Current recommendations for women to delay or avoid pregnancy are unfair and unrealistic. In many areas hit hardest by Zika, women have limited access to contraception; there are, moreover, high rates of unplanned pregnancy worldwide. Preventing pregnancy may be the right course for some women, and preventing Zika in women before they get pregnant is critical. But these responses cannot be the whole answer. If we are serious about addressing the devastating impacts of Zika on normal brain development (Zika congenital syndrome), we must consider all approaches to preventing infection during pregnancy. This will require, at the very least, conscientious consideration of the role of pregnant women in the vaccine development agenda.