Reproductive and Child Health Trajectories in Successive Novel Infectious Disease Crises

University Of Pennsylvania, Philadelphia PA

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Abstract

PROJECT SUMMARY/ ABSTRACT The objective of this proposed research is to provide one of the first in-depth, mixed-method analysis of women's reproductive trajectories in the context of successive novel infectious disease crises – Zika in 2015- 17 and Covid-19 since 2020 – in a country hard-hit by both these epidemics/pandemics. These analyses will center on how contextual and individual-level experiences with these shocks have influenced women's reproductive lives both in the short-term and long-term. Understanding women's reproductive responses to successive novel infectious disease crises is key to developing a nuanced understanding of how the impact of these shocks extend beyond mortality to fertility and reproductive wellbeing. With scientists predicting an “era of pandemics” characterized by increased risk of novel infectious disease crises, it is pertinent to consider how the successive nature of such population health shocks have lasting, interconnected implications for the course of women's reproductive lives. This is especially important in the context of a developing country where vast inequalities in economic security, healthcare access, unintended pregnancy, and morbidity and mortality persist. Currently, little population-based data or research is available on how women's reproductive trajectories have evolved through different stages of the Covid-19 pandemic anywhere, and in the wake of the Zika epidemic. To address this, the proposed study will expand upon an existing three-year longitudinal study (DZC-1), the first-ever panel study on women's reproductive lives in Brazil of any kind, for an additional three years to generate one of the longest empirical records of reproductive trajectories of a multi-age cohort (ages 18-34 in 2020) of women (DZC-1-2). This data will be collected twice each year for the next three years and include information on individual and municipality Zika and Covid experiences, reproductive intentions, behaviors, and outcomes (with questions on monthly contraceptive use history and relationship history), and a range of potential mediators such as risk perceptions, knowledge about disease transmission, economic vulnerability, healthcare access, and contraceptive self-efficacy. We will link new waves of data with DZC-1 waves to understand if, and how, the experience of living through successive health shocks produces immediate, lagged, and compounded effects. We will also merge DZC 1-2 data with municipality and census tract data (e.g., vaccine availability, Covid-19 case rates and death rates) to address the implications of contextual Covid-19 conditions on reproductive processes. In addition to creating a 6-year panel, the aims of this study are to examine how varied individual and contextual Covid-19 experiences across space and time have influenced women's reproductive lives, including their child's health. We will use panel data methods and difference-in-difference models for our proposed analyses. We will add nuance to these analyses with in-depth interviews to understand how women classified as outliers (e.g., unvaccinated (vaccinated) women in low (high) municipalities) navigated pregnancy during the Covid-19 pandemic.