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Zika: Reshaping the Discussion of Rights in Latin America

The World Health Organization (WHO) has stated that the Zika virus is “spreading explosively,” estimating that there are approximately 4 million diagnosed cases of the virus. As of early February, according to WHO, Zika cases have been diagnosed in 21 countries, most of which are in Latin America and the Caribbean. As a result, most of the media coverage and most of the public panic has revolved around this area of the globe. However, by and large, Zika remains fairly mild, with possibly as many as 80 percent of cases not showing symptoms. And while many specifics of the virus have made it difficult to strategize about prevention, regulation, and response, one aspect of the virus has important ramifications: A tenuous link has been found between Zika and a birth defect called microcephaly, which is characterized by abnormal smallness of the head and incomplete brain development. This link has the unique potential to challenge prevailing abortion legislation and lift the veil of silence over public health discussions in many Latin American countries.

Latin America has noticeably strict abortion laws: only two countries, Guyana and French Guiana, have legalized abortion. Latin America has 40 percent of the world’s Catholic population and 69 percent of adults in the region identify as Catholic. On the other hand, many legal scholars and activists are trying to use the medical crisis as a way to loosen the region’s restrictive abortion laws.  According to David Sim of the International Business Times, these two interests are “pitting religious beliefs about abortion against the risk that babies could be born with [microcephaly].” Brazil’s bishops have already announced their opposition to the expansion of abortion exceptions to include Zika-related birth defects. To further complicate matters, detection of microcephaly happens relatively late, usually around the 28th week of pregnancy, which would mean that abortion laws would have to be drastically loosened to permit abortions in cases of microcephaly. In addition, potential abortion reform efforts are muddled by the tenuous nature of the link between the virus and the birth defect. Out of 4800 reports of Zika-related microcephaly, only 404 cases have been confirmed while 709 have been disproven. Furthermore, only 17 of those 404 cases have actually shown a causal link between Zika and microcephaly. On the other hand, there is a strong case for why this potential link needs to be discussed. There has been a thirtyfold increase in microcephaly incidences in Brazil since the virus was first detected in the country. The World Health Organization and CDC have both taken action, with the former declaring a state of emergency and the latter recommending blood tests and ultrasound services to all pregnant women. Still, the policies of Latin American governments have been noticeably passive. El Salvador and six other countries have only issued announcements advising women to delay pregnancies for two years. As a result, discussions about the implications of the virus on abortion policy remain hushed for now.

Expanding abortion exceptions to include microcephaly, and more widely, the overall issue of abortion rights, is an important discussion for Latin American countries to have considering that their abortion laws often disregard or fail to prioritize women’s health. This discussion certainly should not be hindered by suggestions to delay pregnancies for the specific context of the Zika virus. In 2008, 4.4 million abortions were performed in Latin America, with 95 percent of them being in clandestine or unsafe conditions, resulting in 1 million women being hospitalized annually. According to Angela Rivas of the Salvadoran nonprofit Acdatee, the response by many Latin American governments, including the suggestion to simply not get pregnant, is not a solution or a even a stopgap. On the contrary, she argues that the legal circumstances for abortion are leading to “an increase in the rates of illegal abortions, unsafe abortions and mental health [issues] for women.” Indeed, as of yet, the Latin American governments’ response has shown no clear success in deterring pregnancies or abortions; in fact, the nonprofit organization Women of Web, which sends pills to carry out clandestine abortions to women in countries without abortion services, reports an increase of 10,000 requests per month for its services.

A case study in recent US history can shed light on not only how the discussion about Zika in relation to abortion rights can be expected to evolve, but also on how this issue should be addressed by Latin American governments. In the 1960s, women in the US faced a comparable dilemma because of the Rubella virus, also known as German measles. The disease had been linked to infants being born with heart problems, blindness, and microcephaly. Over the course just two years, there were a reported 1.25 million cases across the country. Due to this outbreak and its health implications, abortion shifted from being a taboo topic to one that was discussed at the political dinner table. Roe v. Wade, the Supreme Court’s landmark ruling in 1973 ruling that restriction abortion was a violation of the Due Process Clause, came only a few years later. Although Rubella wasn’t the deciding factor in the case, Becky Little argues that it was “the opening that made it possible for women, and men too, to talk about the validity of this procedure and the necessity of making it legal.”

Bringing the debate about abortion rights to the forefront, the Rubella case contains important insights into how the discourse surrounding Zika and abortion rights should be shaped. First, the case of Rubella offers insight into how a productive conversation around abortion can be framed; by bringing the focus from the moral to the medical, a more productive and meaningful conversation can be had. Second, the laws governing abortion need to be clarified. While many states in America made exceptions for “therapeutic abortions,” it took a push from doctors to clarify what is legally defined as a “therapeutic abortion” and allow Rubella-afflicted women to seek abortions without fear of retribution. Latin America faces similarly ambiguous laws. While abortion exceptions for anencephaly, a condition where portions of the brain are missing, were approved in Brazil due to it being “incompatible with life,” ambiguities in this clause have complicated expanding such exceptions to microcephaly, a disease characterized by a high prevalence of mental disabilities and lower life expectancy.

"The recommendation of these governments to delay pregnancies, while not providing the proper education and services to do so, carries as much weight as a polite suggestion."

All in all, there are three main issues of misguided prioritization that need to be addressed before substantive progress is made in terms of the Zika response in Latin America. First, suggestions to delay pregnancies are detrimental because the only thing they end up delaying is the discussion of public health issues facing women, as bioethical researcher Débora Diniz argues. She elaborates that in Latin America, there is “no appropriate policies for family planning…[and] no regular access to contraception.” The recommendation of these governments to delay pregnancies, while not providing the proper education and services to do so, carries as much weight as a polite suggestion. Such a policy is not only ineffective, but also detractive and counterproductive. Nevertheless, despite Pope Francis’ repudiation of abortion, he has recently lent his support to better contraception services to fight Zika, stating that “avoiding pregnancy is not an absolute evil.” The Pope’s stance has the potential to reshape the views of not only society but also important religious parties in the fight against Zika, such as Catholic hospitals.

Second, there needs to be more focus on how social inequalities contribute to Zika’s infection and spread. Débora Diniz claims that social stratification plays a large part in Zika infection: Overcrowded living conditions, stagnant water, and labor conditions found in lower-class areas have resulted in the impoverished population being disproportionately affected by the virus. Dr. Hughes of the Warren Alpert Medical School adds that Zika has hit well-to-do areas much less severely. An optimal response to Zika, which affects the entirety of society, albeit disproportionately, can’t be devised without understanding its socioeconomic dimension and helping the most marginalized.

Third, as Sarah Boseley argues, so much attention has been paid to the logistical and scientific aspects of the disease that the people who are actually carrying its burden, particularly women, are reduced to “an asterisk.” As she argues, “Yes, it is about a mosquito carrying a dangerous virus, but it is also about a health system failing women.” Similarly, Charles Abbott of the Center for Reproductive Rights maintains that current policy has followed a dangerous trend of shifting disease-fighting responsibilities from the government to the afflicted. As he concludes, “Women cannot solely bear the burden of curbing the Zika virus.”

Regardless of the scientific developments and new knowledge surrounding the Zika virus in the upcoming months, treating the already-afflicted population requires awareness of the disease’s human element. This process will inevitably open the door to larger questions of reforming abortion legislation in Latin America and how the public health system fails women.

About the Author

Oliver Tang '19 is a Staff Writer for the Brown Political Review.