Abortions — legal or otherwise — may be increasing in Latin American countries where the Zika virus is spreading, new research suggests.
The data, published Wednesday in the New England Journal of Medicine, provide an early glimpse of a hard-to-track phenomenon that may be altering the way this unprecedented Zika outbreak is recorded in the annals of medical history.
Requests for abortion-inducing drugs shot up in some Zika-affected countries after the alarm was raised about Zika infection in pregnancy, according to researchers who analyzed traffic to the website of an international nonprofit organization that provides the drugs early in pregnancy. The requests rose by between 36 and 108 percent. Abortion restrictions are widespread across Central and South America.
Although the researchers acknowledge their data don’t prove a connection, there were no increases in requests from countries where Zika was not spreading.
If this is an indication of the desperation women in affected countries feel, the steep rise in cases of microcephaly and other devastating birth defects observed in Brazil may not be repeated in countries whose outbreaks started later, experts acknowledge.
“I do wonder if in some of the other countries that they had more time to react, and you may see fewer cases of microcephaly because of the actions women are taking where it’s possible for them to take those actions,” said Dr. Abigail Aiken, lead author of the study.
Getting public health officials to discuss whether abortions will mask the true impact of Zika’s sweep through the Americas is difficult; abortion is a highly charged issue. During a recent World Health Organization press conference, for instance, a top official studiously sidestepped the words “abortion” and “termination.”
But Dr. Bruce Aylward admitted the WHO is hearing some women who know they’ve been infected are making choices about their pregnancies. When asked what he meant by that, Aylward, the agency’s executive director for outbreaks and health emergencies, muttered: “They don’t have the children.”
A recent report from the WHO’s regional office for the Americas, the Pan American Health Organization — known as PAHO — acknowledged that fact. Of nearly 5,300 pregnant Colombian women suspected or confirmed to have been infected with Zika and whose pregnancies had concluded by the last week in April, 316 did not give birth. The report noted 68 percent of those pregnancies ended in abortions, while most of the rest ended in stillbirth.
If enough women choose to abort or defer pregnancies for fear of Zika, birth rates may actually decline for this period in some countries. But in the near term, any drop in births because of Zika may go unspotted.
“Some of this may never make it to the public health surveillance pages,” Michael Osterholm, an epidemiologist and director of the University of Minnesota’s Center for Infectious Disease Research and Policy, told STAT.
Dr. Rebecca Gomperts, an author of the New England Journal study, agreed that if women in Latin America are having abortions to avoid giving birth to babies with Zika-induced defects, it’s going to be very hard to track.
“Especially when there’s no access to legal abortion services, there’s no way to have reliable statistics. Because there are no reliable statistics about illegal abortion,” Gomperts said.
A Dutch physician, Gomperts is a founder of WoW — Women on Web — a nonprofit Internet-based organization that will arrange to provide drugs that induce abortion to women who live in countries where safe abortion is not universally available.
She and the other authors of this study compared requests for drugs that came in to WoW from Jan. 1 to March 2 to the pattern of requests received from individual countries over the previous five years.
The drugs, mifepristone and misoprostol, are available in some countries in Latin America, including Colombia, Gomperts told STAT. In Brazil, however, they are banned, and authorities have been seizing prescriptions sent to Brazilian women who seek WoW’s help.
“Most of them didn’t arrive there. We know that. We track packages,” she said.
WoW’s analysis showed appeals for abortion drugs in Brazil rose 108 percent when compared to what the organization would have anticipated based on previous years’ requests. Instead of the expected 582 requests for help from Brazil, it got 1,210.
Microcephaly is a condition in which babies are born with abnormally small heads and sometimes underdeveloped brains; it is the most marked of Zika’s tragic effects on infants infected in the womb.
Gomperts said Latin American women approaching the organization for help are scared. “We have many, many, many emails from women that are expressing concern about Zika.’’
The appendix to the study quotes a number:
“I need to do an abortion because of the great risk of infection with Zika here. … Please help me. My economic situation is extremely difficult!” one anonymous email from Brazil wrote.
“Here Zika is a major problem and the health authorities do not help with it. … I have no resources at this time and want to ask for your help because fear overwhelms me. What if the baby is born sick?” an email from Venezuela asked.
The researchers found statistically significant rises in requests from women in countries where Zika was spreading locally, access to abortion was legally restricted, and the government had issued some type of warning to women, such as declaring a health emergency or advising women to delay pregnancy.
The requests to WoW from Colombia and El Salvador rose nearly 39 percent and early 36 percent, respectively.
But the organization didn’t record a statistically significant increase in requests for help from women in countries where governments didn’t issue alerts to pregnant women, despite local spread and abortion restrictions.
“When countries issue advisories to women saying that they should avoid pregnancy until Zika no longer remains a risk and they don’t provide any options for women who may already be pregnant or who can’t avoid a pregnancy, the uncoupling of the message and women’s actual ability to act on the message … [makes it] very hard for women to act on these advisories,” said Aiken, a public health policy specialist at the University of Texas at Austin.
In some places, fetuses that bear the scars of Zika infection are being counted by those trying to keep statistics. For instance, researchers in French Polynesia — which had a Zika outbreak in 2013-14 — spotted cases of microcephaly after the fact, when they combed through medical records of pregnant women and saw reports of eight affected fetuses that were either stillborn or aborted.
Likewise, the US is counting cases of microcephaly and other Zika-related birth defects in aborted fetuses — if officials learn about the cases and are able to test for presence of the virus.
Last week, the Centers for Disease Control and Prevention started reporting on babies born in the US with birth defects linked to Zika infection, as well as pregnancies affected where the fetus wasn’t carried to term. That second category, called pregnancy losses, includes miscarriages, stillbirths, and terminations where the fetus is seen to have birth defects and tests positive for the virus.
But other places — Colombia for instance — are only reporting cases of microcephaly when there is a live birth, the WHO’s Aylward said.
Osterholm thinks medical historians won’t have a problem comprehending Zika’s horrible toll. But he agreed that the picture may be somewhat skewed by the actions of women who saw what happened in Brazil and took steps to prevent that from happening to them.
He wondered: “In the Americas, how readily available is that abortion information going to be, because of all the challenges that come up in these Catholic countries with having an abortion?”