The mosquito-borne Zika virus has reproductive-age women, families and governments across the Americas nervous, and for good reason. Some 4,000 babies have been born with microcephaly, a condition marked by an abnormally small head and potentially devastating brain damage, very possibly caused by the virus. Zika has been found in more than 20 countries and could infect as many as 4 million people. The U.S. Centers for Disease Control and Prevention has warned pregnant women in the United States against traveling to affected countries. The threat is so severe that the government of El Salvador told women to postpone pregnancy until 2018.
Besides the obvious paradox (how exactly are women supposed to prevent pregnancy in a heavily Catholic country when the Church opposes condoms and birth control pills?), the response to the Zika epidemic from Latin American governments is striking: It distills the disregard so many of them have for women, for maternity, and for the complex and deeply personal calculations all women make when becoming mothers or choosing not to — often at the expense of public health.
According to Gallup polling, people living in Latin America are less likely to say that women are treated with respect and dignity than people living anywhere else in the world. Violence against women is endemic — in Peru, for example, half of women say their first sexual experience was forced. Poverty remains feminized. Contraception access is improving, but remains low for adolescents and low-income women in particular. Half of pregnancies are unplanned. Despite the region’s severely restrictive anti-abortion laws, there are an estimated 4.4 million abortions every year in Latin America and the Caribbean, 95 percent of them unsafe. Every year, a million Latin American women end up hospitalized and an estimated 2,000 die from unsafe abortions. Those are epidemics, too, and they’ve been met largely with a shrug.
Take El Salvador. For every 100,000 women who give birth, 54 die from pregnancy-related causes. (By contrast, in Denmark the number is seven, France is eight and the United States is 14.) And unlike most of the world, maternal deaths in El Salvador have been increasing since 2003.
Rising maternal deaths have yielded little self-inquiry from the country’s leaders. El Salvador is one of seven countries in the region that outlaws abortion in all cases, not even permitting procedures to save a pregnant woman’s life. Women there go to jail not just for having abortions, but for having stillbirths or premature births officials suspect are abortion-related. When one woman, known internationally as Beatriz, was carrying a pregnancy that not only threatened her life but was anencephalic (that is, the fetus lacked a brain), she petitioned the El Salvador Supreme Court to allow her a lifesaving abortion. It denied her, reasoning that the threat to her life “is not actual or imminent, but rather eventual.”
Under the law in El Salvador, Zika exposure during pregnancy or a fetus with microcephaly would not be grounds for an abortion.
Microcephaly has a variety of causes, of which Zika is suspected to be only one, but providers say that microcephalic children whose disorders appear to be caused by Zika have particular abnormalities, and those whose mothers were infected during the first trimester suffer the most severe brain damage. Many children being born in Latin America will have profound disabilities and will require care for the rest of their lives. The Salvadoran government expresses concern for those children but little practical assistance to their mothers, and it certainly doesn’t defer to women to make critical decisions about their own pregnancies.
Latin American women outside of El Salvador are unlikely to fare better. Ground zero of the Zika outbreak is Recife, a Brazilian city with widespread poverty. A few years back, in Recife, a 9-year-old showed up at the hospital with her mother. She was pregnant with twins after being raped by her stepfather. Under Brazilian law, her case was a trifecta of abortion exceptions: She was a minor, she was a rape victim and, as a tiny girl carrying two fetuses, the pregnancy endangered her life. The Brazilian courts granted her a legal abortion. Nevertheless, the influential Catholic Church stepped in — the local archbishop eventually generated an international spectacle when he excommunicated the girl’s mother and the doctor who performed the procedure, but not the rapist stepfather.
The doctor who performed that procedure and was excommunicated for it, Olimpio Moraes, still lives in Brazil. (It was his second excommunication and the Church never sent over the proper paperwork, he said, so maybe it didn’t count.) I interviewed him a year and a half ago, at his home in Recife. The girl and her mother, who were from a rural area outside the city, were forced to take on new identities and move after the attention generated by the Church’s anti-abortion protests.
The “pro-life” current of Brazilian politics and religion’s influences compromise women’s health beyond just abortion — according to Moraes, staunch opposition to abortion rights also means that many pregnant and birthing women get substandard care. The clearest example of that, he says, is misoprostol, a drug sold by the brand name Cytotec in Latin America, which induces both labor and abortion and is used to combat hemorrhaging after childbirth.
The drug has lowered rates of maternal death around the globe significantly; it’s also decreased illegal abortion deaths, since using misoprostol off-label is a much safer way to end a pregnancy than having a clandestine surgery. But the Brazilian government is so concerned about women terminating pregnancies illicitly that they’ve heavily restricted access to misoprostol, making it unavailable at pharmacies and, Moraes says, making it more difficult for even hospital maternity wards to stock it: Prohibiting women from terminating pregnancies was more important than giving birthing women easy access to a drug that could save their lives.
Enter Zika. Again, prohibiting women from making their own decisions about pregnancy takes precedence over public health concerns, even while governments scramble to prevent thousands of births of profoundly impaired children. Again, the burden is on women to avoid pregnancy, and again, those same women have few tools to do it. Again, women are being treated like little more than vessels for someone else’s interests — now it’s avoiding pregnancy, before it was keeping pregnancies they didn’t want. At no point have women been given the necessary medical, social and financial support to carry out the task assigned to them.
Zika means women who already carry enormous weight with little assistance are being assigned even more reproductive burdens, in countries where their labor is demeaned and their own decisions denigrated and unsupported. The socio-economic status of millions of women is unlikely to change in a few weeks. Their access to health care, including contraception and abortion, could — if there’s the political willpower. Perhaps the virus will finally make Latin American governments realize the load with which they’ve saddled women is too heavy. Maybe a mosquito will finally tip the scales.
Jill Filipovic is a journalist and lawyer living in Nairobi, Kenya.