“The Mosquito Brings the Sickness”: Local Knowledge, Stigma, and Barriers to Zika Prevention in Rural Guatemala

  • Michaela E. HowellsEmail author
  • Michelle M. Pieters
Part of the Global Maternal and Child Health book series (GMCH)


The emergence of Zika virus and the resulting occurrence of intrauterine infections has been responsible for increased numbers of spontaneous abortions and significant neurological deficits in newborns—termed the congenital Zika syndrome. Globally, South and Central America are experiencing the highest rates of Zika infection and associated neonate microcephaly, creating a critical need for knowledge regarding barriers to effective Zika prevention. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have issued recommendations to block the future spread of the disease through mosquitoes and sexual transmission. Although well intentioned, these recommendations fail to account for some of the significant barriers to preventing the spread of Zika in areas with weaker public health programs, such as rural and impoverished areas of South and Central America. In particular, these are areas where indigenous people and mestizos are concentrated. In this chapter, we address some of the economic and cultural barriers that rural populations face in accessing preventative health care against Zika. We combined data from a two-month ethnographic study with 40 semi-structured interviews in a mestizo farming community in Escuintla, Guatemala. Although 87.5% of participants were able to identify Zika virus transmission risk through mosquitoes and associated preventative measures, only 5% reported sexual transmission as a risk, and none of the participants listed condom use as a way to prevent transmission. Our research illustrates that, although this population was able to articulate the need for preventing mosquito bites, their actual ability to prevent these bites is limited. We discuss the role of taboos and stigmatization surrounding sexual practices and critical preventative measures that can influence individual decision-making and place people at higher risk of contracting Zika infection. Taken together, challenges in complying with public health recommendations may disproportionately affect less affluent mestizo communities, leading to an increased burden of risk.


Indigenous women Maternal health Community participation Pregnancy Central America Prenatal care Guatemala Mestizo Arbovirus Congenital Zika syndrome Zika virus Arthropod-borne infection Stigmatization Sexual practices Prevention Sexual transmission Prevention Condom use Health education Mosquito Family planning 



We would like to extend our sincere thanks to the participants of the Escuintla farm communities who shared their lives with us. We would also like to extend our thanks to Richard Bender, Carolyn Robinson, Christopher Dana Lynn, Samantha Fernando, Holly Wood, Katherine Woolard, Mallory Walker, Santiago Ortiz, David A. Schwartz, and Uli Howells-Loudon for feedback on drafts. Additionally, we would like to acknowledge Katherine Pieters, Nicole De Nes, Jacobo Pieters, Ruth Escobar, Barbara Arroyo, and Amadeo Garcia for their support throughout the field work. Funding was provided by University of North Carolina Wilmington’s Center for the Support of Undergraduate Research and Fellowships (CSURF) and the Summer Undergraduate Research and Creativity Awards (SURCA).

This study was approved by the University of North Carolina Wilmington Internal Review Board (protocol number 16-0340).


