J Med Ethics doi:10.1136/medethics-2016-103862
  • Current controversy

‘Hey everybody, don't get pregnant’: Zika, WHO and an ethical framework for advising

  1. Dana Howard
  1. Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
  1. Correspondence to Katie Byron, Department of Bioethics, Clinical Center, National Institutes of Health, 10 Center Drive, Bldg. 10, Room 1C118, Bethesda, MD 20892-0001, USA; Katie.byron{at}
  • Received 3 August 2016
  • Revised 13 September 2016
  • Accepted 12 November 2016
  • Published Online First 5 December 2016


WHO recently issued new guidance on the prevention of sexual transmission of Zika virus. The updated guidance states that ‘[c]ountry health programmes should ensure that… [i]n order to prevent adverse pregnancy and fetal outcomes, men and women of reproductive age, living in areas where local transmission of Zika virus is known to occur, be correctly informed and oriented to consider delaying pregnancy’. While the media has reported this advice as WHO telling couples in Zika-affected regions to avoid pregnancy, WHO states that they are not doing that. In an interview with the New York Times, a spokesperson from WHO stated, ‘it's important to understand that this is not WHO saying, “Hey everybody, don't get pregnant.” It's that they should be advised about this, so they themselves can make the final decision’. In this statement, the WHO's spokesperson distinguishes between actively directing individuals to delay pregnancy and advising them, which is portrayed as a merely informative act that facilitates but does not direct an individual's final decision. This paper proposes that advising should not be understood as a purely informational and non-directive act. The choices that agencies make in what advice to offer and to whom to offer the advice are ethical choices with practical implications. We will thus lay out a framework for considering the ethical issues that arise in the context of advising and demonstrate how it can be used to evaluate the WHO guidance.


  • Contributors Both authors made substantial contributions to the conceptual and written work of the manuscript and have approved this version and both agree to be accountable for the accuracy and integrity of the work.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of JME.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Navigate This Article