The rapid spread of the Zika virus has prompted Latin American governments to urge women not to get pregnant for up to two years, a precaution aimed at avoiding birth defects believed to be linked to the mosquito-borne illness. In El Salvador, where 96 women are suspected of having contracted the virus, the health ministry last week advised women to postpone pregnancy until 2018. "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," said Deputy Health Minister Eduardo Espinoza.
There is no vaccine for the virus transmitted by the Aedes mosquito, which has been linked to microcephaly, a neurological disorder that sees babies born with smaller craniums and brains. The hardest hit nation has been Brazil. According to latest government figures, there have been almost 4,000 suspected cases since October 2015, compared to 150 in 2014. So far 49 babies born with suspected microcephaly have died, of which five were found infected with the Zika virus.
The entire region has erupted in concern. Other Latin American countries such as Colombia and Ecuador, as well as Jamaica in the Caribbean, have advised women to delay their pregnancies. In the United States, pregnant women are cancelling trips to the region after the Centers for Disease Control urged pregnant women to avoid travelling to 22 countries and territories because of the risk associated with Zika outbreaks.
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So far, there have been no cases of microcephaly detected in El Salvador. But Espinoza said the government decided to make the announcement because 5,397 cases of the Zika virus had been detected in the country in 2015 and the first few days of this year.
Rosa Hernandez, the El Salvador director of Catholics for a Free Choice, tells Broadly that local women's rights groups have criticized the recommendations and blamed the health ministry recommendations for failing to address the role of men. "Calling attention to women not to become pregnant has caused outrage amongst all the women's movements here," she says. "The virus doesn't just affect pregnant women, but also their partners; men should also be told to protect themselves and not impregnate their partners."
El Salvador has one of the highest rates of teenage pregnancy in Latin America, with girls aged 10 to 19 accounting for about a third of all pregnancies. It also has a total ban on abortion, which makes it a crime under all circumstances including rape and incest. According to Salvadoran group Citizens' Coalition for the Decriminalization of Abortion, 129 women were put on trial for abortion between 200 and 2011. In 2013, the Supreme Court refused to allow an ill woman carrying a malformed fetus to have a potentially life-saving abortion.
With little or no sex education in schools across El Salvador, Hernandez says the caution against pregnancy in light of the Zika outbreak must be accompanied by public discussion of the cause of unwanted pregnancies. "In a country where there is sexual violence, it's not only women who are responsible; girls become pregnant [as a] product of violations either [by] gang members, their own relatives or others," she explains. "How are we going to prevent pregnancies of these girls... [if] there are no emergency contraceptive pills available at health units after someone is raped? Abortion would be the solution but [it] is fully penalized... Asking only women not to become pregnant is irresponsible when all these factors exist."
Health experts are unsure why the virus—first detected in Africa in 1947 but unknown in the Americas until last year—is spreading so rapidly. Brazil is developing a vaccine, but the Pan American Health Organization (PAHO), the regional office of the World Health Organization, "anticipates the virus will eventually reach all countries in the Americas that have Aedes mosquitos."
Dr Suzanne Serruya, director of PAHO's Latin American Center for Perinatology, Women and Reproductive Health, tells Broadly that the organisation "can remind its member states of various international accords they may have signed on reproductive and sexual rights" in light of the outbreak.
"PAHO's position is that any decision to defer pregnancy is an individual one between a woman, her partner, and her healthcare provider," Dr Serruya says in a written statement. "Not knowing how long Zika outbreaks will last, PAHO urges public health authorities in its member countries to ensure that women are well informed about personal protection measures and about the eventual risks they may be exposed to."
According to WHO's most recent report on the issue, 21.6 million women had unsafe abortions in 2008. Of them, 47,000 women died as a result of the abortion.
The government must protect the life and health of women who are already pregnant, those of childbearing age and the whole population in general to the Zika virus.
But as WHO/PAHO member states, Dr Serruya says "all the countries of the Americas have agreed to work to improve perinatal care to promote family planning respecting cultural differences and ensuring access to modern and safe methods, and to develop and implement measures to reduce unsafe abortions.
"PAHO promotes a reproductive rights framework that recognizes the autonomy of women to decide when and if to become pregnant or to terminate pregnancy. However, given that countries in the region have their own laws in this regard, health systems should ensure adequate care to all women and newborns."
With increase in cases of Guillain-Barre syndrome and other neurological and autoimmune problems that may be associated with Zika, those in the affected areas can only follow WHO guidelines to prevent mosquitoes breeding by emptying and cleaning containers that can hold even small amounts of water. While Dr Serruya says that governments "make their own recommendations based on available evidence about the Zika virus infections," women can only protect themselves by using insect repellent, covering up, and keeping windows and doors closed.
But women like Hernandez in El Salvador can only hope for laws that protect their health as potential mothers. "The government must protect the life and health of women who are already pregnant, those of childbearing age and the whole population in general to the Zika virus," she says.
"Since 1997, women's movements are fighting for the total decriminalization of abortion because it is a must for women, more for those facing health problems. Of course we want a change of law but this is not subject to the Zika virus, but also many other factors that women go through in this country.
"It is absurd; women have the right to decide what to do."