  1. Abraham, T., Macauda, M., Erickson, P., & Singer, M. (2011). “And let me see them damn papers!” The role of STI/AIDS screening among urban African American and Puerto Rican youth in the transition to sex without a condom. AIDS and Behavior, 15, 1359–1371. CrossRefPubMedGoogle Scholar
  2. Alvarado, M. G., & Schwartz, D. A. (2017). Zika virus infection in pregnancy, microcephaly, and maternal and fetal health: What we think, what we know, and what we think we know. Archives of Pathology & Laboratory Medicine, 141(1), 26–32.CrossRefGoogle Scholar
  3. Banco Mundial. (2016). Gasto en salud per capita (US$ a precios actuales). Retrieved March 7, 2017, from
  4. Cauchemez, S., Besnard, M., Bompard, P., Dub, T., Guillemette-Artur, P., Eyrolle-Guignot, D., et al. (2016). Association between Zika virus and microcephaly in French Polynesia, 2013–2015: A retrospective study. Lancet, 387(10033), 2125–2132.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Centers for Disease Control and Prevention. (2016a). Clinical evaluation and disease. Retrieved March 7, 2017, from
  6. Centers for Disease Control and Prevention. (2016b). Protect yourself and others. Retrieved March 7, 2017, from
  7. Centers for Disease Control and Prevention. (2016c). What we know about Zika. Retrieved March 7, 2017, from
  8. Centers for Disease Control and Prevention. (2017a). All countries and territories with active Zika virus transmission. Retrieved March 7, 2017, from
  9. Centers for Disease Control and Prevention. (2017b). Microcephaly and other birth defects. Retrieved from
  10. Hayes, E. B. (2009). Zika virus outside Africa. Emerging Infectious Diseases, 15(9), 1347–1350. Retrieved April 3, 2017, from CrossRefPubMedPubMedCentralGoogle Scholar
  11. Howells, M. E., & Pieters, M. M. (2016). Zika’s frightening stranglehold. Sapiens. 8 April 2016. Retrieved April 3, 2017, from
  12. Información Socioeconómica de Guatemala. (2015). Gobierno de la República de Guatemala. Retrieved March 22, 2017, from
  13. INSIVUMEH. (2016). Gobierno de la Republica de Guatemala. Retrieved March 22, 2017, from
  14. MacNamara, F. N. (1954). Zika virus: A report on three cases of human infection during an epidemic of jaundice in Nigeria. Transactions of the Royal Society of Tropical Medicine and Hygiene, 48(2), 139–145.CrossRefPubMedGoogle Scholar
  15. National Health Expenditures. (2015). Highlights. Centers for Medicare & Medicaid Services. Retrieved March 21, 2017, from
  16. Pan American Health Organization. (2017). Zika cases and congenital syndrome associated with Zika virus reported by countries and territories in the Americas, 2015–2017. Cumulative cases. Data as of 6 April 2017. Retrieved April 6, 2017, from
  17. Pocasangre, H., & Orozco, A. (2016). Nacieron 36 niños con microcefalia asociada al Zika. Prensa Libre. 6 January 2017. Retrieved April 3, 2017, from -con-microcefalia-por -zika-el-2016
  18. Rasmussen, S. A., Jamieson, D. J., Honein, M. A., & Petersen, L. R. (2016). Zika virus and birth defects reviewing the evidence for causality. New England Journal of Medicine, 374(20), 1981–1987.CrossRefPubMedGoogle Scholar
  19. Schwartz, D. A. (2015). Unsafe abortion: A persistent cause of maternal death and reproductive morbidity in resource-poor nations. In D. A. Schwartz (Ed.), Maternal mortality: Risk factors, anthropological perspectives, prevalence in developing countries and preventive strategies for pregnancy-related death (pp. 425–439). New York: Nova Science Publishers.Google Scholar
  20. Schwartz, D. A. (2017a). The origins and emergence of Zika virus, the newest TORCH infection: What’s old is new again. Archives of Pathology & Laboratory Medicine, 141(1), 18–25.CrossRefGoogle Scholar
  21. Schwartz, D. A. (2017b). Searching for yellow fever: The Rockefeller Foundation, Haddow towers, monkeys, and the discovery of the Zika virus. First International Conference on Zika Virus, Washington, DC February 22, 2017.Google Scholar
  22. Schwartz, D. A. (2017c). Autopsy and postmortem studies are concordant: Pathology of Zika virus infection is neurotropic in fetuses and infants with microcephaly following transplacental transmission. Archives of Pathology & Laboratory Medicine, 141(1), 68–72.CrossRefGoogle Scholar
  23. Singh, S., Prada, E., & Kestler, E. (2006). Induced abortion and unintended pregnancy in Guatemala. International Family Planning Perspectives, 32(3), 136–145. Retrieved from CrossRefPubMedGoogle Scholar
  24. Sunday, E. A., & Obioha, E. E. (2016). Partner communication and decision-making regarding sexual issues among students in a South African University. Journal of Sociology and Social Policy, 7(2), 103–124. CrossRefGoogle Scholar
  25. Tambo, E., Chuisseu, D. P., Ngogang, Y., & Khater, E. I. M. (2016). Deciphering emerging Zika and dengue viral epidemics: Implications for global maternal–child health burden. Journal of Infection and Public Health, 9(3), 240–250. CrossRefPubMedGoogle Scholar
  26. Weiss, E., Whelan, D., & Gupta, G. R. (2000). Gender, sexuality and HIV: Making a difference in the lives of young women in developing countries. Sexual and Relationship Therapy, 15(3), 233–245. Retrieved from CrossRefGoogle Scholar
  27. World Health Organization. (2016a). WHO Director-General summarizes the outcome of the Emergency Committee regarding clusters of microcephaly and Guillain-Barre Syndrome. Retrieved from
  28. World Health Organization. (2016b). Knowledge, attitudes and practice surveys Zika virus disease and potential complications. Resource pack. WHO reference number: WHO/ZIKV/RCCE/16.2.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of AnthropologyUniversity of North Carolina WilmingtonWilmingtonUSA

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