The objective of the proposed research is to provide one of the first in-depth analyses of how the Zika virus (ZIKV) epidemic has affected and potentially continues to affect reproductive processes in Brazil. These analyses will include investigations into how different types of physical and social exposure to the virus shape women's desires for pregnancy and contraception, contraceptive use and sexual frequency, prenatal healthcare use, abortion, and pregnancy and birth outcomes. Understanding women's reproductive responses to ZIKV exposure is key to developing a nuanced understanding of the effects of population health shocks on family health and health disparities more broadly, and is especially important to consider in a developing country context where vast inequalities in healthcare access, unintended pregnancy, and morbidity and mortality persist. Currently, little data or research is available on the secondary effects of the Zika epidemic on reproductive health in Brazil. To address this gap the proposed study will collect new panel data among a racially and socioeconomically diverse, population-representative sample of women of reproductive age from two Brazilian states. These data will be collected twice?once every two years?and will feature a wide range of measures of individual and municipal Zika exposure as well as measures of women's reproductive intentions, behaviors, and outcomes; and a range of potential mediators such as risk perceptions, knowledge about Zika, healthcare access, and psychosocial dimensions of fertility like contraceptive self-efficacy and gender ideology. Repeated measurement among the sample will allow us to observe dynamic changes in women's ideational and behavioral responses as medical science advances the prevention of Zika and/or Zika reemerges as an epidemic in Brazil. To better understand the effects of Zika exposure at the community and state level, we will merge our longitudinal survey data with municipal, state, and national administrative data and climate data. In addition to these analyses, we will also examine administrative data on live births to estimate fertility responses to the ZIKV epidemic.
The specific aims of this project will be to: (1) collect longitudinal data on physical and social ZIKV exposure, reproductive processes, and potential mediators; (2) estimate the extent to which sociodemographic, municipal, and state characteristics affect women's physical and social experiences of ZIKV exposure; and (3) investigate how and why reproductive intentions, behaviors, and outcomes vary with ZIKV exposure. Multilevel fixed and random effects regressions, regression discontinuities, and difference-in-difference models will be used to assess how different types and intensities of ZIKV exposure influence women's reproductive strategies and to investigate the mechanisms underlying reproductive responses to the epidemic.
The proposed study will collect new panel data to investigate the effects of different types of physical and social exposure to the Zika virus on women?s reproductive intentions, behaviors, and outcomes in Brazil. The findings promise to advance research and theory on population health shocks by examining whether and how women adopt reproductive strategies aimed at mitigating perceived threats to fetal wellbeing while also highlighting the consequences of the recent epidemic for disparities in reproductive health. Findings from the proposed study will further inform policies and outreach strategies intended to reduce unmet need for contraception and unintended fertility, especially amidst major reproductive health crises.