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More than half of Brazilian women of childbearing age have avoided or tried to avoid pregnancy because of the outbreak of the Zika virus, which can cause devastating defects in fetuses, according to a new survey.

The survey, published late Thursday in the Journal of Family Planning and Reproductive Health Care, demonstrates just how deeply alarming the epidemic has been for women most likely to be exposed to the mosquito-borne virus.


“Right now, if you go to prenatal care, it’s not a happy place to be,” said Debora Diniz, a public health researcher at the University of Brasília, who helped lead the survey. “Women are depressed because they don’t know what’s going on.”

Diniz and her colleagues surveyed more than 2,000 women between 18 and 39 years old who live in cities around Brazil and are literate. They found that 56 percent had delayed or tried to delay pregnancy because of the virus, 27 percent had not been avoiding pregnancy, and 16 percent had not been planning on getting pregnant regardless of the outbreak.

The survey has a margin of error of 2 percentage points. It was conducted in June, when more new cases of Zika were being reported than in recent months.


After experts noticed the tie between Zika and birth defects, several Latin American governments recommended that women try to delay getting pregnant. Now, women who are pregnant are part of what Diniz described as “the second generation” of the outbreak.

Women in the first generation, she said, were those whose infants helped scientists make the connection, or those who were already pregnant by the time researchers did so. Women in the second generation know what may happen if they get the virus, which is often asymptomatic, but won’t know if their babies are healthy until months after birth.

Dr. Abigail Aiken, a public health policy expert at University of Texas at Austin who was not involved with the survey, noted that it just captured the sentiment just at one point in June and did not capture the baseline percentage of women in the age group who might normally be avoiding pregnancy. But she called it an impressive national survey that matched other evidence suggesting at least some women were trying to avoid having children during the outbreak.

In a paper this summer, for example, Aiken and colleagues found that requests for abortion drugs were increasing in areas where Zika was circulating, even though abortion remains illegal in most or all cases in many Latin American countries.

“It fits with our findings,” Aiken said about the survey. “We found that there’s this demand for abortion that was unmet already and has been exacerbated by the government’s decision to tell women to delay pregnancy.”

The survey results also suggest that women in areas most affected by Zika are more concerned about its impact. Northeastern Brazil has recorded many more cases of Zika-related birth defects than the rest of the country, or any other country where they virus has spread. And in the survey 66 percent of women in the northeast said they were trying to delay pregnancy, compared with 46 percent of women in southern Brazil.

Scientists have wondered if there is an unknown factor in northeastern Brazil that has made the virus more likely to cause defects — perhaps a genetic distinction among the people there or the timing of previous dengue outbreaks. But they haven’t been able to pinpoint such a scientific reason. It’s possible that women in other places are avoiding or terminating pregnancies or health officials are failing to accurately record all the cases of defects.

In the survey, roughly the same percentage of Catholic and Evangelical women reported avoiding pregnancy, but the researchers discovered differences among races. While about half of white women said they were trying not to get pregnant, 56 percent of “brown” women, as they were classified in the study, and 64 percent of black women replied they avoiding pregnancy. Diniz said that corresponded with the fact that black and brown women tend to be poorer, and are thus more likely to be exposed to mosquitoes and Zika.

“We have this overlap between class and color,” Diniz said. “The Zika epidemic is a kind of mirror of Brazilian social inequality.”

For women who do want to avoid pregnancy, their options are limited, Diniz and others experts say. Access to contraception in many places is limited, especially for poorer women, advocates say. Advocates also say that men in the region should be enlisted in the effort to delay pregnancies, especially because the virus can be sexually transmitted.