“I contracted Zika four days ago. I need an abortion. I love children, but I don’t believe it is wise to keep a baby who will suffer. I don’t know who to turn to – please help me.”
This message was sent from Venezuela, where abortion is illegal unless a woman’s life is at risk, to a charity that sends abortion pills through the post. It epitomises the plight of countless Latin American women at the moment.
New figures suggest abortions have soared in countries where Zika is rampaging. The pills are safe and approved for early abortion in other countries, but can be hard to obtain in countries where abortion is illegal or highly restricted, which includes most of Latin America. Many women in places where they cannot access this method are driven to unsafe abortions, a major public health problem in the region.
The study comes as Colombian data confirms fears that even symptomless Zika infection during pregnancy can damage babies’ brains. Only one in five people who catch the virus get symptoms, such as fever and a rash.
At the epicentre
The abortion figures come from an analysis of emails sent to Women on Web, which mails contraceptives and abortion pills to women around the world. Requests for abortion pills have doubled from Brazil, the epicentre of the outbreak, as well as Ecuador and Venezuela, with smaller rises in some other countries.
The charity won’t send these pills to Brazil because its packages get stopped at customs, so the figures cannot indicate the number of abortions taking place in the region, but they give a picture of how people are reacting to Zika, says Abigail Aiken of the University of Texas at Austin.
Countries such as Brazil have advised women to delay getting pregnant, but access to contraception in the region varies. Abortion is illegal or severely restricted in most of the continent.
Risking death or prison
Aiken’s team compared requests for help sent to Women on Web from before last November, when government warnings began, with the period from November to March 2016. During that period in Brazil, for instance, there were more than twice the number that would have been expected based on trends before the start of the Zika outbreak. “The emails are from people in pretty desperate situations and they show the anxiety and the fear,” says Aiken.
The abortion pills can also be bought directly from underground providers. “Women on Web probably isn’t the easiest route to an abortion if you are living in the mountains and don’t have internet access,” says Aiken.
The pills that the charity sends to women comprise two drugs, mifepristone and misoprostol, which cause bleeding and cramps that expel the embryo. While safe to use in the first three months of pregnancy, later than that they can cause heavy blood loss requiring a transfusion.
Other methods of illegal abortion in developing countries include drinking herbal concoctions or inserting toxins or objects like a twig or chicken bone into the womb through the vagina, which can cause infections, infertility and death. Women who seek medical help after an abortion risk being jailed in countries where it is illegal. “We can’t collect data on [the underground providers],” says Aiken. “All we can do is show this window on what might be happening.”
Symptomless problem
An estimated 1600 babies with microcephaly that was probably caused by Zika have been born since the start of the Latin American outbreak, and the vast majority of these were in Brazil.
The Colombian study found that, of 24 babies born with microcephaly between January and April, the four for whom no other cause for the condition could be found were infected with Zika.. None of their mothers had noticed symptoms of the virus.
However, the study did find that the risk of a baby being brain damaged is low if the mother is infected during the last three months of her pregnancy. Of about 600 women who noticed Zika symptoms in the last trimester, none had a baby with microcephaly.
Journal references:
- Abortion study: New England Journal of Medicine, in press
- Colombian study: New England Journal of Medicine, DOI: 10.1056/NEJMoa1604037
