By Beatriz Galli and Christine Ricardo
Like other mosquito-borne viruses, Zika thrives in areas with substandard sanitation and infrastructure—which are directly linked to state failures to ensure the basic human right to an adequate standard of living. Until recently, the Zika virus was thought to be relatively harmless, usually only causing mild symptoms. But in October 2015, Brazil reported a concurrent increase in the number of babies born with unusually small heads, a condition known as microcephaly. Almost immediately, governments and public health officials began to ask women to delay their pregnancies, seemingly without considering the ethical or practical implications of such advice, and with hardly any effort to bolster sexual and reproductive health policies and services.
The evidence on a link between Zika and fetal development is becoming increasingly persuasive. Earlier, in late March, the World Health Organization declared that there is “strong scientific consensus” that Zika virus is a cause of microcephaly as well as other neurological disorders.
One study in particular has drawn much attention: using mathematical modeling based on a recent outbreak of Zika in French Polynesia, the study estimated that women who are infected with Zika during the first trimester of pregnancy face a 1 in 100 chance that their fetus will develop microcephaly. The modeling was based on only eight identified cases from the French Polynesian outbreak and did not take into account other complications that may be associated with Zika. As the study authors themselves explained, the study is only one more piece in the puzzle and not intended to be “the end of the story.”
But no sooner had the study been published then various anti-choice voices exploited the information to criticize on-going efforts in Brazil and elsewhere to lift abortion bans. The rationale was that a 1 in 100 risk was sufficiently “small” that it did not justify allowing for a woman to decide whether or not to continue a pregnancy.
There are, however, significant fallacies in these criticisms.
First, the French Polynesia study is based on only one outcome—microcephaly. There is increasing evidence, however, that Zika infection may in fact cause a wide range of complications. In a study involving 42 pregnant Brazilian women who tested positive for Zika, researchers found that 29% experienced a range of “grave outcomes” that included fetal death, shrunken placentas, and fetal nerve damage, including potential blindness. The same study also found that effects were associated with infection at various stages of pregnancy, not just the first trimester.
The estimated risk from the French Polynesian study does not thus reflect the full range of risks that women in Brazil and other countries in the region are currently facing.
But, even more importantly, anti-abortion arguments miss an essential point: risk perception is not something that can be generalized. It is something that is, in and of itself, extremely personal and contextual. In the face of a Zika infection and its many uncertainties, each individual woman’s perception of the possible risks to her fetus will be dependent on her own particular life circumstances and plans, including her disposition to bear the psychological and emotional strain of possible pregnancy and fetal complications, and her willingness and/or capacity to continue the pregnancy to term.
Whatever the statistical risk for a particular pregnancy, each woman has the right to decide on her own level of acceptable risk. The role of the state, of service providers, of policy makers, is simply to ensure that information is provided in accessible, non-judgmental ways so that women—together with partners, if women so wish—can make informed choices for themselves and their families.
Reproductive rights are fundamental human rights that have been recognized by international, regional, and national legal frameworks, standards, and agreements. In responding to Zika, states must be accountable to their obligations to all affected women. They must ensure women’s rights to autonomy and self-determination—including the right to the necessary information, counseling, and services to have full control over their bodies and reproductive lives, be it to access quality prenatal care, or to prevent or end a pregnancy.
In response to Zika, the United Nations High Commissioner for Human Rights has publicly called for Latin American countries to liberalize access to comprehensive sexual and reproductive health services, including abortion on demand. WHO has advised that “[a]ll women, whatever their individual choices with respect to their pregnancies, must be treated with respect and dignity.”
Unfortunately, most governments have not yet stepped up. Brazil, the country that has been hit hardest by Zika, has not yet adequately addressed the legal and socio-economic constraints that affect women’s health and access to care. The Ministry of Health’s guidelines on Zika, for example, are shamefully silent on the issue of abortion, failing to acknowledge that unsafe abortion is a public health reality in Brazil and one that might potentially worsen as a result of Zika and its uncertainties.
It is time for accountability and for concerted action. Millions of women in Brazil and throughout Latin America have already been living with constrained choices regarding their reproductive lives—Zika has further aggravated their situations. Given the unprecedented public health crisis, we must act urgently to hold states accountable and ensure rights-based health systems and policies respect women’s autonomy to make decisions about their bodies and lives.
Beatriz Galli is Senior Regional Policy Advisor for Latin America, Ipas
Christine Ricardo is Clinical Fellow, Yale Global Health Justice Partnership