Happiness Matters: Measuring Happiness To Inform Government Policy

By Summer Bales
Staff Writer

Happiness is typically thought of as an abstract; a mere state of mind. Rarely do we consider the real systems that influence such abstract facets of our lives. We as a society have a tendency to cast aside concerns about our own happiness because we are taught to pursue more concrete goals such as financial stability, job security and career advancement.

Such cultural ambivalence toward happiness permeates our society, including the institutions tasked with creating government policy. Policies that seek to improve the standard of living generally focus on singular goals like raising Gross Domestic Product. This presents a problem for the effectiveness of government policy: it is difficult to improve people’s lives on a limited budget and a lack of comprehensive feedback on how policies perform. Improving government policy requires understanding the factors contributing to people’s happiness and how they interact with policies.

Happiness is gaining attention as a metric for policy analysis. The World Happiness Report has been at the forefront of evaluating and explaining differences in happiness worldwide in an effort to inform government policy. The report credits “a new worldwide demand for more attention to happiness as a criterion for government policy” for fueling additional research into what makes people happy. Economic research increasingly focuses on measures of happiness and how these measures can provide a more comprehensive understanding of wellbeing than traditional methodology.

Measuring Happiness

Modern studies seek to discover the key factors determining happiness, and how those factors can be useful in policymaking. However, methods of defining and quantifying happiness differ among researchers, and have yet to become as objective as those used for income or GDP. One prominent method is Cantril’s Ladder, pioneered by American psychologist Hadley Cantril. In this approach, participants are asked to rate their quality of life on a zero to 10 “ladder,” where zero is the worst possible life and 10 is the best possible life. This method is notable for being “self anchored,”  meaning interpretations of zero and 10 are set by the participant rather than the researcher. This indirectly measures the participant’s gap between his/her expectations and reality. Research from the World Bank indicates that Cantril’s Ladder tends to prompt responses that are more closely correlated to income than are responses to open-ended questions. The difference between Cantril’s Ladder and open-ended questions is greater across countries than within them, suggesting that cultural factors — differing between countries — have a strong influence on how participants assess their own happiness. Governments must account for these cultural factors in happiness in order to craft effective development policies.

Using the Happiness Index

Governments usually promote public well being by addressing issues of income and wealth. While income is a necessity, it does not completely explain happiness. A study performed jointly by the University of British Columbia and Michigan State University shows that poverty and extreme income inequality can have a great effect on an individual’s dissatisfaction with the life they lead, but the removal of these factors has very little effect eliciting positive emotions. Reducing income inequality is an important step to improving overall well being, though it misses several variables whose profound effects are necessary to understanding what determines happiness.

The World Happiness Report used its finding to construct a concrete model of happiness. The report identified six key factors contributing to happiness levels:

  • GDP per capita;
  • Healthy life expectancy;
  • Social support, as measured by having someone on whom to rely during times of trouble;
  • Trust, as measured by a perceived absence of corruption in government and business;
  • Perceived freedom to make life decisions; and
  • Generosity, as measured by recent donations.

We cannot rely on income alone without blinding ourselves to the majority of these factors when setting government policy.

Wiser, Happier Policymaking

The government of Bhutan, a small Himalayan nation situated between the vast populations of China and India, has begun using a “Gross National Happiness index” to measure improvements in the wellbeing of its just under 750,000 inhabitants and provide an objective source of feedback from government policy.

Measuring happiness is not just a stoic practice in tiny, religiously devout Bhutan. These types of indices gained recognition on the international level when the United Nations General Assembly solicited input from member states on constructing new indicators for happiness and “holistic development.”

The new focus on happiness may already be informing us about international policy priorities for development. The World Happiness Report has used Cantril’s ladder to calculate the mean and variance of happiness for each region of the world. The regions with the most internal inequality among their inhabitants are Latin America and the Caribbean, the Middle East and North Africa, and Sub-Saharan Africa. The most important factors contributing to the poor performance of these regions are differences in social support, incomes and healthy life expectancy.

In 2014, global leaders crafted a set of Sustainable Development Goals as policy targets for ending poverty, ending hunger, improving education and fighting climate change. The researchers from the World Happiness Report have pushed to be able to guide the progress towards the Sustainable Development Goals by providing indicators of “subjective well being” to shape policy.

