Issues of Contraception and Abortion in the Zika Outbreak

Director General Margaret Chan of the World Health Organization (WHO) officially declared the Zika virus a global health emergency Monday, February 1. Given the intense backlash from their delayed response to the Ebola crisis, it comes as no surprise that the international agency would take little time in declaring the Zika outbreak an international emergency.

CDC_map_of_Zika_virus_distribution_in_January_2016Though the disease has been seen in Africa, Southeast Asia, and the Pacific Islands for years, it was only introduced to the Americas within the last year. The first cases were seen in Brazil last May, and it has since spread rapidly to 20 Latin American countries. The lack of immunity in Latin American populations has fostered rapid transmission, while experts anticipate heavy rain from El Niño weather patterns to further catalyze the spread of this mosquito-borne illness.

Little attention has been paid to the virus in the past, as the symptoms, only experienced by a fifth of those infected, are relatively mild and rarely fatal. The main concern lies in the perceived link between prenatal infection and microcephaly, a condition that causes infants to be born with abnormally small heads and brain damage. The Director General stated that, “The experts agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven. All agreed on the urgent need to coordinate international efforts to investigate and understand this relationship better.”

Brazil, Colombia, El Salvador and Ecuador have all responded to the crisis by asking the women of their countries to avoid getting pregnant. Beyond broad issues of population management and economic development for these countries, such requests carry serious threats to the health of these women.

Latin American women are faced with limited access to viable resources to manage their pregnancies, and must frequently resort to life-threatening options to do so. It is estimated that over half (56%) of all pregnancies in the region are unintended—a direct symptom of the 23 million women who lack access to contraception and wide spread gender based violence.
Screen Shot 2016-02-16 at 10.02.36 PMFurthermore, Latin American countries have some of the most prohibitive abortion laws in the world. El Salvador is one of only six countries worldwide with a complete ban on abortions. Of the four countries currently advising against pregnancies, only Columbia allows for abortion in the case of fetal impairment (check out this interactive to learn more about abortion laws worldwide). But the fact of the matter is that, rather than stopping abortion services, these laws only push women towards unsafe abortions. Unsafe abortions represent 95 percent of the 4.4 million abortions performed in Latin America and the Caribbean each year. Women continue to seek out these risky procedures, despite that fact that roughly a quarter result in hospitalization. Worldwide, abortion remains among the top five causes of maternal mortality.

With Latin American governments pushing women towards these life-threatening operations, it remains unclear whether the WHO’s announcement will mediate or exacerbate the situation. On one hand, it seems probable that their emergency designation will incite public panic and further encourage the use of unsafe abortion services. However, on the other hand, this classification will serve to stimulate funding and action from the international community, position the organization as a global coordinator, and allow for more standardized surveillance of the virus’ spread. Additionally, the Emergency Committee has not supported the calls to avoid pregnancy, instead stating that “attention should be given to ensuring women of childbearing age and particularly pregnant women have the necessary information and materials to reduce risk of exposure.”

The United Nations High Commissioner for Human Rights has stepped in as well, asking Latin American governments to improve access to contraception and abortions. Though this request is both obvious and necessary, it has yet to be seen whether it is culturally feasible. The current lack of contraceptive use results not just from medication shortages but prominent religious aversion as well. As discussed during the recent cultural competency event, culturally appropriate interventions take bottom-up approaches and years of research and development. However, the current rate of transmission does not provide such a time frame.



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