The international scientific community has mobilized in response to the Zika virus outbreak, racing to find ways to contain the emerging pandemic and grappling with understanding the health risks posed by the virus.
However, the day-to-day reality of the Zika threat for women living in affected areas has not prompted similar attention or action. Despite advising women to delay or avoid pregnancy, the World Health Organization and the governments of affected Latin American countries have remained silent about the options that should be available to women who are already pregnant or who will be unable to avoid pregnancy.
Throughout most of Latin America, abortion is either illegal or restricted to a few very limited circumstances. These laws leave pregnant women with two options in response to the threat of Zika: self-source their own abortions or continue their pregnancies.
In a study that we conducted that examined the responses of pregnant women in Latin America to Zika and its associated public health advisories, we found that pregnant women may be responding to official warnings to avoid pregnancy by taking matters into their own hands.
In Zika-affected countries that issued advisories against pregnancy but where abortion is legally restricted, requests for abortion medications through Women on Web soared. As requests increased, so too did women’s desperation. Women described their fears about the risks of Zika to their pregnancies and their anxiety and outrage about the lack of help from their governments and health care systems.
For many women, the decision to end their pregnancy was made drastically more difficult by the fear caused by careless public health messaging and the absence of basic reproductive rights.
As Zika spreads to the United States, women living in the states most likely to be hardest hit, including Florida, Mississippi and Texas, face a situation that may not be so different from that of women in Brazil, Venezuela and Ecuador. Abortion access in these U.S. states has been seriously curtailed following a wave of legislation designed to close clinics.
The U.S. Supreme Court recently struck down a controversial Texas abortion law that required doctors performing abortions to have hospital admitting privileges and clinics to maintain the same standards as hospital-ambulatory services. Although women in the state will not suffer further restrictions on their access to abortion providers, women with the fewest resources still stand to be disproportionately affected by the risk of Zika.
These women are the least likely to be able to access highly effective methods of contraception to prevent pregnancy, the least likely to be able to access the medical care required to diagnose and monitor Zika infection, and the least likely to be able to access a full range of reproductive options, including abortion.
The World Health Organization, the Centers for Disease Control and Prevention, and federal and state governments cannot afford to ignore the lessons we have learned from the experiences of Latin American women caught up in desperate situations by the growing pandemic of Zika virus.
Issuing advisories against pregnancy to women who are already pregnant or who lack the means to avoid pregnancy is irresponsible public health practice and unjust policy. Health organizations and governments must act now to prevent perpetuation of the same fear and injustice in the United States.
In the midst of the distress and confusion, women in the U.S. and Latin America are experiencing two messages that stand out clearly. The first is that there is a need for timely and accurate information about the risks of Zika virus in pregnancy. The second is that women must be supported by national and international health organizations and governments to obtain safe, legal abortions through their own health care systems. To uncouple advice about avoiding pregnancy from reproductive choice will only harm rather than improve overall health.
Abigail Aiken is an assistant professor at the LBJ School of Public Affairs at The University of Texas at Austin. Catherine Aiken is an academic clinical lecturer in maternal-fetal medicine at the University of Cambridge.
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