Utilizing new happiness indices can both inform policymaking and allow for considerations of cultural difference in the context of international policy, where cultural differences can be deep and far-reaching. As our world grows increasingly interconnected, we would be wise to endorse this groundbreaking research into the effects of government policy if we truly mean to improve the wellbeing of all the world’s people.

Image by Dietmar Temps


By Daniel Firoozi
Contributing Writer
Reducing Open Defecation in Rural, Northern India

Executive Summary:
Open defecation poses one of the single most significant health and safety challenges to the people of the provinces of rural, Northern India. Eliminating the practice could save thousands of lives per year through reduced infant mortality, improve early childhood development and curb both malnutrition and the spread of disease. Existing policy options have succeeded at expanding access to improved sanitation, but have failed at making comparable reductions in the rate of open defecation, due largely to individual preferences. Policymakers must overhaul the Total Sanitation Campaign and Nirmal Gram Puraskar to focus on latrine usage, local leadership, long-term goals and accountability to build on the progress made in latrine access.

Statement of Problem
As India continues along its path of long-run economic growth, it grapples with an array of health crises ranging from malnutrition, to elevated rates of infant mortality and widespread instances of diarrheal disease, even when compared to countries with lower per capita incomes, because of open defecation. Despite representing only one sixth of the world’s population, at 597 million people, Indians are the majority of the world’s remaining practitioners of open defecation (Progress 2014, p 21-22). Although 291 million Indians have gained access to improved sanitation since 1990, 792 million continue to lack access to latrines and other forms of improved sanitation facilities, concentrated largely in Northern and rural provinces (Progress, 19-20 & 60). For key demographic groups, particularly Hindus, Dalits, the rural poor, women, children and the elderly, open defecation contributes to a broad degree of disparities in outcomes for healthcare, education, economic opportunity and even personal safety. In the enclosed report, we will (1) explore the origins of the continuing open defecation crisis in India, (2) analyze and critique the Total Sanitation Campaign (TSC), a recently implemented broad-based program aimed at expanding access to latrines and the Nirmal Gram Puraskar (NGP), a financial incentive to promote latrine use, (3) issue a revised plan for phase two of the Total Sanitation Campaign built on demand stimulation, more funding for NGPs and a set of local sanitation divisions administered at the Gram Panchayat (GP) level which will compete for long term financial awards for latrine use and maintenance and (4) conclude with a summary of these findings and rationale for renewal of the TSC with amendments.

On balance, the evidence suggests that while traditional approaches to moving toward an open defecation free (ODF) India have emphasized and been successful in boosting construction of and access to latrines, they have not succeeded at achieving corresponding gains in the reduction of open defecation due to engrained group preferences for the practice. While expanding access to improved sanitation facilities continues to be of great importance, a substantially larger degree of focus should be placed on stimulating demand for latrine use via educational campaigns and future policy approaches must factor in long-term GP, district and block oriented sanitation strategies to build a culture of use and maintenance for existing latrines. By taking large strides towards ODF communities, India may dramatically reduce incidence of diarrheal disease, malnutrition, sexual assault, parasitic infection and infant mortality, as well as promote better outcomes for early childhood development and educational attainment in the long run.

Origin of Problem and Current Context
Open defecation has been a longstanding problem on the Indian subcontinent, tracing its historical roots to a period long before British colonization and has been engrained in the lifestyles of most rural Indians. Many households display a strong preference for open defecation over latrine use, often citing pleasurability and a belief in the health benefits of the practice as primary motivators (Coffey 2014, p 1). However, the data from healthcare outcomes robustly suggest that the ubiquity of open defecation in rural, Northern India poses strains on the indigenous population and entails severe negative consequences. One half of all Indians regularly practice open defecation (Lamba 2013, p 1593), including nearly two thirds of rural households and a majority ofpeople living in households with a government provided toilet (Coffey, p 1). Open defecation is more common in India than many countries with lower indicators for per capita income and approximately one third of the global population of open defecators live in just five Indian provinces: Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh and Haryana (Coffey, p 5). For key demographic groups rates of open defecation can be even higher and pose additional risks to individual health and safety. Indians from scheduled castes (Lamba, p 1593), men (Coffey, p 13), children (Child Feces 2015, p 1) and Hindus (Geruso 2015, p 2) are more likely to engage in open defecation than their demographic counterparts. Often the subgroups most in need of latrines, women with safety concerns, the disabled and the elderly, are precisely the groups with the least amount of economic clout within their household (Coffey, p 13).

