How the Zika Virus Exacerbates Abortion Access Problems for Women
As weather warms up and mosquitoes awaken, the Zika virus panic grows — but what many don't know is that not too long ago there was a similar outbreak that put pregnant women in its crosshairs and abortion rights in the spotlight.
Dolores Stonebreaker caught the Rubella virus from her 12-year-old son, breaking out into the same rash he had a few days earlier after coming home from school. It wasn’t a terrible illness, as far as illnesses go; both mother and child were fine a few days later. But then Dolores found out she was pregnant, and the then-two-week-old embryo inside of her had been exposed to the virus, too.
Stonebreaker, like many women in the 1950s and 1960s, contracted the Rubella virus within the first month of her pregnancy, which meant her fetus had a 50 percent chance of being born with deafness, blindness, heart defects and mental disabilities. Because of this increased risk, her doctor advised her to have an abortion.
Life magazine told Stonebreaker’s story in its June 4, 1965, issue. At the time, abortion was illegal throughout the United States, but doctors at her California hospital went ahead with the minor procedure anyway. Many women, however, did not have a choice in the matter. Often, their doctors would make the decision for them by keeping important information about Rubella’s effects on early pregnancy from them, or by subjecting them to the whims of (mostly male) hospital review boards.
Over half a century later, pregnant women who may have been exposed to Zika virus in Latin American and Caribbean countries — where strict laws permit abortions only in specific cases, if at all — are being subjected to the same lack of choice. And as the weather warms and the mosquitos that can carry Zika begin to awaken in the United States, the women here might not have much of a choice, either.
Scientists have known about Zika virus since the 1950s, but the first major outbreaks occurred in 2007 in the Micronesian island of Yap and in Tahiti in 2013 and 2014. The virus can be passed to humans by two species of mosquitos, Aedes aegypti and Aedes albopictus, although there have also been some cases of sexual transmission. According to the Centers for Disease Control and Prevention, while some people develop a rash, fever, joint and muscle pain and red eyes, most people who are infected show no signs.
Researchers became concerned when people who had been infected with Zika in Tahiti began presenting the neurological symptoms of Guillain-Barre Syndrome, which causes muscle weakness and paralysis as the immune system attacks a person’s nerves. A recently published case-control study seems to have confirmed the association.Then, a 20 percent uptick from 2014 to 2015 in the number of babies in Brazil born with microcephaly — which causes the child’s head to be smaller than normal and may, in turn, cause cognitive and motor impairment — became cause for more concern about Zika virus.
The link between Zika virus infection in a mother and microcephaly in her fetus hasn’t yet become conclusive. But new studies have added to the evidence that seems to suggest a relationship. Researchers recently showed that Zika virus was able to infect and change the development of brain cells in a dish in a study published in the journal Cell Stem Cell. Another study published in the New England Journal of Medicine used ultrasounds to examine pregnant women and their fetuses in Rio de Janeiro. The fetuses of 29 percent of the women who were proven to have Zika virus also showed abnormalities in both their physical growth and central nervous system development. None of the fetuses of the women who tested negative for Zika in that study had abnormalities detected by ultrasound.
Despite the association not being fully proven, Margaret Chan, director general of the World Health Organization (WHO) said recently, “Strong public health actions should not wait for definitive scientific proof.”
Unfortunately, most of the public health actions the governments in the region are taking include advising women to just avoid getting pregnant, with little information or resources as to how women should do so.
“I think this is a good opportunity to talk about access to emergency contraception in the region. It is also important to talk about safe and legal abortion for those who want to pursue that option,” said Giselle Carino, deputy regional director of the International Planned Parenthood Federation-Western Hemisphere Region. “Both the response of the government and the response of the global health institutions has been quite limited in that regard.”
Officials in Brazil and Ecuador (where abortion is illegal except in cases of rape or to save a woman’s life) proposed women avoid pregnancy indefinitely. El Salvador (where abortion is illegal with no exceptions) recommends women wait until 2018.
And because there are 425 million Catholics in Latin America according to the Pew Research Center, the church’s stance on contraceptives and abortion has also served as an important factor in women’s decision-making process and public policy makers’ actions. At a press conference in February, Pope Francis said that “avoiding pregnancy is not an absolute evil,” although abortion still is, in his eyes.
Women’s reproductive rights activists and other advocacy groups do not see these sorts of public policies as being reasonable or practical, especially because contraceptives are not always easily accessible in Latin American and Caribbean countries. A recently released Kaiser Family Foundation report showed that the rate of women in 18 Zika-affected countries who use any contraceptive method ranged from an average of 37.8 percent in Haiti to 79.5 percent in Nicaragua. In the seven countries that make contraception accessibility data availability, supply did not meet demand in five of them.
It’s important to keep in mind that the aforementioned contraceptive usage rates are just averages; women in rural areas and women with fewer financial resources have a more difficult time accessing contraceptives and safe abortion, according to MÃ³nica Roa, vice president of strategy and external relations at women’s rights organization Women’s Link Worldwide.
“In reality, you have women with money and women without money, regardless of what the law says. Women with money can access safe abortion; women without money cannot,” Roa said.
An astounding 95 percent of the abortions performed in Latin America were unsafe, according to the Guttmacher Institute.
“We fear that unsafe abortions might increase mostly because women already are affected who tend to suffer the most anyway for the lack of contraception, the lack of education and the lack of information,” Carino said.
The reproductive rights situation in the United States is beginning to mirror that of Latin America, and we are not immune to Zika virus. The warming of spring will bring with it an opportunity for mosquitos here to hatch and grow. If a human has enough of the virus in their blood and is bitten by a mosquito, that mosquito can pass the virus to another human and so on, causing an outbreak.
It’s uncertain whether the United States will become endemic to Zika, especially because a large number of Americans have the air conditioning or screened windows that allow them to avoid mosquitos, but it is certainly possible.
And the regions where these mosquitos that carry Zika virus are native happen to coincide with states that the Guttmacher Institute named “Very Hostile” toward abortion, meaning there are six to 10 restrictive laws on the procedure. If Zika begins actively spreading in U.S. states where waiting periods and closing clinics force women to experience undue stress to practice their constitutional right to an abortion, we will have a public health crisis on our hands, as well.
The effects of Rubella on pregnant women’s fetuses brought about a change in how Americans thought of abortion and reproductive rights, and some argue that it partly ushered in the Roe v. Wade and Doe v. Bolton decisions that led to nationwide decriminalization of abortion in 1973.
Our country is beginning to look similar to how it did then in terms of abortion access. Eight of the 10 states where people Google searched for self-induced abortions most are hostile or very hostile to abortion, according to the New York Times. Mississippi, which only has one abortion clinic left, had the most searches.
When asked about how countries in Latin America could make reproductive rights a priority not only in the emergency response to Zika, but also for the future, Roa said, “It’s important to have a chain of reproductive rights that starts with sexual education, access to contraception, attention to health care for victims of sexual violence, access to abortion and safe motherhood.”
The same could be said for those of us in the United States.
Pregnant women who are infected with Zika must be supported in whatever the choice they make. As University of Illinois professor Leslie Reagan writes in her book Dangerous Pregnancies during the Rubella crisis, many women who gave birth to children with congenital Rubella syndrome lacked the financial and government resources to care for their children. Many doctors told parents to institutionalize these children, and public schools at the time were not required to provide equal access to education for children with disabilities.
“Women that decide to have babies with microcephaly say that their babies haven’t received treatment yet,” Roa said. “So we’re telling women that they have a choice and they can decide to give birth, but that choice has to be real.”