Women Told Not To Get Pregnant Until 2018 Because Of Zika, But Some Have Few Options

Sara García has been working on women's reproductive rights in the tiny Central American nation of El Salvador for decades, and the fight has never been easy. Since 1998, El Salvador has banned all abortions, even in the case of rape, incest, or when a pregnancy threatens the life of the mother. But now, García's fight is even more urgent: Like governments in Brazil, Colombia, Jamaica, and Ecuador, the Salvadoran government recently advised women to avoid becoming pregnant for the next two years due to the suspected connection between the mosquito-borne Zika virus and microcephaly, a serious birth defect. On Thursday, a case report published in the New England Journal of Medicine confirmed the link between Zika and microcephaly in five babies and fetuses that had been tested. Microcephaly causes babies' heads to be smaller, and can cause many lifelong health problems, including seizures, intellectual disabilities, and difficulty eating, swallowing, speaking, standing, walking, hearing, and seeing, according to the CDC. The Zika virus is currently spreading through more than two dozen countries. But in a nation like El Salvador, where sexual education is scarce, contraception can be expensive, and abortion is illegal, what are women to do? "We are one of the few countries in Latin America and one of seven countries in the world where abortion is totally illegal," García, who is part of the Citizen's Group for the Decriminalization of Abortion in El Salvador, told Refinery29. "So the situation is incredibly worrisome."

And it isn't just El Salvador. Other countries grappling with Zika have issued similar guidance urging women to avoid pregnancy. But contraception options can be hard to come by, especially for poor women. As a result, the Guttmacher Institute reported in 2012, more than 50% of pregnancies in Latin America and the Caribbean — the regions hardest hit by the current Zika outbreak — are unplanned.

Women who are worried about microcephaly affecting their children, the rare and serious birth defect linked to some Zika cases in Brazil, face few options. Roughly 97% of women of childbearing age in Latin America and the Caribbean live in countries subject to "highly restrictive" abortion laws, according to The Guttmacher Institute. As the virus spreads across the Americas, reproductive-rights advocates and high-profile officials are calling on governments to give women more options.

"The advice of some governments to women to delay getting pregnant ignores the reality that many women and girls simply cannot exercise control over whether or when or under what circumstances they become pregnant, especially in an environment where sexual violence is so common," U.N. High Commissioner for Human Rights Zeid Ra’ad Al Hussein said in a statement released last week.

Ensuring access to "quality sexual- and reproductive-health services," he said, is an essential component of "upholding human rights" in a public-health crisis. "Health services must be delivered in a way that ensures a woman’s fully informed consent, respects her dignity, guarantees her privacy, and is responsive to her needs and perspectives," Hussein said. The combination of a lack of access to education and services and a "very vague and very empty" response that puts the burden on women is especially troubling to Paula Avila-Guillen, the Center for Reproductive Rights' specialist in Latin America and the Caribbean. "[Lawmakers] are forgetting that they have a responsibility to protect women's rights and to make sure women have access to all these services," she told Refinery29. While stronger laws and policies can certainly help mitigate the crisis, it's essential, she said, that men are also part of the conversation about preventing pregnancies amid the outbreak.

"Women don't get pregnant by themselves," Avila-Guillen said. "Reproduction is something that takes two people. I feel governments forget that when [they give] these recommendations." Just because abortion is illegal, however, does not mean women in El Salvador and other countries subject to strict laws aren't ending their pregnancies. The Guttmacher Institute estimates that at least 4.4 million abortions were performed in Latin America in 2008. And some reproductive-rights advocates have predicted an uptick in abortions — including illegal procedures that can put women's lives in jeopardy — amid concerns over Zika. "Women in the region are having abortions, they're just having them in an unsafe and clandestine manner," García said. Women who are better off financially, she added, "can simply go to another country to have an abortion." "They can go to Miami, they can go to Mexico [City], they can go to whichever place. And they do it just fine. But the women who don't have enough to eat, the women who are students, the women who are workers, they have to exist in a system that is going to criminalize them, that is going to stigmatize them," García said.

The already dire situation and dearth of choices for women will likely get worse as Zika spreads. As of January 23, 122 pregnant women in El Salvador have been diagnosed with Zika, according to the country's health ministry. Those women — and others who suspect they may also have Zika — are in desperate need of information and support, García said. And with few signs of change from the government, her organization, as well as CRR and its partners, have pledged to continue to push for better access and aid. "We are talking about basic reproductive-health services, we are not talking about luxury treatments," Avila-Guillen said. "This is the basic access that every government should be guaranteeing for women."