Because of the extraordinarily low rates of access to and use of latrines and improved sanitation, the population of India faces severe negative health effects. India alone accounts for approximately one third of all deaths from diarrheal disease (Patil 2014, p 3), driven largely by the relatively high population density of Northern villages which can often multiply the negative externalities of open defecation (Coffey, p 24). The outlook is particularly bleak for children. Poor sanitation access among children in rural, Northern India has been linked to the prevalence of enteropathy, stunted growth, malnutrition and intestinal worm infections, which can cost on average three and three quarters IQ points worth of brain development during every infestation (Child Feces, p 3). The long term consequences caused by repeated fecal-oral transmission of parasites have even been traced to poor cognitive development, lower school attendance, reduced educational attainment, reduced literacy and higher risk of chronic disease in adulthood (Andres 2014, p 6) (Spears 2013, p 3,17-18, & 28). The gaps between ODF and non-ODF communities come into full clarity when one considers that the children of Muslim Indians, despite lower household incomes, lower consumption levels, worse educational attainment and worse access to piped water, have a lower overall infant mortality rate than their Hindu counterparts primarily because of resistance to latrine use among Hindu fundamentalists (Geruso, p 3).

Local governments, organized into districts, blocks and Gram Panchayats (GPs) led by Sarpanches, local elected leaders, are the most critical stakeholders in sanitation policy. Since villages are the core political unit across the rural region of Northern India, they are primary stakeholders in the struggle to construct more latrines and combat the prevalence of open defecation (Lamba, p 1594). Traditionally, administration of sanitation policy has been conducted at the local level, because of the need for political autonomy and flexibility to address the wide variation in climate, water access and cultural differences across the subcontinent. Both rural families and government institutions have a vested interest in improving sanitation access, but the federal government has been slow to act and unresponsive to the unique challenges facing the GPs. Local administrators are also on the frontline of contacting and working with individual households, which often have latrines but may have individual family members who refuse to use them, giving them a unique opportunity to educate and motivate on a personal level.

Critique of Policy Options
In 1999, the federal government of India launched the Total Sanitation Campaign, with the stated goal of achieving universal latrine use and the elimination of open defecation by 2012, but the project failed to achieve a dramatic reduction of open defecation despite contributing to a 19% increase in the availability of improved sanitation (Patil, p 1). An accompanying program, the Nirmal Gram Puraskar, was established to provide funding to Gram Panchayats and households, particularly those below the poverty level, upon the construction and verification of the use of latrines (Lamba, p 1594). Taken in total, the Indian government allocated the equivalent of $1.4 billion for the Total Sanitation Campaign and $1.5 billion for the NGP, providing approximately Rs 820 per household for the construction of a latrine, Rs 30 Lakh for the NGP grant to each Gram Panchayat achieving ODF status and Rs 8,000 for NGP grants to each household in Gram Panchayats that successfully achieved ODF status (Robinson 2008, p 20 & 38-40). While these policies were effective in contributing to a nineteen percentage point increase in latrine coverage in participating villages relative to control villages, the evidence seems to suggest that the policy intervention resulted in latrine construction but fell well short of achieving total sanitation due to the low rates of latrine use (Patil, p 5). According to one analysis, if the Total Sanitation Campaign and NGP awards were extended to cover every village in the rural, Northern provinces, open defecation in the region would only fall from sixty four percent to forty six percent, because the marginal rate of latrine use among latrine owners remains low (Coffey, p 18).

The wedge between latrine ownership and latrine use, which proves the biggest obstacle to the elimination of open defecation, can be traced to social, political, economic and religious factors. Among households with a government constructed latrine, one third of such latrines are not used by anyone at all and rates of open defecation were twice as high as rates for households that constructed latrines without government assistance (Coffey, p 3 & 14). Likewise for Gram Panchayats with Sarpanches from scheduled castes, like Dalits, figures point to high rates of toilet construction on par with that of other participating Gram Panchayats, but the frequency of receiving the NGP proved far lower because of lower rates of latrine use conditional on latrine construction (Lamba, p 1602-1604). In fact, a contributor to both the dearth of households constructing affordable latrines and the use of affordable government sponsored latrines seems to be that many rural Indians in the Northern provinces have an expensive concept of what an acceptable latrine looks like and thus are less likely to build or use facilities that do not meet their personal standards (Coffey, p 7-8). The TSC and NGP programs have both neglected to consider reaching out to local religious institutions and leaders who often give guidance to their worshippers regarding the practice of open defecation (Geruso, p 5-7). Finally, it seems that in spite of the companion programs’ noticeable impact on latrine construction household surveys reflect similar rates of awareness of the programs between villages receiving the policy intervention and control villages (Patil, p 14).

