Epidemiology cannot end stories of disease. They do not conclude when the graphs decline; nor do they remain confined to public-health domains. They often continue to shape the formation of social relations and identities. People continue to live with social impacts, as is evident in the COVID-19 pandemic. Although most of society now regards it as past, it persists in mourning, in interrupted lives and in bodies still seeking recognition for the persistent, disabling symptoms of long COVID. The same goes for chikungunya, Zika and other diseases whose social traces far exceed the clinical timeline of infection.
Ilana Löwy upends traditional epidemiological analysis and shifts focus: from infection to women’s bodies, from biomedicine to reproductive rights, from vector to social structure. The book proposes to go beyond the patriarchy of epidemics – that is, to break with a model that naturalizes motherhood, silences women and frames public-health events within narratives of sacrifice and compulsory care. By using the Zika epidemic as exemplary of reproductive injustice, Löwy shows how the Brazilian state simultaneously lionized mothers of children born with microcephaly and reinforced control over their bodies. This contradiction becomes acuter in a context of the growing influence of conservative religious sectors, which moralize reproduction and openly advocate for the criminalization of abortion.
The 2015–16 Zika epidemic was largely framed as a typical public-health crisis: a matter of viruses, mosquito vectors and technical control strategies. Images of babies with microcephaly mobilized public opinion, urgent biomedical research, emergency responses to Aedes aegypti and government actions focused on childcare. However, historians and anthropologists of health have highlighted less visible – in many cases deliberately silenced – dimensions of epidemics, raising deeper issues of gender, reproductive rights and inequality.
Löwy challenges the dominant epidemiological emphasis on infectious agents and vectors, focusing instead on women’s bodies – particularly those of those most vulnerable – on which the epidemic’s deepest marks are inscribed. Löwy, a long-time visiting researcher in Brazil, is deeply familiar with the country’s entangled histories of mosquitoes and inequality. She reveals crisis dimensions that were largely neglected: unequal access to health care, the limits of reproductive planning, the criminalization of abortion and the persistence of patriarchal models that naturalize motherhood as women’s moral destiny.
Not just a public-health emergency, the Zika epidemic was a moral and political crisis, marked by disputes over who could to decide whether to bring to term a child with concrete risk of a severe disability. Yet public discourse avoided this debate. Pregnant women were positioned as bearers of a near-patriotic responsibility: to gestate, to birth and to care. The possibility of terminating a pregnancy – even in a context of uncertainty, fear and suffering – was systematically silenced.
Löwy argues that although the epidemic mobilized new campaigns for recognition and reparation, especially regarding care for children with congenital Zika syndrome (CZS), it also reinforced a moralistic model of motherhood. Mothers were portrayed as heroic symbols of love and resilience. This narrative acknowledged their efforts while concealing a structural violence: the absence of choice. Care became an obligation; maternal love, an imposition. Brazil, already shaped by restrictive abortion laws, saw even more hostility toward expansion of reproductive rights. In a country with a growing, influential Pentecostal population, advocacy for the decriminalization of abortion – even limited to Zika-related cases – was drowned out by conservative and misogynistic moral frameworks. For Löwy, the problem is not merely legal or religious, but cultural. The epidemic reinforced the idea that women’s natural role is to care. Zika thus reaffirmed compulsory motherhood and absolved the state of responsibility for the conditions that produced vulnerability. Solutions such as vaccine development, mosquito control and specialized care for children with microcephaly were important. But, treated as the sole or primary responses, they overshadowed other equally crucial dimensions – especially reproductive autonomy and social justice.
For Löwy, this reflects a technocratic, colonial logic that treats health as a problem of control and management. The absence of public campaigns to communicate reproductive risks, or ensure safe access to contraception and abortion, points to deliberate disinformation and governance through ignorance. While health care professionals learned to identify signs of CZS and to support mothers, little was said about pregnant women’s psychological suffering, their fear of unwanted pregnancies, or the possible pathways to safely terminate them. What could have been an opportunity to expand sexual and reproductive rights became yet another chapter in their denial.
The women most affected were black, poor and peripheral – historically, the most exposed to mosquitoes, to failures in the health care system and to moralistic bodily control. Löwy works with a sensitive intersectional reading: epidemic affects women unequally because its enabling conditions – poor sanitation, precarious health services, criminalization of poverty – are unequally distributed. Reproductive injustice does not affect all women in the same way. Middle- and upper-class women – often white – were able to terminate pregnancies safely, albeit illegally. Those without access to resources faced an impossible choice: continue a pregnancy under risk of severe consequences, or resort to unsafe methods.
By foregrounding reproductive injustice, Löwy compels us to rethink the stakes of epidemics like Zika. Institutional responses to health crises often deepen existing social and gender inequalities. If this epidemic was an inflection point, it is because it revealed with brutal clarity the limitations of a health care system still enacting a logic of moral control. Löwy invites us to look beyond the framework of childcare and glorification of motherhood and to focus on what is rarely addressed in times of crisis: women’s right to choose.
Viruses and Reproductive Injustice, more than a historical analysis, is a powerful critique of how societies – especially those marked by deep inequalities and religious conservatism – manage female bodies in times of crisis. Löwy shows with clarity and sensitivity that there can be no health justice without reproductive justice – and that disrupting the patriarchal and colonial underpinnings of biomedical discourse is essential to imagining equitable responses to public-health crises.
