Zika and the Abortion Rights Debate

What happens when a country without legal abortion tells women not to get pregnant? This was the question many asked when government officials in El Salvador recently told women to avoid getting pregnant until 2018 as a precaution against the Zika virus. Zika, which displays common cold-like symptoms in adults, can cause serious birth defects in children born to mothers who have been infected, including the miniaturized head that has characterized depictions of the outbreak since the end of 2015. In response to the pandemic, El Salvador’s deputy health minister told Reuters, “We’d like to suggest to all the women of fertile age that they take steps to plan their pregnancies, and avoid getting pregnant between this year and next.” But here is the problem with the minister’s request: Abortions are illegal in El Salvador, and birth control is extremely difficult to come by — especially for women on the lower end of the economic spectrum. For the health of both women and children in El Salvador, access to abortion may be the only solution.

According to a 2011 study from the UN, there are only six nations in the world that deny abortions under any circumstances, and El Salvador is one of them. This creates the terrible irony that the government denying women control over their reproductive health is now asking those same women to control their reproductive health until 2018.

El Salvador is not alone on this front. Brazil, another country affected by Zika, has recently demanded even more restrictive policies on women’s health, despite also calling for women to hold off on pregnancy for the next two years. The heavily Catholic government is drafting legislation that would sentence women to five years in prison if they abort a fetus with microcephaly — the brain disorder characteristic of Zika. Brazil’s existing allowances for abortion include rape, threats to the woman’s health, and anencephaly, a condition in which the fetus is missing parts of the brain and skull. The typical jail time for a woman who’s had an unauthorized abortion is three years, but this law specifically targets women who abort babies affected by Zika, increasing the already harsh sentence by two years. The proposed law is even tougher on doctors, who could face up to 15 years in prison for performing the procedure. Lawmakers in turn claim that Zika has increased public acceptance of abortion, blaming feminist groups for a different kind of public health crisis: pro-choice rhetoric.

Conversely, global discourse on Zika has inspired multiple organizations and numerous officials to demand change in the way American countries stigmatize abortion. Two weeks before the release of this bill, the UN encouraged countries affected by Zika to lift their limits on abortion, saying that these governments “ignore the reality that many women and girls simply cannot exercise control over when or under what circumstances they become pregnant.” The bill directly contradicts the statement of a respected judge in Brazil, who earlier this year said that he would allow women to end a pregnancy in cases of microcephaly. And his statement agreed with the demands of a Brazilian group, led by Portuguese Catholic University’s Institute of Bioethics, that recently announced their plan to send a petition to Brazil’s Supreme Court requesting to legalize abortions in cases of microcephaly.

But these protests might fail in comparison to the wide swath of Catholic Latin Americans whose opposition to the procedure seems to have only grown stronger. Between 2007 and 2010 (the most recent data available) the percentage of Brazilians who believe their country should not expand access to abortion increased from 65 percent to 82 percent. Zika has the potential to bring this number back down, but these conservative lawmakers are ensuring it doesn’t. Reproductive health advocates fear that negative bills like these will only increase the number of women dying from illegal abortions and the number of impoverished families saddled with the cost of rearing a child with severe brain damage.

What’s more, the increased stigmatization of abortion also has negative implications for the future of other contraceptive care in the region. In El Salvador, birth control pills and condoms are legal, but the pill requires a prescription and can only be sold in specific locations. The country offers subsidies for condoms, but they are very limited and nearly inaccessible for poor families. The result is that, according to a study published in 2008, of the 73 percent of El Salvadorian women who used some form of birth control, female sterilization was the most common method by far. Close to 40 percent of the women in the country opt for this permanent solution, with less than 10 percent using temporary forms of contraception. These numbers are sure to increase as the government warns against pregnancy, leaving many women with only two options: abstain from sex altogether or permanently give up reproductive capacity.

Yet using public health as an excuse for abortion law liberalization is not without precedent. In the 1960s, a public health scare erupted in the United States over rubella: a rather mild virus similar to Zika in that it displayed mildly in adults but could cause severe birth defects (or even death) in babies born to mothers infected during pregnancy. Abortion had been a taboo topic in US discourse until then, but rubella changed how the procedure was discussed. Abortion shifted from a moral decision (with attached moral stigma) to a medical one.

When rubella hit the United States in the late 1950s and the mid 60s, US public officials warned women about the dangers of becoming infected while pregnant. Although abortion was illegal in the United States (and birth control was also still illegal in many states), criminal laws contained a clause allowing doctors to perform “therapeutic abortions” for medical reasons. These “therapeutic” procedures were intended for cases in which the life of the woman was in danger, but this terminology was loosely defined and these abortions began to be performed in turn on women with rubella.

When word of these procedures got out, doctors pushed to legally define what conditions allowed for a “therapeutic abortion,” and eventually began a national conversation on the legal status of abortion. In 1967 the Therapeutic Abortion Act made California one of the first states to legalize abortion. The procedure could only be performed after a committee had decided that the life of the mother was obviously at risk. Rubella allowed the conversation to be framed as a family issue instead of a women’s liberation issue. Even though ideally both framings should hold the same amount of weight, departing from the idea of women’s reproductive rights shifted the conversation away from challenging social norms. There was also an important race and class aspect of the debate. Many of the women who were speaking out were seen as respectable middle class married mothers. Most of them were white, discussing an unborn child they wanted but could not keep.

Eventually, allowing women access to abortion services if they were infected with the virus led to a movement focusing on allowing women to control their bodies no matter the circumstance. This same shift could occur if the Zika epidemic expands the circumstances under which women can seek abortions. The existing precedent in Brazilian law allowing for abortion in the case of anencephaly suggests that Zika also has the potential to change abortion practices as rubella did in the United States, providing a way to give women access to the choices they need without upsetting established Catholic social mores.

Then again, the direct pushback in these countries against this type of “feminist” rhetoric may suggest otherwise. Actions by extreme conservatives are seeking to prevent any changes in attitude towards abortion. By harshening sentences and telling women not to get pregnant, these countries are taking the debate in the opposite direction. They are playing into conservative and religious fears about women’s liberation, and curtailing women’s rights as a preventative measure in their holy war.