Policy Recommendations
The Indian Ministry of Drinking Water and Sanitation should recommit itself to a substantial reduction of open defecation in the rural, Northern provinces and launch a second phase of the Total Sanitation Campaign and Nirmal Gram Puraskar by (1) setting up latrine demand stimulation campaigns and triggers, (2) increasing NGP awards by 25% across the board and (3) setting up a system of local sanitation organizations, administered at the Gram Panchayat level, which will compete for new long-term NGP block grants awarded for latrine use, reduction of open defecation and latrine maintenance. As the TSC and NGP have already demonstrated, the larger the financial incentive for latrine construction, the greater the rate of expanded access to improved sanitation, but such plans alone are insufficient for guaranteed latrine use and curtailing open defecation (Patil, p 21).

The policy intervention outlined in this report will tackle current problems and context by challenging existing notions surrounding open defecation, promoting demand for latrine use, targeting relief and demand stimulation to key groups and engaging local policymakers as stakeholders in the process. With fifty one percent of people without latrines believing that open defecation is at least as beneficial to health as latrine use, any proposal geared at curbing open defecation must begin with latrine demand stimulation and program triggers (Coffey, p 21). A revamped TSC must tout not only the health benefits of ODF communities, but must recognize existing social roles and make targeted appeals to personal safety of children and adolescents, personal privacy for women and low costs for men (What Works 2014, p 5). Local leaders and households should indicate a desire for behavioral change prior to the disbursement of funds for latrine construction and the allotment of construction grants should be tied to a participatory rural appraisal process that would gauge the fraction of people in a Gram Panchayat interested in pursuing to an ODF community, ask for a reasonable target date for ODF status and target funds at the GPs with the strongest commitments (What Works, p 6 & 9). Rather than emphasizing disgust and shame in the context of open defecation, the initial educational campaign should rely on the pride, dignity and security associated with latrine use as well as the most effective messaging surrounding convenience, children’s safety from insects and animals, reductions of sexual assault and safety from the rains to appeal to middle age fathers, the holders of most economic clout in the rural provinces (What Works, p 10-11). Lastly, the educational program must be administered at the local level, with Sarpanches indicating a firm commitment to participation, setting up a sub-GP governing structure and drafting a time table for policy implementation, before a village is deemed eligible for participation in the renewed TSC and NGP programs.

Phase two of the Total Sanitation Campaign and Nirmal Gram Puraskar should strike at the heart of past policy failures by emphasizing latrine use rather than construction, creating safeguards against caste-based discrimination, challenging perceptions about latrines and raising awareness about the program itself. Apart from the financial incentives to build latrines, the bulk of the NGPs for ODF Gram Panchayats and households in ODF GPs should be disbursed only after independent auditors evaluate a GP for latrine use in one, two, three, five and eight year intervals after a GP enters the program (Robinson, p 49). Moreover, a financial incentive for workers in the locally-administered sanitation organizations should be tied to these evaluations as a means of incentivizing community engagement and education in the period between evaluations. This will shift the incentive away from construction and toward fostering a culture that makes ODF communities a priority, while improving baseline statistics, allowing for decentralized management and providing independent accountability (Monitoring Systems 2010, p 4 & 12). Independent auditors will schedule evaluations without proactive warnings for GPs, will be randomized among the GPs and will meet with the members of the local sanitation organizations and Sarpanch only after submitting an initial report, to curtail possibilities for corruption and eliminate the potential for biased reporting linked to the caste of a Sarpanch. Coupled with this new focus on external verification, local sanitation organizations must work hard to relay the message that the low-cost latrines funded by the TSC are a transitory step along the path to the high quality latrines many Indians envision and underscore that successful achievement and maintenance of ODF status in a GP will lead to financial grants that may be used to upgrade latrine quality (Patil, p 9). By framing the move to latrine use as a step in a process yielding larger and larger payoffs over time and by incorporating local sanitation organizations, the new TSC and NGP will foster a culture of latrine use over the long-run and become more familiar to targeted villages than their predecessor programs.

