Women in Brazil and in several countries affected by the spread of the Zika virus are being told not to get pregnant for fear that the virus causes microcephaly, a birth defect in which children are born with undersized heads.
The link between Zika and microcephaly still has not been confirmed, but the circumstantial evidence is strong enough to cause alarm. As is to be expected, the risk of giving birth to a child with severe problems coupled with the lack of concrete information has been stoking panic among pregnant women in Brazil. With the lack of safe guidelines for family planning and use of contraceptive methods, the old debate about legalizing abortion in the country has been reawakened.
Changing the law
Abortion is considered a crime in the Brazilian penal code except in three cases: pregnancy caused by rape, risk of life for the pregnant woman, and where the fetus has been diagnosed with anencephaly, a condition in which a child is born with a major portion of the brain missing.
With the increase in microcephaly and fears around Zika, pregnant women are searching for illegal abortions to interrupt the pregnancy, according to the newspaper Folha de São Paulo. At the same time, some women from Pernambuco were abandoned by their partners as soon as they got the microcephaly diagnosis for their babies, according to the newspaper o Estadão.
Now, a group of activists is drafting a plan that asks the Federal Supreme Court (STF) to change the law criminalizing abortion in Brazil.
"Our proposal for action is not only a discussion about abortion, but it is also for a social policy focused on these women and children that may be born," anthropologist Débora Diniz, who is leading the charge around the petition, told Motherboard in Portuguese.
The project will demand social protection and assistance for women who opt not to have an abortion, Diniz said, considering that the Zika epidemic highlights the state's negligence in controlling the spread of mosquitos. (In other words, according to the proposal, the government is indeed at fault for not having been able to stop the disease from spreading.)
In Brazil, independent of the Zika epidemic, the issue of abortion is urgent. It's estimated that over one million illegal abortions are performed in the country per year. The group National Research on Abortion (PNA) shows that at least one in five women has already had an abortion.
In São Paulo, a backstreet abortion performed by a doctor in a reasonable clinic can cost from $750 USD to $3,700 USD. Another option is the use of medications, such as misoprostol, commonly known as cytotec, the sale of which is also criminalized.
"Women will try anything to get an abortion, everyone knows that, and when they don't have access to a safe way of getting it, they will die over nothing."
The issue is with the women who don't have access to a good healthcare system. Abortions, which many times are poorly executed, are the fifth leading cause of maternal deaths in the world according to the World Health Organization, in addition to being a cause for three years of incarceration for Brazilian women.
Some Brazilian doctors see the Zika epidemic as an opportunity to legalize abortion, even if only in cases of microcephaly.
"It is not a responsibility of the pregnant woman, it is not fair to make her bear all of the consequences," Dr. Thomaz Gollop, professor of genetics for the School of Medicine of the University of São Paulo, told Motherboard in Portuguese.
A court authorization does not mean that every woman has to interrupt their pregnancy, he said. "What is being presented is that they should have the right to decide, given that these children will have an extraordinarily severe neurological compromise, over which there are very few tools to resolve the issue."
Support for Brazilian pregnant women seeking the right to abort has been coming from abroad. The Dutch NGO Women on Web started shipping mifepristone and misoprostol pills, which can induce an abortion when combined, to Brazil. Along with the medication, they are sending a brochure with information that details the procedure and what can happen after taking the medication.
In previous years, Brazilian authorities had seized the packages at customs. The group hopes that in light of the Zika epidemic and associated microcephaly fears, the authorities will let the packages through.
"We hope that this public health emergency can prevent the Brazilian agencies from seizing the packages, and that they may be able to see how important this is for public health and how important it is for women to have access to safe abortion services," Dr. Rebecca Gomperts, Women on Web founder, told Motherboard. "Women will try anything to get an abortion, everyone knows that, and when they don't have access to a safe way of getting it, they will die over nothing."
Pro-life versus pro-choice: an old debate
Ultimately the debate is a fundamental one, however. Abortion rights tend to permeate almost every electoral decision in Brazil.
Simone Tavares, full-time mother of two para-athletes with microcephaly, is starting a campaign against abortion in cases of microcephaly in the state of Mato Grosso.
"I defend the rights of women to decide what to do with their bodies, but then I saw with the eyes of a mother this microcephaly issue," she told Motherboard in Portuguese. "I believe that everyone has the right to be born, everyone has their mission and needs to go through certain understandings, regardless of handicap."
Brazilian journalist Ana Carolina Caceres, who was born with microcephaly, recently wrote an op-ed for BBC News opposing abortion as "short-sighted," saying she found the campaign to allow abortion in cases of microcephaly offensive.
However, Zika-related microcephaly may be particularly insidious. A recent study in Brazil showed extensive brain damage in children born with microcephaly to mothers who were infected with Zika, especially if they were infected in the first trimester.
Abstinence is a notoriously difficult policy to follow
Microcephaly allegedly caused by Zika is different than the one that happens in an isolated form by other infections and genetic causes, Dr. Gollop said. According to him, the microcephaly associated to Zika has been showing signs of being much more serious, since it causes lesions to the fetus's central nervous system.
"This is something very uncommon, what we are seeing in the country are much more severe types, not only of microcephaly but also of encephalic lesion," he told Motherboard in Portuguese. "The regular children with microcephaly, who don't have microcephaly caused by the virus, are different."
Thomaz explained that the damage to the nervous system is caused at the moment where the virus crosses through the placenta, causing an encephalitis—a serious brain inflammation—and that has pretty serious consequences, such as risk of deafness, blindness, and mental handicap. "Those children are very damaged," he said in Portuguese.
Since WHO declared a state of emergency over Zika and the spread of microcephaly on February 1, health officials in affected countries have emphasized family planning; El Salvador is advising women to delay pregnancy all the way until 2018. But abstinence is just one aspect of family planning, and it's a notoriously difficult policy to follow. For now, however, women in Brazil worried about microcephaly don't have any other legal option.
This story originally appeared at Motherboard Brazil and was translated by Gustavo Araujo Curi.