections here.  If there is transmission in your area, have your family avoid large crowds and visibly sick individuals.  Finally, and perhaps most importantly, understanding that the prevention of infectious diseases in pregnant women is not just about what a pregnant woman can do.

So that brings us back to Zika virus.  Zika is a mosquito-borne virus, meaning that it is not primarily transmitted person-to-person, but instead by person-to-mosquito-to-person.  Of course, avoiding mosquito-to-pregnant woman transmission is step number 1.  So there are things that pregnant women should do (or not do) to prevent Zika infection during pregnancy such as using insect repellent, covering body surfaces, staying indoors, and avoiding travel to Zika endemic areas.


However, these same steps should also be applied to the first person in the person-to-mosquito-to-person transmission cycle.  And that first person may be–wait for it–a man!

Think about it this way, a woman has planned a vacation with a group of friends to the Caribbean. Before the trip she gets pregnant and because of the Zika outbreak, she makes the tough, but rational decision to stay at home.  While on vacation, one of her friends gets bit by a mosquito, becomes infected with Zika virus, but doesn’t experience any symptoms (a reality for about 80% of Zika-infected people).  After the trip, all the friends get together to regale tales of their vacation, the friend with unknown Zika virus gets bit by a mosquito who then goes on to bite the pregnant woman.  Voila!

I’d be remiss if I didn’t mention that 3 cases of Zika virus infection transmitted via sexual intercourse have been reported.  It’s not clear to me how mosquitoes were excluded in these cases, but Zika virus has been isolated in semen.  Experts agree that this is likely a very rare occurrence, but if true, this provides even more rationale for including significant others in the vigilance against Zika.

Public health authorities in Ecuador, El Salvador, Jamaica, and Colombia have issued controversial statements urging women to delay pregnancy until Zika is under control.  There are a variety of issues with these recommendations (reported really well here and here).  One of the major issues is a lack of sufficient sex education and access to birth control in these areas, making these recommendations entirely unrealistic.

Just as ridiculous, however, is the erroneous notion that this is solely a women’s issue.  Last I checked, it took a man and a woman (or at the very least a sperm and an egg) to conceive.  In areas where more than half of all pregnancies are unplanned, implementation of sex education programs and access to birth control for both men and women should be a public health priority, and one that should reduce Zika-related pregnancy complications along the way.

Another case of derisively pinning family planning solely on women has happened right here in the U.S.  The Centers for Disease Control and Prevention (CDC) recently brought up the important issue of fetal alcohol syndrome–a spectrum of disorders caused by drinking alcohol during pregnancy.


Modified from
Modified from

Because it may be weeks for a woman to know she’s pregnant, even when planned, this is a very important issue.  When trying to conceive, if pregnancy is ever suspected, and definitely while pregnant, women should absolutely abstain from consuming alcohol.  However, this still leaves quite a grey area for women who accidentally conceive and may be consuming alcohol for weeks before they know they’re pregnant.

To combat this issue, the CDC released the patronizing infographic (modified above) urging all women who are not consistently and reliably using birth control to totally abstain from alcohol.  Setting aside the fact that this recommendation is at its core socially- and not medically-driven, again men are no where to be mentioned.

To be sure, fetal alcohol syndrome isn’t caused by paternal alcohol consumption.  However, if the CDC going to focus on the alcohol side of the equation, at least recommend everyone limit alcohol consumption–thereby reducing incidence of abuse, sexually transmitted infections (STIs), and improper use of birth control.  Condoms may certainly be considered heavy machinery in this regard.

Otherwise, we might be on a road to regulation like this:

Birth Control

Again, increasing sex education and access to birth control (yes, even through employer-provided health insurance) is a better way to combat fetal-alcohol-syndrome instead of shaming women who could hypothetically become pregnant and completely ignoring the fact that men are required for this transaction.

Women are certainly not Schrodinger’s boxes, walking around living their lives as if pregnant and not pregnant at the same time, so please don’t treat us as such.  This is as simple as changing the message from don’t drink to always practice safe sex.  And guess what?  A by-product of this message will also be reductions in STIs, abortions, teenage parenthood, as well as the goal of reducing fetal alcohol syndrome.

As Rob Base and DJ EZ Rock once told us, “it takes two to make a thing go right“, we should also remember that it takes two to make it go wrong.

One thought on “It takes two to make a thing go right, or wrong

  1. I’ve been following the Zika virus and it’s heartbreaking to see these sick babies. Your article was interesting and very well written! Love the birth control card!
    Love, Mom

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