In keeping with the overall plan of taking a bold step toward eliminating open defecation, the policy goal will be to cut open defecation in half by the eighth year of the revised programs and will be evaluated through a series of benchmark checks with accompanying performance grants for post-NGP outcomes (Robinson, p 49). While local sanitation organizations governed by Gram Panchayats can effectively act to provide timely monitoring at block, district and GP levels they will be financially compensated for providing regular updates on sanitation information and for successful implementation of strategies to promote latrine use after one year, two years, three years, five years and eight years (What Works, p 5). Financial incentives from the NGP will be broken up to reward communities at each time interval for retaining ODF status and reimbursements will be provided to cover the recurrent costs of maintenance of latrines to sustain sanitation outcomes, extending the effectiveness of the plan well into the time horizon (Robinson, p 49).


To achieve dramatic improvement in health, educational and life outcomes India’s federal government must overhaul its rural sanitation policies to prioritize latrine use, rather than latrine access as a means of combating open defecation. Despite measurable progress in latrine construction in rural, Northern India, the country has not achieved parity declines in open defecation, making it a laggard among its non- industrialized peers on a variety of health indicators. Without substantial reform of the TSC and NGP, India will continue to subsidize construction of improved sanitation facilities rather than stimulate their demand, fail to address systemic inequalities on the basis of gender, caste, religion and age and will continue to face stubbornly high rates of preventable illness and infant mortality. With the population burgeoning and growing increasingly mobile, the federal government must prioritize slashing rates of open defecation to hedge against the growing threat of communicable disease. Local governments and families should commit themselves to better sanitation practices to not only raise their standards of living, but improve childhood development and save young lives.

The most achievable and pragmatic approach to curbing open defecation involves launching a second phase of both the TSC and NGP programs, while making a clear break with their previous top-down, near term, construction-focused approach. By allocating funds for the establishment of a network locally administered sanitation organizations, shifting focus to latrine demand stimulation and providing a new set of

long term grants for achieving non-construction goals, policymakers may best address the factors which limited the success of past initiatives. These clean breaks with the structure of past policies prove necessary because of the high rates of disuse of existing sanitation infrastructure, the disparities between demographic groupings and the political realities of rural village life in each of the provinces. The revamped proposal for the implementation the Total Sanitation Campaign and Nirmal Gram Puraskar ought to receive the full support of the Ministry of Drinking Water and Sanitation to improve the efficiency of the existing programs and the Minister Chaudhry Birender Singh should propose an increase in the allocation for these programs in the annual federal budget to cover the higher expenditures associated with a restructured grant system and new public worker salaries.


1) Sneha Lamba & Dean Spears (2013) Caste, ‘Cleanliness’ and Cash: Effects of Caste-Based Political Reservations in Rajasthan on a Sanitation Prize, The Journal of Development Studies, 49:11, 1592-1606, DOI: 10.1080/00220388.2013.828835

2a) Patil SR, Arnold BF, Salvatore AL, Briceno B, Ganguly S, et al. (2014) The Effect of India’s Total Sanitation Campaign on Defecation Behaviors and Child Health in Rural Madhya Pradesh: A Cluster Randomized Controlled Trial. PLoS Med 11(8): e1001709. DOI:10.1371/journal.pmed.1001709. <https://openknowledge.worldbank.org/bitstream/ handle/10986/23197/journal.pmed.1001709.pdf?sequence=1&isAllowed=y>.

2b) Patil, Sumeet R., Benjamin F. Arnold, Alicia Salvatore, Bertha Briceno, John M. Colford, and Paul J. Gertler. “A Randomized, Controlled Study of a Rural Sanitation Behavior Change Program in Madhya Pradesh, India.” Policy Research Working Papers (2013): n. pag. Worldbank.org. The World Bank, Nov. 2013. Web. 20 Jan. 2016. <http:// www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/ 2013/11/14/000158349_20131114094224/Rendered/PDF/WPS6702.pdf>.

3) Progress on Drinking-water and Sanitation 2014 Update. Geneva: World Health Organization, 2014. searo.who.int. World Health Organization, 2014. Web. 20 Jan. 2016. <http://www.searo.who.int/indonesia/documents/progress-on-drinking- water-2014(9789241507240_eng).pdf>

4) Coffey, Diane, Aashish Gupta, Payal Hathi, Nidhi Khurana, Dean Spears, Nikhil Srivastav, and Sangita Vyas. Revealed Preference for Open Defecation: Evidence from a New Survey in Rural North India. Working paper no. 1. Research Institute for Compassionate Economics, 26 June 2014. Web. 16 Feb. 2016. <http://squatreport.in/ wp-content/uploads/2014/06/SQUAT-research-paper.pdf>.

