Approaching this issue from a reproductive health perspective the absence of ‘men’ as a site of intervention is rather striking in the recommendations that have come from a number of countries that women should refrain from getting pregnant, with durations varying from a few months to up to two years. This advice assumes a level of control in reproductive decision-making that many women simply do not have. Although in many of the affected countries some forms of contraceptives are legally permitted, in practice they can be incredibly difficult to access. The women who face the greatest difficultly are often single women, poor and marginalised women, young women, and particularly women from rural areas. The International Planned Parenthood Federation (Western Hemisphere Region) recently stated that an estimated 23 million women have unmet contraceptive needs within this region alone. So it’s essential to bear in mind that particular women are simply unable to access the contraceptives that might give them some degree of choice in their reproductive decision-making. If we couple that with the fact that sexual violence, including rape, is widespread in much of the affected region, and that it’s estimated that over half of all pregnancies within the region are unplanned, it then becomes somewhat obscene, in my opinion, that governments are suggesting that women alone bear the brunt of this responsibility.
This raises two further problems. First of all, what happens to the thousands of children that will likely be born with microcephaly and other neurological disorders? Who will be responsible for them? Many of the women and families who have been worst affected by this are from very poor backgrounds. What services are going to be provided for them? To what extent is the state going to support them? What kinds of lives will these families be facing, and what kind of financial, political and social stigmas might the coming years entail for them? And the second issue is around access to abortions, and the fact that the affected region has some of the most restrictive abortion legislation in the world. In Colombia, the country worst affected by the Zika virus after Brazil, abortion is incredibly difficult to access. In El Salvador, where women are being advised to not get pregnant for two years, abortion is completely illegal. Of course, that does not mean that women are not seeking and obtaining abortions. Recent research suggests that one in five Brazilian women have had an abortion by the age of 40. It is estimated that around 1 million women obtain illegal abortions every year in Brazil. More affluent women can pay for abortions in reasonably high quality clinics or they can travel to countries where abortion is more easily accessible. But clearly this is impossible for the vast majority of women who are forced to use unsafe measures, such as swallowing toxic substances and inserting foreign objects. In 2014, 200,000 women were hospitalised in Brazil due to unsafe abortions, because their options are so limited. And again, the same populations are affected – poor, marginalised women and girls, reflecting broader social and political inequalities. In Brazil, for example, black women are two and a half times more likely to die due to complications relating to unsafe abortion than white women. And even in places where abortions aren’t completely illegal, many doctors are refusing to perform them either on moral grounds or for fear of prosecution.
Activists and lawyers in Brazil are currently seeking to make an exception in abortion legislation for cases of Zika virus and microcephaly, similar to the Supreme Court ruling on access to abortions in cases of anencephaly. Of course, it should be noted that anencephaly and microcephaly are significantly different conditions, and the optimism that the Supreme Court will automatically follow suit in the case of microcephaly and the Zika virus should perhaps be somewhat restrained. It should also be noted that as recently as December last year, a new bill was introduced in Brazil to make the abortion laws even more restrictive, particularly in cases where women have become pregnant as a result of rape. Clearly there isn’t a strong political will to reform reproductive legislation to make it more accessible. That said, a number of commentators have drawn parallels between the Zika virus and the rubella outbreak in the US in the 1960s, and the ways in which it opened up space for discussion and negotiation around reproductive health and access to abortions. Women on the Web, an online collective that provide consultations and, where appropriate, abortion pills for women who live in countries where abortion is restricted, have already noted an increased demand for abortion pills within the affected region, suggesting a broader increase in the numbers of women seeking illegal abortions. At this point, it’s unclear, to what extent this ‘other’ health emergency – this large number of women who are seeking unsafe, illegal abortions – will also be addressed by this outbreak.
Lucy Lowe is a medical anthropologist working in maternal and child health, and fertility issues.