“Don’t get pregnant at the moment.” That was a Brazilian medical worker’s advice to women late last year as the country struggled to contain the ongoing Zika virus epidemic, which has spread throughout South and Central America, Mexico, and the Caribbean. The dengue fever–like disease only causes symptoms in one out of every five cases, but it is thought to cause microcephaly—a rare birth defect marked by an abnormally small head and stunted brain development—in fetuses of infected mothers. Even health officials in Jamaica, which hasn’t yet seen its first case of Zika but expects the virus to arrive soon, have recommended that women there postpone pregnancy plans for six months to a year.
But pregnancy isn’t always a matter of planning. In 2002, only 51 percent of U.S. pregnancies were intended; the Department of Health and Human Services has set a goal to raise that rate to a mere 56 percent by 2020. That’s in a country where, for all the recent political efforts to stymie access to family planning services, contraception is widely accessible and affordable when compared to many of the nations where Zika is taking root.
So it’s likely that women will continue to get pregnant in the nations that are advising against it, even as the Zika virus spreads. The rate of children born with microcephaly has increased 20-fold in Brazil since the first Zika case was reported last year, and parents are protesting that the state has given them inadequate support, or none at all. Now, as many as 1.5 million Brazilians may have contracted the virus, which is still gaining momentum. What are pregnant women infected with Zika supposed to do?
Though as many as 1 million women obtain underground abortions in Brazil every year, the procedure is currently illegal except in cases of rape, threat to the mother’s life, or fetal brain deformity. Late last year, women protested a law proposed by political leader Eduardo Cunha, who seeks to impose further restrictions on reproductive health care. A sonogram could detect microcephaly in a Zika-infected fetus, and that may qualify as a brain defect severe enough to warrant a legal abortion in Brazil—but in a country that imprisons women for getting abortions and limits medical conversations about the practice, an abortion provider might be nearly impossible to find in time.
Some of the other countries currently battling a Zika epidemic make it even harder for women to terminate their pregnancies. El Salvador, for one, boasts some of the world’s most punishing anti-abortion laws, sentencing women and their doctors to up to 40 years in prison for attempting an abortion. There are no exceptions to the abortion ban; even women who have miscarriages, late-term stillbirths, or premature births are often reported to the police for abortion investigations. An estimated 11 percent of Salvadorean women who obtain an illegal abortion die from the procedure. Haiti, Honduras, and Suriname—all of which have reported Zika infections—also ban abortion without exception, as does the Dominican Republic and Nicaragua, which will likely see Zika cases soon due to their proximity to Zika-afflicted nations. Most of the other Latin American countries where Zika has spread impose restrictions on abortion, too.
Science blogger Mike the Mad Biologist suggests that Zika may become for certain Central and South American nations what rubella was for the U.S. in the mid-20th century: a birth defect–causing disease that becomes an exception to social and political barriers to abortion. Even the staunchest anti-choice crusaders found it hard to stomach the thought of forcing a woman to carry a rubella-afflicted fetus, which could arrive with permanent, life-altering conditions, to term. Thus, in the ‘50s and ‘60s, rubella became a tacit exemption from legal abortion bans and doctors’ policies against the procedure. Though its affected population was narrow, it gave the public an undeniably sympathetic case study for abortion, bringing a stigmatized act into full view and providing a stepping stone for future discussions around reproductive rights.
The Centers for Disease Control and Prevention has recommended that pregnant women in the U.S. postpone any travel to affected regions, and it advised doctors to ask all pregnant patients about their travel histories. It’s possible that the CDC came about as close as it could to suggesting infected women consider abortion: “In a pregnant woman with laboratory evidence of Zika virus in serum or amniotic fluid, serial ultrasounds should be considered to monitor fetal anatomy and growth every 3–4 weeks. Referral to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management is recommended.”
When Latin American countries’ urgings against pregnancy prove futile, their health officials may find similarly coded ways to address the likely upsurge in birth defects. But without a parallel conversation on policy, unsafe and illegal abortions may prove as great a danger to Zika-infected women as the virus itself.