Reproductive Responses to the Zika Virus Epidemic in Brazil

项目摘要/摘要 这项拟议的研究的目的是为寨卡病毒是如何 寨卡病毒(ZIKV)疫情已经并可能继续影响巴西的生殖过程。这些 分析将包括调查不同类型的身体和社会暴露于病毒的情况 妇女对怀孕和避孕的渴望、避孕措施的使用和性行为频率、产前 医疗保健使用、堕胎、怀孕和分娩结果。了解女性的生殖反应 对ZIKV的暴露是发展对人群健康冲击影响的细微差别理解的关键 家庭健康和更广泛的健康差距，在发展中的 在医疗保健机会、意外怀孕和发病率方面存在巨大不平等的国家背景 死亡率持续存在。目前，关于寨卡病毒对人类健康的影响的数据或研究很少。 巴西的生殖健康。为了解决这一差距，拟议的研究将在 种族和社会经济多样性，具有人口代表性的#年育龄妇女样本 巴西的两个州。这些数据将收集两次-每两年一次-并将具有广泛的范围 个人和城市寨卡病毒暴露的措施以及妇女生殖健康的措施 意图、行为和结果；以及一系列潜在的中介因素，如风险感知、知识 关于寨卡病毒、医疗保健和生育的心理社会层面，如避孕自我效能和 性别意识形态。样品之间的重复测量将使我们能够观察到 随着医学进步预防寨卡病毒和/或寨卡病毒，女性的观念和行为反应 在巴西重新出现为一种流行病。为了更好地了解寨卡病毒在社区和社区的影响 州一级，我们将把我们的纵向调查数据与市、州和国家行政数据合并 和气候数据。除了这些分析外，我们还将审查关于活产的行政数据，以 评估对寨卡病毒疫情的生育反应。这个项目的具体目标是：(1)收集 关于实际和社会寨卡病毒暴露、生殖过程和潜在媒介的纵向数据；(2) 估计社会人口、城市和州特征对女性身体健康的影响程度 以及(3)调查生殖意图、行为、 结果会因接触ZIKV而有所不同。多水平固定和随机效应回归，回归 不连续性和差异模型将被用来评估不同类型和强度的 寨卡病毒暴露对女性生殖策略的影响及其可能的机制 对流行病的生殖反应。

PROJECT SUMMARY/ ABSTRACT 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.