Conclusion

This chapter reconceptualises the findings from Zika to the global level to understand what global heath security can learn from unpacking this health emergency and how global health security policy can be made more gender inclusive. It also readdress the state-centric focus of the global health security narrative, which has systematically excluded women, through repositioning women as the referent object of securitisation. The chapter suggests that women’s needs and lived reality should be taken into consideration and that policy might be developed which makes tangible approaches to counteracting the risks posed to women, rather than focusing on broader systems, economies or societies. Finally, it considers that the book has not done justice to women’s agency within outbreaks, and painting them as victims of a broader structural failure within third wave feminism overlooks the activities that women have undertaken to protect themselves from disease or its effects.

Epilogue

This epilogue discusses COVID-19, which reveal much about gender in global health security. It highlights that women are more likely to be healthcare workers, demonstrating the visibility missing in COVID-19, yet this is not recognised by policymakers. Women are also more likely to suffer the downstream effects of social reproduction through school closures and stay-at-home orders as well as the associated mental load. The epilogue also shows how COVID-19 has affected access to SRH services with an impact on stratified reproduction. It concludes that the everyday crisis of women trying to manage the response, whilst at risk of soaring rates of GBV and lack of access to sanitation and space, verifies the argument made throughout this book. Now the world is listening.

Theorizing Feminist Health Security

This chapter conceptualises global health security, discussing its genesis and how it has been theorised. First, the chapter establishes that global health security has failed to consider women and the gendered impact of securitised health policy then conversely, explores how feminists have contended with other security debates, through analysing the sub-discipline of feminist security studies (FSS). FSS seeks to understand women within the security terrain but has yet to consider global health as an area of security analysis. The chapter demonstrates why it is so vital to develop a dialogue between feminist theory and global health security for meaningful development in pandemic preparedness and response activities. It also provides a springboard for the following empirical chapters which engage with a range of further feminist concepts to explore the empirical case of Zika and highlight the need to engage with feminist approaches in order to develop a more comprehensive response to health emergencies and ensure truly global health security.

The Zika Virus

This chapter offers a contextual narrative to the Zika outbreak and justifies a pertinent case study for gender analysis in global health security. It contends that Zika was constructed as a security threat at multiple levels of analysis. This framing perpetuated an exclusion and problematization of women in global health security more broadly. The chapter argues that the key policies developed—integrated vector control, vaccine development and behavioural requests around reproduction, to paraphrase, ‘clean your houses and don’t get pregnant’—were inherently gendered given the activities required are socially prescribed women’s activities. It further argues that although the outbreak revolved around women, gender was not mainstreamed into any of the policies developed, and the securitised policies failed to protect those women most at risk from the disease.

Introduction

This chapter introduces the book’s proposal that Zika offers a window for analysing broader themes in global health security: those of perpetuating global-local inequalities and silencing of women in securitised policy, governed by Westphalian and domestic politics. It outlines how the global health security narrative promoted a path dependency which reproduced state security-focused policies of masculine evidence based medicine and short-term response efforts and rendered the everyday lives of those (women) most at risk of the disease invisible. The chapter analyses the lack of gender considerations in global health security policy and further justifies the need for a feminist global health security, through highlighting the ways in which women are differentially infected and affected by infectious disease.

Zika and In/visibility

This chapter begins with the premise that women are not a homogenous group; and some women are more important than others to global health security, which relays important information about political prioritisation. The chapter then shows how the Zika outbreak provides a pertinent example for a detailed nuanced analysis of in/visibility, which might have wider ramifications for understanding this concept in feminist discourse. Women cradling babies born with CZS were on the front pages of newspapers, policy reports and the collective global psyche. But it was a certain type of woman, performing a particular function of motherhood to legitimise activity within a security narrative, instrumentalised to garner support for extraordinary measures amid the public audience of the security threat. The affected women were conspicuous in the narrative of global health security, and were instrumentalised to facilitate Zika’s securitisation, but that these same Zika infected and affected women were invisible as the target group for public health interventions, particularly when considering intersectionality—these women were poor, black, single, and living in northeast Brazil.

Clean Your House and Don’t Get Pregnant

Drawing on social reproduction, and stratified reproduction, this chapter demonstrates that there is a tension between the securitised approach of the Zika response and the lived reality of the women most affected. In doing so, it also reveals a struggle between the state and women. The securitised policy response at national levels placed the responsibility onto women to avoid being bitten by mosquitoes, to reduce mosquito breeding grounds, and ultimately to avoid bearing a child with CZS. This is problematic: women were not included in the decision-making to create suitable policy pathways to reduce their risks of infection, to the extent that the very population the response should have provided for, has been systematically excluded from the response. Women were instrumentalised, objectified, and responsibilised by the state. Thus, the chapter shows, global health security through a state-centric delivery of security is failing women.

Violence and Everyday Crises

Zika was framed globally as a ‘crisis’ with a narrative demonstrating a paternalistic approach to policymaking and failing to take local contexts into consideration. This chapter examines structural and gender-based violence in juxtaposition to the framing of Zika as a global health crisis at the local level. Despite being invisibilised by global health security and responsibilised by domestic governments, women most susceptible to the Zika outbreak, while providing for their children’s needs, were fighting everyday challenges of financial security, increasing community and gender violence, poverty, and state structural failures in provision of routine health, sanitation, and housing. Zika became just one of a string of individual security threats these women had to battle. This disjuncture needs to be exposed and counteracted, and the lived reality of those infected must be addressed to meaningfully respond to these health crisis events.