archives@tulane.edu / Brazil was at the epicenter of the 2015-2016 Zika virus (ZIKV) epidemic, with approximately 60% of globally reported cases within its borders. This dissertation explored how contextual factors were relevant to women’s ability and desire to adhere to the ZIKV recommendations made by the Brazilian Ministry of Health during the epidemic. More specifically this dissertation focused on women’s response to the recommendation to avoid pregnancy during this epidemic. Methods utilized in this dissertation included a rapid assessment and a series of case studies of pregnancy narratives from women in Fortaleza, Brazil. By more deeply exploring women’s fertility decision making during the ZIKV epidemic, a more comprehensive understanding of the underlying contextual factors influencing women’s fertility desires, decisions, and behaviors was developed. Among the findings, we document that the health recommendations promoted during the epidemic were made without the use of best practices in health communication and without acknowledgement of the context in which the epidemic was taking place. For example, these recommendations assumed women had the power to adhere to health authorities’ directives to prevent ZIKV. Furthermore, we document how these generic recommendations ignored the unique conditions of vulnerable populations constrained by income, class, and gender. Analysis showed that participants perceived the recommendations as unrealistic, recycled, unhelpful, or not directed toward them. Case studies and pregnancy narratives illuminated major gaps in the healthcare and support provided to pregnant women during the outbreak, as well as to the mothers of children born with Congenital Zika Syndrome (CZS). ZIKV is the latest of an inevitable influx of emerging infectious diseases that are being brought on by deforestation, urbanization, and global warming. With these diseases on the horizon, it is important to acknowledge and research the underlying contextual factors that permeate these epidemics and continue to devastate the most marginalized within societies. / 1 / Jeni Stolow