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.
"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.
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."
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