5) Child Feces Disposal in INDIA. Issue brief. UNICEF, Mar. 2015. Web. 16 Feb. 2016. <http://www.wsp.org/sites/wsp.org/files/publications/WSP-India-CFD-Profile.pdf&gt;.

6) Andres, Luis A., Bertha Briceno, Claire Chase, and Juan A. Echenique. Sanitation and Externalities: Evidence from Early Childhood Health in Rural India: Policy Research Working Papers. Working paper no. 6737. World Bank, Jan. 2014. Web. 16 Feb. 2016. <http://elibrary.worldbank.org/doi/pdf/10.1596/1813-9450-6737&gt;.

7) Geruso, Michael, and Dean Spears. NEIGHBORHOOD SANITATION AND INFANT MORTALITY. Working paper no. 21184. National Bureau of Economic Research, May 2015. Web. 16 Feb. 2016. <http://www.nber.org/papers/w21184.pdf&gt;.

8) Spears, Dean, and Sneha Lamba. E Ects of Early-Life Exposure to Sanitation on Childhood Cognitive Skills. Working paper no. 6659. The World Bank, Oct. 2013. Web. 16 Feb. 2016. <https://openknowledge.worldbank.org/bitstream/handle/10986/16872/ WPS6659.pdf?sequence=1&isAllowed=y>.

9) Monitoring Systems for Incentive Programs: Learning from Large-Scale Rural Sanitation Initiatives in India. Guidance Notice. World Bank Water and Sanitation Program, Nov. 2010. Web. 16 Feb. 2016. <https://openknowledge.worldbank.org/ bitstream/handle/10986/17275/593350WP0WSP1m10Box358367B01PUBLIC1.pdf? sequence=1&isAllowed=y>.

10) What Works at Scale? Distilling the Critical Success Factors for Scaling up Rural Sanitation. Working paper no. ACS8929. The World Bank, 27 May 2014. Web. 16 Feb. 2016. <https://openknowledge.worldbank.org/bitstream/handle/10986/18947/ ACS89290WP0P1319160Box385252B00PUBLIC0.pdf?sequence=1&isAllowed=y>.

11) Robinson, Andy, and Rajiv Raman. Enabling Environment Assessment for Scaling Up Sanitation Programs: Himachal Pradesh, India. Working paper no. 72176. Water and Sanitation Program, Jan. 2008. Web. 16 Feb. 2016. <https:// openknowledge.worldbank.org/bitstream/handle/ 10986/17390/721760WSP0Box370108B00PUBLIC00EEHP0TSSM.pdf? sequence=1&isAllowed=y>.

Photo by Meena Kadri


By Bailey Marsheck
Staff Writer

In January of 2016, in response to the rapid spread of Zika virus in El Salvador and surrounding Latin American countries, El Salvador’s Health Ministry Department put out a statement suggesting that women should avoid conceiving children until 2018, or until progress could be made on a vaccine for Zika. Deputy Health Minister Eduardo Espinoza clarified the statement by explaining, “We [Ministry of Public Health] are giving a recommendation, it’s not prohibition or a birth control measure. These children are going to need neurological help for the rest of their lives.” (“El Salvador Launches Fight…”) As the most recent mosquito-borne virus to infect the global population, Zika virus has emerged as a dangerous new public health issue for thousands of unborn children. However, Zika virus is not considered a life-threatening disease in the majority of instances. Most adult victims never know that they have been infected, and only one out of every five infected exhibit any of the disease’s effects. A fever is the most notable marker of the disease for the small percentage of those infected that show symptoms, but rashes, vomiting and muscle pains are also known indicators of Zika virus. It has been linked to cases of the autoimmune Guillain-Barre syndrome, which can be fatal. However, Zika’s typically mild symptoms often lead to its misdiagnosis as a more common illness (“Symptoms, Diagnosis…”).

