Health Ministries of Latin American countries have recommended that women avoid pregnancy until 2018 due to the presumed prenatal consequences of Zika virus. This is despite a lack of sexual education in schools, limited contraceptive access, and strict abortion laws. Women attempting to adhere to this health policy are faced with cultural, religious, financial and legal barriers.
There are a growing number of Zika virus cases, currently estimated at around 1.5 million, with the majority concentrated in Brazil. Over the past twelve months, cases of microcephaly (a rare condition in which babies are born with abnormally small heads and underdeveloped brains) in Brazil have risen from less than 200 to over 4,000. It is postulated that this is a complication of Zika virus.
The issue is further exacerbated by social inequality. The poorest of women in Brazil live in regions where mosquito-borne diseases like Zika are more prone. Often these women spend much of their time working outdoors, exposed to mosquito bites. They often cannot afford to pay for safe abortions, and have less access to prenatal care where diseases may be identified in utero. These women will be the ones who end up having to care for disabled children without the level of adequate education and knowledge required to look after them.
The Zika outbreak has highlighted a dire need for comprehensive sexual and reproductive health care for all Latin Americans. The United Nations high commissioner for human rights has called for Latin America to allow contraceptive and abortion access in response to Zika. Unfortunately, cultural and religious opposition impedes the choice to prevent a pregnancy that could result in an infant with microcephaly or other neurological disorders. The Christian culture of Latin American countries has left women in a precarious position. Many women, especially of lower socioeconomic status, do not have the means to avoid accidental pregnancy or exposure to Zika, and if unwanted pregnancies occur, there are few safe options available.
Rates of abortion, including unsafe abortion, are predicted to rise in Latin America. An unsafe abortion is a procedure to terminate an unwanted pregnancy by persons lacking the necessary skills and/or in an environment which lacks the minimal medical standards. Ninety-five percent of abortions in Latin America are currently unsafe. Unsafe abortions account for 13% of maternal mortality and result in the death of 47,000 women per year worldwide.
Abortion laws in most Latin American countries are strict. Currently, knowledge that a child will suffer from microcephaly or serious neurological disorders is not grounds for a legal abortion in Brazil. However, abortions are still common. One in five Brazilian women under 40 have had at least one abortion. El Salvador, one of the countries affected by Zika virus, has some of the most severe abortion laws in the world. Abortion can result in a 40-year prison sentence regardless of whether if it is for a victim of rape, foetal anomaly, or the woman’s life is in danger. There have even been cases of women being charged with homicide for having miscarriages or stillbirths. Thus, women in El Salvador face another worry in addition to the potential consequence of miscarriage or stillbirth from Zika virus – prosecution for intentional abortion or homicide.
Conditions where demand for modern contraception and abortion are not met, like in current day Latin America, can lead to high rates of unsafe abortion. Tactics of advising abstinence have been long proven to be ineffective, and dangerous, and evidence shows us that making abortion illegal is not the solution either. If we want to prevent unsafe abortion, couples need to be provided with effective, comprehensive, accessible, appropriate and affordable family planning and sexual and reproductive health education. It has been demonstrated in various countries that when modern contraceptive methods become available and their use increases, abortion rates decrease. If women who were not using contraception but wanted to delay pregnancy were provided with effective contraception, 30% of maternal deaths could be avoided worldwide.
In a step towards the right direction, Pope Francis recently indicated that while abortion is an “absolute evil”, “avoiding pregnancy is not an absolute evil,” and may be the “lesser evil” in certain circumstances like exposure to Zika virus, indicating a potential nod towards contraceptive use.
If Latin American governments do not address the issue soon, they will be faced with increasing rates of maternal mortality resulting from unsafe abortion and a generation of disabled infants cared for by parents who lack adequate financial and educational capacity to care for them.
Sarah Borg is a junior medical doctor trained in Adelaide, Australia with a Master of Public Health from The London School of Hygiene and Tropical Medicine. She is currently working as an intern in the Reproductive Health and Research department at the World Health Organization in Geneva.