The Centers for Disease Control and Prevention recently issued a travel warning for a neighborhood north of Miami, in which 39 cases of the Zika virus have been transmitted locally by mosquitoes. Now that Zika has reached the continental United States, efforts have intensified to fight the virus, which is also spread through sexual contact. However, one at-risk group is missing from the conversation: Millennials. Protecting the reproductive rights of Millennials must be central to an effective Zika response that safeguards young Americans and minimizes the possibility of an epidemic.
As of March 2016, nearly half of female U.S. residents carrying the Zika virus were in the Millennial age range. Moreover, young people could face a higher risk of sexually transmitted Zika, a trend that demands attention due to the fact that sexual transmission may contribute more to infection rates than health experts originally suspected. According to U.N. High Commissioner for Human Rights Zeid Ra’ad Al Hussein, an effective response to Zika “requires that governments ensure women, men and adolescents have access to comprehensive and affordable quality sexual and reproductive health services and information, without discrimination.”
Everyone has a right to the full range of reproductive health services, including counseling, contraception, abortion, and pre- and postnatal care, as well as the right to parent with dignity. However, reproductive rights in America are degraded by policies that limit the affordability and accessibility of reproductive health care, especially for young people. As a result, young people shoulder a disproportionate burden of adverse reproductive health outcomes, leaving Americans ages 15 to 24 with nearly half of all new sexually transmitted infections, or STIs, and women ages 20 to 24 with the highest unintended pregnancy rate.
To fully protect young Americans from the effects of Zika, policymakers must expand reproductive rights for young people by addressing the six C’s: comprehensive sex education, confidentiality, contraceptive counseling, choice, community support for young parents, and congressional action.
Comprehensive sex education
Young people must be aware of their risk of Zika infection and knowledgeable about their options to prevent it. Currently, abstinence-only frameworks for sex education leave more than 80 percent of adolescents ages 15 to 19 without formal instruction about STIs or STI prevention, including Zika. Abstinence-only sex education also leaves about 60 percent of young people without instruction on birth control methods. Alternatively, comprehensive sex education would give young people access to information about Zika as an STI, as well as information about abstinence, contraception, condoms, reproduction, relationships, gender identity, and sexual orientation. Young people need all of this information in order to make fully informed health decisions in their own lives.
Confidentiality
Zika is an STI that can affect pregnancy and create potentially sensitive health issues for Millennials who want to keep details about their sex lives and reproductive health private. Pregnant young people may delay or forgo care related to Zika—from initial testing to abortion care—if they feel that information will not be kept confidential. The vast majority of young women say that it is important to them that their use of health services remains confidential. Under the Affordable Care Act, young adults can stay insured as dependents until age 26, but billing processes can still disclose sensitive health information to guardians. Also, many states allow minors’ STI test results to be disclosed to guardians or mandate parental involvement when a minor seeks an abortion. Affording young people confidentiality and the right to consent to their own health care would give them access to much-needed health services that can protect them from Zika.
Contraceptive counseling
For sexually active Millennials and youth, contraception is one of the first lines of defense against Zika. In light of this, young people should have access to an array of contraceptive options and unbiased clinical counseling, with sensitivity to their medical needs and personal preferences. Currently, young people may not receive appropriate contraceptive counseling in the medical clinics that they access the most, including primary care, urgent care clinics, emergency rooms, and retail clinics. For example, less than half of obstetrician-gynecologists consider intrauterine devices, or IUDs, appropriate for adolescent women. However, IUDs are safe for all women and are an important long-acting contraceptive option where Zika may persist. Also, reproductive health policies and services often overlook the needs of young men, and few clinics provide young men with meaningful contraceptive counseling to prevent STIs or unplanned pregnancy. Providing complete information and empowering young people of all genders to make autonomous choices about their reproductive health are important for effective contraceptive use and for positive, trusted patient-provider relationships that are critical to Zika-related care.
Choice
As they weigh the effects of Zika and pregnancy on their lives, young women have a constitutional right to safe and legal abortion. Millennials support the legality of abortion and comprise the majority of those who seek abortion care, yet they are disproportionately affected by restrictive abortion legislation. Young women are less likely to have the income or transportation necessary to obtain an abortion, especially in states that have a low number of providers due to targeted regulation of abortion providers, or TRAP, laws. Moreover, public funding restrictions such as the Hyde Amendment make abortion care unaffordable for many young people covered by Medicaid, especially young women of color. These restrictions will continue to heavily affect Millennials, particularly in Southern states that have some of the most stringent abortion restrictions and environmental conditions that foster the highest risk of Zika transmission. Instead of restricted access to health care, young women across the United States should have full access to resources that support their decision-making process, including social support, counseling, and safe, affordable abortion.
Community support for young parents
Young parents under the age of 18 who have or are preparing for a child with Zika-related health outcomes deserve economic security and dignity for themselves and their family. Instead, many face barriers to affordable child care or health insurance, and school and workplace policies that discriminate against pregnant women. Moreover, 20 states do not explicitly allow parents who are minors to consent to medical care for their children. Such challenges are highly stressful and cause real health consequences for both parents and children. All communities, particularly those affected by Zika, should have affordable housing, health care, and economic supports available for all Millennial parents. Communities should consider the needs of children from Zika-affected pregnancies in order to give all families the tools necessary to effectively respond to Zika and to prosper.
Congressional action
As the national response to Zika takes form, a window of opportunity is open to recognize the reproductive health needs of Millennial Americans and take steps to meet those needs. Congress must prioritize an emergency funding bill for Zika that allocates funds to family planning services. Additionally, several bills have already been introduced that address and support the needs of Millennials, including the Women’s Health Protection Act, Equal Access to Abortion Coverage in Health Insurance Act, and Strong Start for America’s Children Act. Continued movement on these bills is essential to building a more comprehensive and effective strategy to minimize the consequences of Zika among Millennials. Moreover, progressive policies that lift up Millennials will help to protect the reproductive health and rights of all Americans, even after the threat of Zika has subsided.
Kendra Smale is a former intern with the Women’s Health and Rights Program at the Center for American Progress.