The mosquito-borne Zika virus has been grabbing headlines across the world as this little-understood virus has been linked to a range of disturbing birth defects including microcephaly in a growing number of countries. The CDC lists 28 countries with active Zika virus transmission, most in Central and South America, and warns that the virus will continue to spread. Brazil has been hardest hit and almost 4,000 infants have been born with microcephaly linked to the virus. Yesterday various media outlets reported the first case of Zika transmission within the United States, a case of sexual transmission in Texas.
El Salvador has asked women to forego pregnancy until 2018. Many countries have declared public health emergencies, and aggressive mosquito control measures have been enacted in affected areas. Doctors and scientists are scrambling to better understand the virus and have warned that its effects may extend well beyond microcephaly, potentially causing a range of developmental delays in babies not presenting microcephaly at birth. Zika can present with few symptoms and many women may not know they have been infected.
What is notably missing from many of these government responses is discussion of increased access to birth control, reproductive education, and abortions in many affected countries. In fact, several countries affected by the Zika virus have some of the most restrictive abortion bans in the world, causing a dissonance between the government’s advice to women that they control reproduction during this outbreak while actively discouraging most methods of reproductive control. Brazilian mothers of microcephalic infants report that they are receiving little to no government support for the constant lifelong care these babies will need.
The best way to prevent unwanted pregnancy is to provide widespread and affordable access to birth control measures as well as reproductive education for both men and women. Unfortunately many countries that have complete or highly restrictive abortion bans are not providing adequate family planning services to their citizens, and some governments express a moral opposition to both abortion and birth control, leaving families with few options. Unsafe, clandestine abortions are already common in El Salvador and many women turn to sterilization as it is the most accessible, legal method of birth control available to them. Women can be investigated and imprisoned for miscarriages, and seventeen such women are currently imprisoned in El Salvador.
The Zika virus presents a unique dilemma because one bite from an infected mosquito can turn a healthy pregnancy into a pregnancy that may likely result in severe, debilitating, brain damage or stillbirth. In these instances it is imperative that these women have the option to choose a legal, therapeutic abortion, even if the Zika infection or discovery of the infection occurs late in the pregnancy. The UN Human Rights Committee recently declared that access to abortion is a human right, and the Zika outbreak underlines the importance of this declaration. Countries with restrictive abortion bans need to consider the psychological and financial impact of a generation with severe brain damage and the burden their policies will place on families, healthcare and educational infrastructure.
In the United States, Planned Parenthood will be at the forefront of the fight against Zika should it proliferate within our borders, an organization under unprecedented attack from the political right. While some governors are declining to expand Medicaid within their states and right-wing officials in Congress are fighting to repeal the Affordable Care Act, the Zika crisis serves as a prime example of a public health emergency that could cause extensive harm if these public health institutions are stripped bare. Like many public health crises, the people most likely to be impacted are those who are low income and don’t have adequate access to family planning services and health care. This is the population that Planned Parenthood, Medicaid, and the ACA serves.
The Zika virus isn’t the first disease to ignite an abortion debate. In the 1960s a rubella outbreak in the United States caused babies to be born with deafness, sight problems, heart problems, and microcephaly. The rubella outbreak caused over 2,000 infant deaths and 20,000 infants were born with congenital rubella syndrome. California passed legislation allowing for therapeutic abortions in these cases and the public discourse prompted by congenital rubella syndrome informed debates leading up to Roe vs. Wade a decade later. It has yet to be seen how the Zika crisis will inform discourse on access to family planning and abortions across the Americas, but those conversations need to start now.