Although Zika virus is rarely fatal to adults, El Salvador’s governmental advisory was issued to address Zika’s potential to harm fetuses. The difficulty of identifying the disease makes Zika virus an especially significant threat to pregnant women. An infected mother could lack any symptoms while the virus passes unnoticed through her amniotic fluid to the unborn child. The outbreak of Zika virus has a strong correlation, confirmed to be a “causal relationship” by researchers, to the increasing number of babies born with the microcephaly birth defect. Zika slows fetal development by cutting off placental blood flow to the fetus and attacking the brain’s stem cells. Microcephaly causes a child to be born with a dangerously small brain and head, which slows brain development and makes it harder to function as the child matures. The perceived threat to El Salvador’s unborn population has revived debates surrounding the decision of women to avoid pregnancy altogether. This is bringing attention to the socially subordinate position of Salvadorian women and their limited capacity to make such choices in a sociopolitical context where women are disempowered by “Machismo” culture, anti-abortion laws and the strict beliefs of the Salvadorian Catholic Church. The government’s proposal is meant to reduce the country’s rate of reproduction in order slow the virus’s spread, and minimize the number of microcephaly-afflicted newborns whose needs will pose economic difficulties for the country throughout their lifespans. Although the Salvadorian government has not yet taken steps to incentivize or enforce any restrictive policies, the public recommendation that women should postpone becoming pregnant is noteworthy within the context of El Salvador’s extreme abortion laws and predominantly Roman Catholic culture.

The simplest option for women choosing to heed the government’s Zika warning would be to delay pregnancy. But many women attempting anti-natalist action through abstinence or contraceptive-use face harsh consequences in the domestic sphere, where El Salvador’s “machismo” culture can be an even more restrictive force than the law of the state. Machismo accounts for a heightening of emphasis on gender roles. It shapes the concept of an ideal man as being hyper-masculine and dominant over women, often leaving women as a physical outlet for male frustration. In a household structure where men hold a great majority of the power, having children is seen as one of a woman’s main roles in society. Domestic abuse is becoming more prevalent, hinting at a culture of institutional oppression and violence against women. In 2011, El Salvador had the highest rate of femicide in the world (“Central America: Femicides and…”), revealing the intentional and inadvertent consequences of habitual domestic violence against women. Violence and rape is ignored because women are viewed as possessions, subject to the whims of their husbands, and because those in power to stop such abuse are often a part of the same culture that they are supposed to deter. Salvadorian policewomen have confirmed this by publicly criticizing judges and their male counterparts for contributing to damaging gender norms. Silvia Juárez of the Violence Observatory at ORMUSA claims that the impunity rate, or the proportion of crimes where the perpetrator is not brought to justice, for crimes against women is 98% (“El Salvador: Crisis of Masculinity…”). Many of the domestic violence cases that are reported result in authorities telling women to work it out with their partners, which often deters these women from going to the police in future cases of abuse. The institutional disregard for the health of women in society, demonstrated by the high occurrence rate of rape and violence against women, suggests that avoiding pregnancy might not be a viable course of action for Salvadorian women.

Zika’s threat to fetuses may drive pregnant woman to seek anti-natalist action through an abortion. This is an impossibility from a legal standpoint, because abortion in El Salvador is illegal, even in cases of rape, incest, and concern over the health of the mother. El Salvador’s constitution had previously contained exceptions for protecting the health of mothers and for victims of rape. However in 1998, the constitution was amended to ban abortion in all cases. Many countries have trended towards more liberal abortion policies since 1998, but El Salvador is one of two countries in Latin America to have implemented more restrictive policies between 1998 and 2007 (“Global Trend of Expanding Legal…”). The ban has not had its intended effect of ending abortions in El Salvador; it has only led women to attempt abortions on their own, through less conventional means. There is no safe space for these women. Many of those who have been prosecuted for attempted abortion were reported by the very hospitals in which they sought personal safety. Illegal abortions can have severe criminal or fatal consequences in El Salvador, and any woman suspected of an attempted abortion can be tried for homicide and jailed without bail. Women have resorted to hazardous abortion methods utilizing clothes hangers or even battery acid. Because of the strict abortion laws and prosecution of those who attempt illegal abortions, women must do everything in their power to keep attempted abortions a secret within their households.

