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Public health agencies are in the business of advising, yet little theoretical attention has been paid to how they are supposed to do it well. Agencies' responses to the ongoing Zika virus outbreak highlight just how difficult advising a public during a health crisis can be. Due to the impact of Zika virus on a developing fetus, some public health agencies advise women living in affected areas to consider avoiding or delaying pregnancy during the outbreak. Given the unique importance and personal meaning of reproductive health choices, it is useful to examine what it means to give advice, how agencies can advise successfully and what this tells us more generally about how government agencies should advise their constituencies during health crises.
Initially, WHO refrained from giving any advice about the individual reproductive decisions of people living in Zika-affected areas; it focused instead on the preventative measures people could take to protect against Zika transmission.i Then, WHO made news by claiming that people in Zika-affected areas should 'be correctly informed and oriented to consider delaying pregnancy' in its June 2016 guidance on the prevention of sexual transmission of Zika virus. 2 Many experts hailed WHO for explicitly addressing the reproductive choices individuals are facing, but on closer reflection it is not so clear what advice was actually being offered in the guidance. While the media reported this advice as WHO telling couples in Zika-affected regions to avoid pregnancy, WHO claimed it was not in fact doing that. A spokesperson from WHO stated, "it's important to understand that this is not the W.H.O. saying, 'Hey everybody, don't get pregnant.' It's that they should be advised about this, so they themselves can make the final decision." 3 Here, 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 the individual's final decision.
This attitude towards advising as purely informative is echoed in the manner in which WHO explains the changes that it makes to its guidance. In September 2016, WHO issued updated guidance removing the language about delaying pregnancy, among other changes. 4 WHO justified the need for the updated guidance in light of emerging evidence regarding the sexual...