RIO DE JANEIRO — Across Latin America, calls to loosen some of the most restrictive abortion laws in the world in the face of the Zika virus outbreak are gaining momentum but encountering strong and entrenched opposition.
In El Salvador, where abortions are banned under any circumstance, the health minister has argued for a revision of the law because of the dangers the virus poses to fetal development.
In Colombia, an organized movement to lift restrictions on abortion has gained allies in the government but has run into determined opposition from religious authorities. The same is happening in Brazil — and some doctors say that as a consequence, illegal, back-alley abortions are on the rise.
Nearly everywhere in Latin America, including in those countries hit hardest by Zika, women who wish to terminate their pregnancies have few legal options. But as U.N. health officials have projected as many as 4 million infections in the Americas this year, activists are pressing lawmakers to act as swiftly as possible to ease rigid restrictions.
Several governments in Latin American nations have responded to the crisis by urging women to postpone pregnancy. But the availability of contraceptives is limited, especially in rural Latin America, and church authorities in the heavily Roman Catholic region oppose their use.
“If I were a woman, had just got pregnant and discovered that I had been infected by the Zika virus, I would not hesitate an instant to abort the gestation,” columnist Hélio Schwartsman wrote in the daily newspaper Folha de Sao Paulo. Each mother should be able to follow her own instincts, he said.
Those calls have been echoed by others here in Brazil, the center of the outbreak, where the government estimates that as many as 1.5 million people may have caught Zika. It is spread mostly by infected mosquitoes, but it also can be transmitted through sexual contact. Researchers also recently detected “active” Zika cells in saliva and urine.
Brazil’s government blames the virus for a sharp increase in reports of children born with undersize heads, a condition known as microcephaly, but doctors say they are only beginning to understand the dangers posed by Zika to neurological development.
Uruguay and Cuba are the only nations in Latin America where abortion is legal and widely available. Other countries allow it in cases of rape, incest or when a mother’s life is in danger.
In Chile, the Dominican Republic, Nicaragua and El Salvador, the procedure is banned completely. All four have reported cases of Zika, according to the U.S. Centers for Disease Control and Prevention.
Other nations in Latin America, including Colombia, the country with the second-highest number of Zika cases to date after Brazil, permit abortions in cases in which the mother’s health is in danger or a fetus displays signs of a severe deformity. In Brazil, abortion is allowed if the woman has been raped, her life is in danger or the fetus has anencephaly, in which part of the brain or skull is missing.
In Colombia, a woman was allowed last week to abort her fetus at 32 weeks, the first known case of a Zika-related legal abortion in the country, according to Colombia’s leading weekly magazine, Semana. The fetus had severe cranial deformities and microcephaly, according to the report, but the mother’s decision to abort so late in her pregnancy ignited a fierce debate on social media.
Colombian officials say that 3,100 pregnant women in the country have tested positive for Zika, but they have not publicly confirmed any cases of Zika-related microcephaly.
Health Minister Alejandro Gaviria Uribe has said pregnant women infected with the virus could be allowed to have abortions under one of the country’s legal exceptions. (Pregnant women aren’t the only people who should be wary of Zika — Gaviria has linked the virus to three deaths associated with a form of paralysis called Guillain-Barré syndrome.)
“We hope Zika changes the debate,” said Silvia Plana, coordinator of the Bureau for the Life and Health of Women, an abortion rights legal aid group in Colombia.
The government says Colombia probably has 80,000 to 100,000 Zika cases, with as many as 650,000 infections possible this year.
“The pro-abortion lobby is taking advantage of this to liberalize the legislation,” said Danelia Cardona, a psychiatrist and director of the Episcopal Conference of Colombia’s Department for the Promotion and Defense of Life. She said it was inappropriate to modify legislation about “something as serious and delicate as human life” because of Zika, in the midst of what she called “a temporary and uncertain situation.”
The virus is believed to be especially dangerous to women during the end of their first trimester of pregnancy, a critical stage in the development of the central nervous system. But it is extremely difficult for doctors to detect such damage, even several months later, so granting women access to legal abortions based on an ultrasound diagnosis of microcephaly would do little to alleviate the risks of giving birth to a child with severe impairments. Brazilian activists want women who have been diagnosed with Zika to be able to terminate a pregnancy on that basis alone.
A growing concern among pediatricians is that Zika could inflict harm to developing brain tissue in other, less obvious ways than microcephaly.
That condition could be the “tip of the iceberg” of a series of neurological problems, some of which might not show up in the brain scans used to spot microcephaly, and it might not even show up for years to come, said Isabel Madeira, president of the state pediatrics society in Rio de Janeiro.
These could include epilepsy, behavioral problems and mental retardation, said Heloisa Pereira, a leading pediatric neurologist in Rio.
“It could be that these children are born with a normal head size but manifest other problems later in life,” Pereira said. “We don’t know because we haven’t had the time to monitor their development. We are confronting something new.”
Women on Web, an international group based in Canada that provides advice and medication for women wanting an abortion in countries where it is banned, said it has seen a surge in inquiries from women in Brazil.
About 10 percent of the 96,000 emails the group receives every year come from Brazil, a spokeswoman said. Normally, the group asks for a donation of $78 to $100 to send abortion-inducing drugs through the mail. Often, government customs inspectors seize the pills.
On Feb. 1, Women on Web announced that it would send the drugs free to women with Zika. Emails from women in Brazil have increased more than 25 percent.
Upper- and middle-class women can opt for safer, if illegal, abortions at discreet private clinics in Brazil, said Rebecca Gomperts, the group’s founder, but for poor women, the only option may be cheap back-alley clinics.
“We just hope that women won’t resort to really dangerous methods,” she said.
An estimated 800,000 to 1 million illegal abortions take place in Brazil every year, and about 200,000 women are hospitalized with complications from the procedure.
“Imagine the stress, the worry, the desperation of not knowing what will happen with you or the fetus. It is intense suffering,” said lawyer Sinara Gumieri, a member of Anis, a feminist group preparing a proposal to Brazil’s Supreme Court to give women with Zika access to abortion. Most of those affected are women in poorer northeastern Brazil, where the outbreak has been concentrated.
The proposal also will call for better social services for children with microcephaly and for those who care for them.
But Brazil’s powerful antiabortion lobby includes many influential female doctors and academics.
The Brazil Without Abortion movement, which claims 100,000 members across the country, has attacked the Anis proposal. Its president, Lenise Garcia, a microbiologist at the University of Brasilia, compared it to “Nazi philosophy.”
“The mentality that is behind this is the same,” Garcia said. “It is prejudice against a disabled person.”
Women who have Zika should be offered counseling and support, not an abortion they will later regret, Garcia said.
In El Salvador, where abortions are banned under all circumstances, including rape and risks to the mother’s life, women convicted of having the procedure can be sentenced to decades in prison.
But at least 100 pregnant women have tested positive for Zika there so far, and the spread of the virus has intensified the debate about whether the country should ease its blanket prohibition. The health minister, Violeta Menjívar, raised the possibility that abortion laws could be revised.
Symmes Cobb reported from Bogota, Colombia. Joshua Partlow in Mexico City contributed to this report.