What Happens When Countries Without Abortion Advise Against Pregnancy?


Some women will be faced with a heartbreaking decision; some may not have any choice at all. (Photo: AP Images)

Thursday morning, the World Health Organization (WHO) announced that it is calling an emergency meeting to start building solutions to stop the spread of the Zika virus, the mosquito-borne illness that can cause a brain defect called microcephaly in babies born to infected mothers. According to the Mayo Clinic, while some children with microcephaly are of normal intelligence and development, even though their heads will always be small for their age, many children with the condition will experience speech and motor developmental delays and could even be born with dwarfism or forms of mental retardation.

The WHO said today that the virus is “spreading explosively” across all the Americas.

Presently, cases of actively transmitted Zika virus have been reported in Barbados, Bolivia, Brazil, Colombia, the Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, the U.S. Virgin Islands, and Venezuela in the Americas, as well as Samoa in the Pacific Islands and Cape Verde in Africa.

Related: Do Pregnant Women in the U.S. Need to Worry About Zika Virus?

According to a spokesperson for the American Congress of Obstetricians and Gynecologists (ACOG), Zika testing is not yet commercially available. The CDC recommends that women in the U.S. who believe they may have contracted Zika virus work with their doctor to be referred to an appropriate state health department to facilitate testing.

In El Salvador, where the Zika virus is being actively transmitted (unlike the U.S.), there are very limited options. In El Salvador, abortion is completely illegal, with no exceptions of any kind. Per a 2011 United Nations report, El Salvador is one of the six countries in the world that deny abortions under any circumstances.

A report by the Center for Reproductive Law and Policy states that 51 percent of the total population of El Salvador are women and that 53 percent of Slavadoran women use some form of contraception. While contraception is legal in El Salvador and 97.8 percent of Salvadorans between the ages of 15 and 44 were familiar with at least one form of contraception, because of the limited access to health care in the country, the most common form of contraception in the country is female sterilization, a method employed by 20.8 percent of Salvadoran women of reproductive age. Only 5 percent of women use oral contraceptives, 2.2 percent of women use injectable contraceptives, 1.3 percent of women use intrauterine devices, and another 1.3 percent of women use male condoms.

Zika virus is transmitted only via the Aedes aegypti mosquito, which does not survive in all parts of the U.S. And at this point, Zika is not actively spreading within the U.S.

For women in the U.S. who do test positive, the ACOG and the CDC both recommend “serial ultrasounds” every three to four weeks to look for microcephaly — though one challenge, says an ACOG spokesperson, is that microcephaly is traditionally seen later in pregnancy. ACOG points to one recent study that had a mean of 28 weeks of gestational diagnosis; thus, pregnant women in the U.S. who are diagnosed with Zika virus and wish to terminate a pregnancy must live in a state that does not have restrictions on abortion after 20 weeks.

The ACOG recommends that pregnant women in the U.S. diagnosed with Zika virus who do elect to keep a pregnancy seek care in a hospital with high levels of neonatal intensive care for delivery.

According to the Guttmacher Institute, 43 states prohibit some abortions after a certain point in pregnancy, 21 states impose prohibitions at fetal viability, and three states impose prohibitions in the third trimester. Furthermore, 19 states impose prohibitions after a certain number of weeks, and 11 of these 19 states ban abortion at about 20 weeks post-fertilization (or its equivalent of 22 weeks after the woman’s last menstrual period) on the grounds, not confirmed by scientific evidence, that the fetus can feel pain at that point in gestation. In other words, a woman who has contracted Zika virus while pregnant and does not get a confirmation of her fetus’s having contracted microcephaly until well into her third trimester is left without the choice to terminate in many places throughout the U.S.

Related: What to Know About the Zika Virus If You’re Trying to Get Pregnant

An ACOG spokesperson emphasizes that mosquito repellents with DEET are safe for use during pregnancy, so if you are traveling to an affected area while pregnant, be sure to stock up and apply regularly.

“There are many potential health risks related to pregnancy, which is why Planned Parenthood Global asserts that comprehensive sexual and reproductive health services must be a central part of the response to the Zika crisis,” Dee Redwine, Latin America regional director of Planned Parenthood Global, said in a statement today. “Governments cannot on the one hand discourage pregnancy while at the same time limiting their commitments to and funding for family planning and access to safe and legal abortion. 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. … Communities all over the world must have the tools, the information, and the services to live the lives they choose.”

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