February 4, 2016 - LATIN AMERICA - When Brazilian health official Claudio Maierovitch in December first
raised the idea of asking women to delay their pregnancies because of
the Zika virus, it came as a shock. Women rights groups decried what
they saw as unprecedented government meddling in what should be a
private matter. Doctors questioned the practicality of the advice. And
some political experts took it as a desperate sign that the country
lacked a coherent strategy to fight the rapidly spreading virus.
But
then Ecuador followed suit. And Colombia, Jamaica and El Salvador. El
Salvador's plea was the most drastic: asking women to avoid becoming
pregnant for a full
two years, until 2018.
The situation has left many women in the region struggling with what to do.
Latin
America is where the virus — suspected of causing babies to be born
with a condition called microcephaly, which results in unusually small
heads and brains — is most prevalent. It is also predominantly Roman
Catholic, and getting access to modern birth control methods like
condoms and pills can be a challenge.
 |
Transito de Los Angeles Vasquez, 30, has her
prenatal check-up at the National Hospital for Women in San Salvador, El
Salvador, on Jan. 29. In the
Central American nation, authorities have
urged women to put off pregnancy for two years. (Salvador Melendez/AP) |
"There is a lot of fear
about Zika and pregnancy, but women don't have a lot of options even if
they have a desire to comply with the advice," Joshua Michaud, associate
director of global health policy at Kaiser Family Foundation, said in
an interview.
Then there are the women who are already pregnant. "I'm afraid that my baby could have some problem,"
Kerly Rocio Ariza,
17, told the Associated Press. Rocio Ariza, from Colombia, is about
five months pregnant and diagnosed with Zika. "It terrifies me, because
I've seen the symptoms I had on TV, and in truth, they told me it was
dangerous."
In Ecuador, Maria de Jesus Rivera expressed similar
sentiments to the AP. "We're afraid," she said. "We want the child to be
born healthy with no problems of any kind."
Experts have
speculated that places like Colombia — where the Zika pathogen-carrying
mosquitoes are believed to have arrived about five months after showing
up in Brazil — could see the explosion of a "time bomb" of microcephaly
cases in the coming months. Up to 650,000 Zika infections are expected.
“Colombia
will tell us a lot,” said Marcos Espinal, director of communicable
diseases and health analysis for the Pan American Health Organization.
 |
Germana Soares puts socks on her 2-month-old
son Guilherme Soares Amorim, who was born with microcephaly, at her
house in Ipojuca, Brazil, on Monday.
(Ueslei Marcelino/Reuters) |
That terrifying idea has renewed conversations about abortion in the region,
despite the fact that scientists have emphasized that they have not yet
found a definitive link between Zika and fetal deformities and that
it's often impossible to tell how severe the impact of the deformity
will be early on.
Some children with the condition could grow up
with minimal delays and intellectual impairment, an outcome that has
been emphasized in recent days by Brazilian journalist Ana Carolina
Caceres, who wrote in an essay for the
BBC
that she was diagnosed with microcephaly at birth. She said her doctors
told her parents she would never walk or talk and be "in a vegetative
state until she dies," but that with lots of therapy she has managed to
live a normal life.
Countries like El Salvador, the Dominican
Republic and Nicaragua don't allow abortion under any circumstances
while others like Brazil, Venezuela and Guatemala are highly
restrictive, meaning they only allow it if the mother's life is in grave
danger. An analysis of Michaud and his colleagues of abortion policies
and contraceptive prevalence shows just how few choices women may have
if they are infected with Zika while pregnant. (In the table below,
modern methods of contraception include condoms and birth control pills
while the "any" method category also includes withdrawal.)
The situation has created a worry about black-market abortions.
"Those
who can afford to will be able to find a clinic. Those who don't may
run the risk of submitting to an alternative intervention that could put
the woman at risk of infection or even death," Maria Luiza Bezerra
Menezes, president of the Society of Obstetricians and Gynecologists in
Pernambuco state in Brazil, told the
Telegraph.
In
Colombia, the health minister has broached the topic head-on, saying
that a confirmation of Zika infection and possible microcephaly may
allow women to qualify for abortions, which might otherwise be illegal.Michaud
and other experts said that despite questions about the practicality
and ethics of the efforts to delay pregnancies, they make some sense
from an epidemiological standpoint. That's based on the assumption that
the birth defects are linked to the mother having an active Zika
infection while carrying the baby.
At this moment, many countries have
a population that has never been exposed to Zika, so no one or very few
are immune and could become infected at any time.
"This is the
most dangerous position to be in right now," Michaud said. "You have
widespread vulnerability, and the mosquito vectors are spreading
readily."
But the reasoning goes that after a wave of mosquitoes
goes through a country, as has happened in Brazil, many women will have
already been bitten and become infected, triggering the creation of
antibodies. So if they get pregnant in the future, the virus will have
no effect on them or their babies. That's a lot of "ifs," but health
officials in countries that have issued advisories have said it's the
best they can do until they know more.
Lost in a lot of the worry about Zika is the impact such a delay in pregnancies would have on societies. Uri Friedman at
the Atlantic
wrote that if the outbreak lasts one or two years, "it may produce an
enduring 'hole in the age structure'," but that couples would compensate
for it by having more children later.
However, if the epidemic lasts five or more years, that calculus could change dramatically, he said:
In
that (very hypothetical) scenario, a significant portion of the women
who postponed getting pregnant during the health crisis will be over the
age of 35, when pregnancies carry a higher risk, and some of these
women “will not have the possibility to have more kids.” That drop in
the birth rate might not be canceled out by a subsequent rise, leading
to a substantially smaller generation than otherwise would have emerged.
Such
a shift in the age structure could present problems in Latin America,
where the informal economy is massive and people tend to not save much
money for the future. As a result, the elderly often depend more on
material support from their kids and grandkids than on inadequate
pension and social-security systems.
Maria
Erlinda Guzman, 34, is one of those, because of Zika, whose hopes of
motherhood have been overwhelmed by fear. She had been trying to
conceive a child, but now plans to use birth control and worries she may
be too old by the time it's safe, she told the Associated Press.
"I'm going to be left childless." - Washington Post.
