Part of my day job is keeping track of outbreaks of infectious diseases, and I have to tell you I am losing sleep over the emergence of the Zika virus. Zika is a mild illness related to Dengue Fever which is caused by the bite on an infected mosquito. 80% of people who contract the disease are asymptomatic, and those that do have symptoms recover quickly. Cases reported in the United States were thought to have been contracted in South America, and it is not expected to become a serious problem here.
In Brazil, however, Zika is thought to be causing serious birth defects. Women who contract Zika during the first trimester of pregnancy are thought to have an increased risk of giving birth to baby with microencephaly, characterized by a smaller than normal head, moderate to severe brain damage, and even death. Nearly 4000 cases of this condition have been reported in Brazil since October in a country that saw only 150 cases in all of 2014.
Management of this crisis must take multiple forms. Vaccine research is already underway and increased mosquito control programs are also in the works. Meanwhile, Brazil (along with Colombia) has advised that women simply do not get pregnant.
In this heavily Catholic country, access to birth control has increased a great deal over the last decade. Just this past May, the government announced that oral contraceptives would be available at reduced cost without a prescription in both private and government run pharmacies.
How available these pills are to the poorest of Brazil’s women who are more likely to be exposed to the elements including infected mosquitos is unclear. What we do know is that some Brazilian women will become pregnant over the next few years, and some of them will have been infected with Zika.
Abortion in Brazil is legal only in the case of rape or to save the life of the mother or if the fetus has a rare birth defect called anencephaly. Like microcephaly, anencephaly affects brain growth, but is considered incompatible with life. Even with these exceptions, information about legal abortions is hard to come by, and finding a provider is even more difficult. Only about 3000 legal abortions are performed annually.
Nonetheless, abortion is actually more common in Brazil than in the United States with more than 1 million performed per year. That’s a lot of illegal abortions. Despite the growing black market for safer pharmaceutical abortificants, back alley abortions remain dangerous. It is estimated that a Brazilian woman dies from an illegal abortion every 4 days.
Whether or not you believe that abortion in the case of severe birth defect is a moral choice, rest assured, it’s already happening. We can expect the maternal death rate from abortions to go up from here. The question is just how bad will it be? Letting women bleed to death who feel unable to care for a severely handicapped child is not a solution.
If the Brazilian government is serious about preventing a generation of brain damaged children and an increase in illegal abortions, cheap pills are not good enough. Long term forms of birth control such as implants and injections must be offered to all women, especially those with little access to even basic medical care.
As these children continue to be born and need care, taxing the current medical and social services systems, will attitudes towards abortion change? In the United States, many medical personnel who were on the fence about abortion in the 1970’s became more sympathetic after witnessing birth defects in children born to mothers who had contacted Rubella, which like Zika caused severe and often fatal birth defects. Abortion suddenly became a compassionate choice.
It will take several years to fully realize the effects of Zika on the women of Brazil, their children, and the choices they must face. I have no idea what I would do if I found myself pregnant under the threat of Zika. I only know I would want to have choices. The women of Brazil as well as the other 20 affected countries deserve choices too.