The research, published on Wednesday as a letter in the New England
Journal of Medicine, is the first to measure the response of
pregnant women to Zika warnings in countries where abortion is
limited or banned. First detected in Brazil last year, the current
Zika outbreak has been linked to more than 1,400 cases of
microcephaly, a rare birth defect that can lead to severe
developmental problems.
As the Zika virus spreads through Latin America, several countries,
such as El Salvador, advised women to avoid pregnancy, even if their
access to birth control or abortion was restricted. The World Health
Organization also recently advised couples living in areas with Zika
transmission to consider delaying pregnancy.
"When you issue these kinds of advisories, but you uncouple them
from pathways to safe and legal care, you create a really difficult
situation for women," said study co-author Dr. Abigail Aiken, a
reproductive health expert at the University of Texas at Austin.
Aiken and colleagues analyzed requests for abortion services from
Women on Web, a nonprofit that provides access to the abortion
medications mifepristone and misoprostol, as well as online
consultations to women in countries where legal abortion is limited.
The group offers the pills in the first 10 weeks of pregnancy to
induce a miscarriage.
The researchers compared abortion requests made after Nov. 17, 2015,
when the region was first warned about Zika's potential risk of
birth defects, with expected requests to this same group based on
five years of prior data.
They found statistically significant increases in abortion requests
in seven out of eight countries where Zika is circulating, abortion
is limited and the country had warned about the risk of Zika in
pregnancy.
Requests for abortion medication between November and March 2016
doubled in Brazil, where abortion is outlawed except in cases of
rape, when the mother's life is at risk or the child is too sick to
survive. Requests rose by 35.6 percent in El Salvador, 36.1 percent
in Costa Rica, 38.7 percent in Colombia, 75.7 percent in Honduras,
93.3 percent in Venezuela and 107.7 percent in Ecuador.
Jamaica, where women had been advised to avoid pregnancy even before
Zika transmission was ever confirmed, was the only country in this
group not to see a major increase.
"Many of these women felt underinformed and very scared," Aiken
said, based on an analysis of women's emailed comments to the group.
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Abortion pills from Women on Web are only offered in the first
trimester of pregnancy, which is often too early to confirm whether
a fetus has been affected by Zika. Researchers have said signs of
microcephaly may not appear until well into the second trimester,
when abortion may be illegal in many places, including U.S. states.
In Colombia, where nearly 12,000 pregnant women have been reportedly
infected with Zika, abortion is allowed when the fetus might not
survive after birth - a category that includes microcephaly.
However, Dr. Juan Carlos Vargas, research director of Profamilia, a
Colombian agency that provides abortion and family planning
services, has not seen an increase in requests for abortions. His
clinic only provides abortions through the first trimester.
Zika can take several weeks to diagnose in Colombia, so women often
do not know they have been infected until their second trimester,
when they must seek care in public clinics and hospitals, he said.
Finding providers to perform the procedure can be challenging,
Vargas said.
At the same time, requests for fertility services at Vargas's clinic
have fallen sharply in the past six months, suggesting that women
are actively trying to avoid getting pregnant when they can, he
said.
Dr. Thomas Gellhaus, president of the American Congress of
Obstetricians and Gynecologists, said the study underscores the need
for legal abortion.
"The Zika crisis makes it impossible to ignore that women around the
world do not have access to this basic health care need," he said.
(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and
Bernard Orr)
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