Reproductive Responses to the Zika Virus Epidemic in Brazil

项目概要/摘要 拟议研究的目的是提供关于寨卡病毒如何传播的首批深入分析之一。 寨卡病毒（ZIKV）流行已经影响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接触如何形成病毒 妇女怀孕和避孕的愿望，避孕药具的使用和性频率，产前 医疗保健使用、堕胎以及妊娠和分娩结果。了解女性的生殖反应 ZIKV暴露是深入了解人口健康冲击对人类健康影响的关键。 家庭健康和健康差距更广泛，特别重要的是要考虑在发展中国家， 在获得医疗保健、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，关于寨卡疫情对人类的次级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，拟议的研究将收集新的面板数据， 种族和社会经济多样化，人口代表性的育龄妇女样本， 两个巴西国家。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，如风险认知，知识 关于寨卡病毒，医疗保健的获得，以及生育的心理社会方面，如避孕自我效能， 性别意识形态在样品中重复测量将使我们能够观察到 随着医学科学的进步，妇女的观念和行为反应预防寨卡和/或寨卡病毒 在巴西再次流行为了更好地了解寨卡病毒暴露对社区的影响， 在州一级，我们将把纵向调查数据与市、州和国家行政数据合并 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， 估计生育率对ZIKV流行的反应。该项目的具体目标是：（1）收集 关于身体和社会ZIKV暴露、生殖过程和潜在介质的纵向数据;（2） 估计社会人口学，城市和国家特征影响妇女身体健康的程度 以及ZIKV暴露的社会经历;以及（3）调查生殖意图，行为， 结果随着ZIKV暴露而变化。多水平固定和随机效应回归 不连续性和差异中的差异模型将用于评估不同类型和强度的 ZIKV暴露影响女性的生殖策略并研究其机制 对这一流行病的生殖反应。

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.