One of the main factors for the ban on all forms of abortion is the Roman Catholic Church. Its influence is exemplified by a 2013 case involving a woman known by the pseudonym “Beatriz,” who became severely ill with lupus while pregnant. She received counsel from her doctors to terminate her pregnancy, since the fetus was confirmed to be missing part of its brain and skull and was not expected to live more than a few days. Beatriz went to court in hopes of being granted access to an abortion. The case went to the El Salvadorian Supreme Court, where the Roman Catholic Church lobbied heavily against Beatriz. The court eventually ruled against the legality of an abortion in these circumstances. Although Beatriz ended up living, the child survived all of a few hours. Even though the fetus couldn’t have survived for more than a few days, its life was valued over that of the mother, in the eyes of the court (“A High-Risk Pregnancy…”). With an influential force like the Catholic Church actively fighting against the legalization of abortion, pregnant women have little hope of protection within El Salvador’s judicial system.

The Salvadorian government’s attempt to encourage women to delay pregnancy emphasizes both the severity of Zika’s effects on the population as well as the state’s failure to combat the virus’s spread through more comprehensive means. El Salvador is a country torn apart by violence and distrust of the government, making it nearly impossible to institute nationwide policies to combat the Zika virus. There were 2,474 new infections in the first three weeks of January alone, many of which surfaced in areas so afflicted by gang wars and violence that the government has had trouble providing aid to the infected. Some residents in gang-controlled areas even see the government’s attempts to educate the population as a conspiracy to re-establish authority in areas where it has lost control. Brazil’s attempt to eradicate the virus by eliminating still water breeding grounds for mosquitos has been endorsed by many experts as the most effective way of fighting the virus until medical research for some type of vaccine is completed. This promising potential solution is impossible to apply in regions of El Salvador where the government has relinquished control to gangs. Fear of violent retaliation from gang members leaves citizens both too afraid to cooperate with the government, and ignorant of the disease’s potential connection to the microcephaly birth defect. El Salvador’s lack of practical solutions to Zika virus makes the debate surrounding abortion and the use of contraceptives all the more relevant.
The Health Ministry’s stance on pregnancy also serves to highlight a contrast of opinions between the country’s older and younger populations.

Roman Catholicism is on the decline in El Salvador and the rest of Latin America, with younger generations turning towards Protestantism or atheism at an increasing rate. The change in religious demographics could lead to a revision of abortion laws as Roman Catholicism slowly loses influence in the population and the government. With Zika virus currently hurting newborns the most, the country’s struggle to prevent Zika’s spread could seriously affect the demographics of the next generation. El Salvador is in Stage Three of the Demographic Transition model, characterized by a slowing of population growth and birth rates along with an increase in age of the population (“Stage 5 of the Demographic…”). The Demographic Transition Model categorizes countries into stages one through five, using trends in birth and death rates to predict how the population demographic will change. If Zika virus and the government’s advisory were to have a significant effect on fertility rates in El Salvador, the country could feasibly skip directly to Stage Five, where death rates exceed birth rates and the country falls into a steady population decline. A decrease or complete cessation of pregnancies would have disastrous effects in 20 years, when the generation affected by Zika would reach adulthood and face a shrunken workforce and stunted economic growth. Despite the possible repercussions of decreasing birth rates, the government also can’t ignore the plight of pregnant women struggling with poverty in El Salvador. A notable percentage of these women are teenagers carrying children conceived through rape, who can’t afford to provide for the special needs of a child with the microcephaly birth defect, yet have no alternative because of the current abortion laws. Unless the government can slow the spread of Zika soon, which has proven resoundingly unsuccessful so far, it may have no choice but to institute a more effective anti-natalist policy.

Some El Salvadorian women are taking the health warnings seriously and making conscious efforts to avoid conception through any possible means, but the effectiveness of government suggestions will remain minimal as long as the Roman Catholic Church and its pro-natalist religious beliefs retain power over a majority of the population. Most women simply don’t have the choice to avoid childbirth because of their subordinate positions in family and society, and their inability to access safe abortions. El Salvador is torn between old Roman Catholicism and younger, more progressive views, as the fates of future generations hang in the balance. Research on Zika virus is still in the beginning stages, and experts are still struggling to understand its transmission and spread. As Zika spreads further and countries exhaust their potential solutions to slow its advance, the call for reform of El Salvador’s abortion and natalist policies will only get more deafening.


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“Symptoms, Diagnosis, & Treatment.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 2016. Web. 31 Jan. 2016.
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Zabludovsky, Karla. “A High-Risk Pregnancy Is Terminated. But Was It an Abortion?” The New York Times. The New York Times, 2013. Web. 16 Apr. 2016.
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Image by Joshua E. Cogan