The governments of many Latin American and Caribbean countries are responding to outbreaks of the Zika virus that appear to be linked to high rates of microcephaly, when a baby’s head does not develop fully. Among other actions, officials of Brazil and other nations have publicly called for women to avoid getting pregnant, since the risk to a pregnant woman is likely to be greatest if she contracts the virus during the first trimester of pregnancy.
This warning might not sound preposterous to many—but in most of these countries, the availability of contraception to avoid unwanted pregnancy is seriously limited. And access to safe abortion is rare or nonexistent due to highly restrictive criminal laws, even in cases where it’s legal. So these recommendations put a ridiculous burden on women. The Zika virus, in addition to being a widespread medical crisis, has effectively drawn attention to countries’ neglect of women’s reproductive rights in many of the affected countries.
In Brazil, health officials are operating under the assumption that there is a linkage between Zika virus and the increase in cases of microcephaly—up from 150 reported cases of microcephaly in 2014 to nearly 4,000 cases of the birth defect since October 2015. The Ministry of Health has launched an emergency protocol to deal with apparent cases of microcephaly due to Zika virus, providing guidance to health staff on early diagnosis, prenatal care to women of reproductive age, and public health care for pregnant women infected with Zika virus.
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However, this medicalized approach to a continuum of care reduces women to their pregnancies and doesn’t recognize their agency with respect to their bodies. Access to legal pregnancy termination as an emergency measure in the context of a major public health crisis is not mentioned as a legitimate option in the Brazilian protocol for women not willing to continue with their pregnancies. Right now, abortion is limited and only permitted in cases of rape, anencephaly, and to save the life of the pregnant person.
In addition, testing for the virus and for fetal anomalies is not widely available, particularly for more marginalized groups of women, who are also disproportionately lacking access to reproductive planning and effective contraceptive methods to avoid unwanted pregnancies. In Brazil, roughly half of pregnancies are unintended.
The case is much the same in other countries affected by the virus, such as Dominican Republic and El Salvador, where abortion is banned in all cases.
From a public health and human rights perspective, what would be most helpful to women and communities significantly affected by the Zika outbreak is accurate and comprehensive information, and access to rapid diagnosis and counseling on the health risks. Furthermore, there needs to be a massive overhaul in national policies: Safe abortion should be a legal option for women. No contraceptive method is 100 percent effective, so abortion availability should be guaranteed as part of comprehensive sexual and reproductive health care.
Recognition of women’s right to information and services, including safe abortion, is what is expected from governments that are accountable under human rights agreements such as the Convention for the Elimination of All Forms of Discrimination against Women (CEDAW) and the Montevideo Consensus—the outcome document of the first Latin American and Caribbean Regional Conference on Population and Development, which calls on states to effectively address women’s reproductive autonomy.
Each woman whose pregnancy is at risk should have counseling and support so that she can make a knowledgeable decision about whether or not to continue the pregnancy and have access to support either way. Unfortunately, in many Latin American countries, women’s rights to make informed choices in these circumstances are still not fully guaranteed. Women are still seen as instruments for reproduction.
The discussion around the Zika outbreak and recommendations for women is really a matter of reproductive justice and gender equality. We know that when women cannot obtain a safe abortion, they are more likely to risk their health and their lives by turning to an untrained provider or unsafe method to terminate.
This Zika epidemic will likely continue to disproportionately affect pregnant women with less access to information, those who are poor, and those who lack good quality health care. Unsafe abortion rates are likely to rise during the Zika outbreak in Brazil, and this reality cannot be ignored when governments and UN agencies meet to discuss urgent measures needed to face this global health crisis. No woman deserves to have to choose between carrying her pregnancy to term against her will—facing potentially aggravated social, mental, and physical health risks—and resorting to unsafe abortion and risking serious injury or death. This terrible choice is no choice at all; it is equivalent to torture.