The Zika virus is spreading like wildfire across the Americas, and with it, a hard but imperative conversation about women’s health care.
The presence of Zika is now confirmed in more than 25 countries, and the virus is suspected to be linked to a rise in microcephaly, a condition where babies are born with abnormally small heads. The connection is so far unconfirmed, but the Zika epidemic has led to global concern and a declaration of international emergency from the World Health Organization.
The epidemic has also led to the exposure of another serious threat to public health: the denial of women’s reproductive rights. The reported spike in microcephaly among infants in regions most affected by Zika led the governments of Brazil, Ecuador, Colombia and El Salvador to issue advisories for women to delay pregnancy for months (or, in El Salvador’s case, until 2018).
Such recommendations have renewed controversy surrounding access to contraception and the legality of abortion in the Zika-infected countries that are predominantly Roman Catholic; but these conversations are far from new.
“We’re talking about issues that have been around for a long time,” said Diane Bushley, global program manager at Planned Parenthood of the Great Northwest and the Hawaiian Islands, in an interview with Humanosphere. “But the potential association between Zika and microcephaly, and other problems that could occur during pregnancy … is really highlighting these issues.”
Latin America’s abortion laws are among the world’s most restrictive. Across all 25 countries where Zika has been confirmed, only Guyana and French Guiana permit abortion without restriction. In Brazil, where the Zika outbreak has hit the hardest, abortion is currently allowed only in cases of rape, danger to the woman’s life, or in the case of fetal anencephaly (the absence of a major portion of the brain).
Abortion is banned in all circumstances in the Dominican Republic, El Salvador and Nicaragua, according to a recent report by the Kaiser Family Foundation. Six others – Guatemala, Haiti, Honduras, Paraguay, Suriname and Venezuela – allow abortion only to save a woman’s life.
Even so, women across the continent had around 4.4 million abortions in 2008, 95 percent of which were considered unsafe, because they were performed by people without adequate training or in an environment that didn’t meet medical standards, according to the Guttmacher Institute, a U.S.-based nonprofit that researches family planning. Because of situations like these, 760,000 women in Latin America and the Caribbean are hospitalized due to complications from unsafe abortions every year, and an appalling 9,000 women die in childbirth.
Another barrier for women’s health is that basic contraception can be expensive and difficult to access across the region. According to Kaiser’s report, which surveyed 18 countries across Latin America and the Caribbean, Haiti has some of the worst access to contraception, with 62 percent of women of reproductive age lacking access to birth control (although that number in Nicaragua, which fares the best in terms of access to contraception, is just 20 percent).
This lack of access is not due to an inability to deliver these services, but to a lack of political will and coordination.
“Sometimes there are problems at the national level with having these methods available,” Bushley said. “So when we talk about supply chain management of contraception, there can be breakdowns at lots of different levels in terms of getting contraceptive methods into the country, getting them out into the hospitals, the clinics, and then way out into the communities.”
According to the Kaiser report, in 2015, clinics in five countries – the Dominican Republic, El Salvador, Guatemala, Haiti and Honduras – simply ran out of contraceptive supplies. But even when contraceptive resources are available, they may not be being utilized by the women that need them the most.
“One barrier is just even being aware that contraception exists, or what types of methods are available,” Bushley said. “In many countries in Latin America… there tend to be some misconceptions about the side effects of contraceptive methods, which is another barrier.”
Women’s health care is in desperate need of reform across Latin America, but activists hope that if anything good is to come out of the Zika crisis, it will be a wake-up call for governments across Latin America.
“We can no longer afford this state of denial. Urging women to avoid pregnancies indefinitely is not a realistic solution to a public health problem; access to family planning information and services plus safe and legal abortion is what women want and need.”