The first case of Zika virus in Brazil was confirmed in May 2015. Since then the virus, which is mainly transmitted via the bite of Aedes mosquitoes (the same ones that transmit dengue and chikungunya), has spread and is already present in 26 countries in the continent.
Those infected usually are afflicted with fever, skin rashes, joint pain and conjunctivitis. More worrisome, however, is the likely link between the virus in pregnant women and microcephaly—children born with smaller heads and insufficient brain development. The report of 4,000 microcephaly cases in Brazil and Zika’s rapid spread across the continent—some three million infections are expected for 2016—along with rising numbers of Guillain–Barré syndrome cases in areas affected by the virus, led the World Health Organization on February 1 to declare the Zika epidemic a public health emergency of international concern.
The increasing cases of microcephaly have given unprecedented urgency to the debate on Latin American women’s right to access safe abortions and the enforcement of restrictive laws in the region. “It has been hypothesized that Zika causes microcephaly. But there is still no evidence of the true risk of microcephaly for a pregnant woman infected with Zika. Therefore, an abortion in that case may not be necessary,” says Fernando Althabe, obstetrician and researcher at the Institute of Clinical Effectiveness and Health Policy in Buenos Aires and one of the scientists WHO appointed as a member of the Emergency Committee on the Zika virus. “It's different if the woman already knows that she is carrying a baby with microcephaly. Faced with a diagnosis of a malformation, it is logical for a woman to consider the possibility of an abortion,” he says.
The Catholic Church, which holds great influence in the region, has made it clear that abortion, even in this case, is not an option within their institution or for Catholics. Asked about the issue, Pope Francis said last Thursday, in his flight back to the Vatican after his visit to Mexico, “Abortion is not the lesser of two evils. It is a crime. It is to throw someone out in order to save another. That’s what the Mafia does. It is a crime, an absolute evil.” Nevertheless, recalling the case in which Pope Paul VI allowed nuns in Africa use contraception for cases in which they were violated, he opened the door to the use of contraceptive methods in the context of the Zika epidemic. “Avoiding pregnancy is not an absolute evil”, he said.
“Unwanted pregnancies and access to contraceptives, particularly in highly religious countries in Latin America, are an issue. It is a matter that falls on the side of ethics and human rights,” says Marcos Espinal, director of the Department of Communicable Diseases and Health Analysis of the Pan American Health Organization. “But what we say is that the decision of pregnancy is a decision of the woman, her partner and their doctor. We advise that women talk to their doctors, tell them if you have symptoms of Zika virus. Of course, we must obey the country's laws and this should be discussed in this context.”
Abortion in Latin America
In Latin America the rules vary from extremely restrictive in nations such as El Salvador, where women have been imprisoned after deciding to undergo a voluntary abortion and, even in some cases, after suffering a miscarriage; to legal in Uruguay, where since 2012 abortion is authorized during the first 12 weeks of gestation, making the nation one of the exceptions in the region along Cuba, Guyana, Puerto Rico and the capital of Mexico.
In addition, access to safe abortion not only depends on the rules but the actual implementation of measures of sexual and reproductive health, such as the ones pointed out by the Convention on the Elimination of All Forms of Discrimination against Women. Cécile Pouilly, spokesperson for the Office of the High Commissioner for Human Rights (OHCHR), says, “The outbreak of Zika exacerbates a situation of human rights about the sexual and reproductive health in the Latin American region that was already worrisome. Even before the outbreak, the mechanisms of international human rights and the OHCHR had urged countries with laws restricting abortion to decriminalize it and ensure legal access at least in cases where there was a violation or incest or there is need to save the life or one’s health.” Additionally, Pouilly says, “in some countries that allow some legal abortions, abortion is still not available for many women, especially for the most vulnerable. Health services should always be available, accessible and affordable, of good quality and without discrimination.”
The Zika epidemic awakened a debate over an issue that has been present in the region for different reasons. “Strong restrictions are maintained by a complex combination of additional reasons than those of religious background. A key is the prevalence of beliefs, attitudes and behaviors that exacerbate the subordination of women and deny their physical and economic autonomy to decide. There is also much ignorance of the legal tools to modulate the regulation of abortion offering a balance between the protection of women's rights and interest in fetal life. This causes the debate to continue in whether abortion is allowed or prohibited, when there are many intermediate legal options, "says Paola Bergallo, a researcher at National Scientific and Technological Research Council in Argentina and the School of Law at the Torcuato di Tella University. “These regulatory options have begun to be used in countries such as Argentina, Colombia, Brazil, Peru and Mexico, where despite religious beliefs, the permissions to abort have expanded. There is still much to be done, but when you begin to separate the religious argument from the legal commitments towards human rights, restrictions begin to sag.”
Brazil's government has said it refuses to authorize abortions in pregnant women with Zika. For Bergallo, “this denial is inconsistent with the commitments undertaken by Brazil in its constitution and the human rights treaties signed by the country with regard to the rights of women. It is a decision that would not pass a test of constitutionality and could make Brazil and other countries in the region face international responsibility of the monitoring bodies of the U.N. treaty or inter-American human rights,” she says.
OHCHR’s Pouilly said that access to abortion for both women with Zika or other reasons should be considered in the context of public policies on sexual and reproductive rights. "Ensuring equal rights of women to decide the number of children and timing of them is a guarantee of a basic right,” she said. “Women must not only have access to adequate information on Zika but also the availability of different contraceptive methods, with the idea of enabling them to make decisions about whether and when they want to get pregnant,” she noted. “That countries ensure access to a wide range of contraceptive methods for women and their partners would be an important step towards the fulfillment of obligations to human rights in Latin America,” she added.
—Debbie Ponchner contributed in the reporting of this information.
Editor's Note (2/23/16): This story has been corrected to reflect the fact that the first case of Zika virus in Brazil was confirmed in May 2015. It originally reported that the virus arrived in Brazil May 2015.