Zika leads more women to seek abortion help

Requests for medical abortions have surged in Latin American countries with Zika outbreaks — but only in places where government officials have issued health alerts to pregnant women, a new study finds.

Authors of a study published Wednesday in the The New England Journal of Medicine found sharp increases in appeals for abortion pills to Women on Web, a non-profit based in the Netherlands that provides prescriptions for abortion pills to women from areas with restrictive abortion laws. Most Latin American and Caribbean countries ban or sharply restrict access to abortion.

Women on Web uses a pharmacy partner to mail the pills — drugs called mifepristone and misoprostol — to women in the first nine weeks of pregnancy. The group is providing abortion pills free of charge to women in Zika-affected countries.

Study authors looked at six years' worth of requests to Women on Web, including the four-month period after the Pan American Health Organization, part of the World Health Organization, issued a health alert about Zika in November.

Women from Brazil and El Salvador sent twice as many requests for abortion pills from November to March than researchers would have expected, based on typical seasonal patterns, the study said. Requests also increased sharply from Colombia, Costa Rica, Ecuador, Honduras and Venezuela.

Government officials in each of those countries had issued national health advisories, warning pregnant women of the risks of Zika. Officials in five countries — Brazil, Colombia, Ecuador, El Salvador and Jamaica — went so far as to urge women to delay pregnancy.

Although demand for abortion pills has been especially high in Brazil, women in this country are often unable to receive them. Brazilian customs agents have been confiscating abortion pills sent through the mail since 2013, said co-author James Trussell, an emeritus professor of economics and public affairs at Princeton University. Women on Web still arranges for abortion pills to be mailed to Brazil, but the group warns women that their medications may not arrive, said Trussell, a board member of the Women on Web Foundation.

Appeals for abortion pills also increased by 20% to 22% in Argentina and Peru, which did not have Zika outbreaks at the time of the study. Interest in medical abortion in Peru may have increased because the health director in one of the country's northern states suggested declaring a state of emergency in anticipation of Zika's eventual arrival, said study co-author Abigail Aiken, an assistant professor at the University of Texas at Austin.

Zika has since spread to both Peru and Argentina, according to the Pan American Health Organization.

Jamaica was the only country in which officials issued warnings to pregnant women about Zika in which requests for abortion pills did not increase, according to the study.

Although the study can't definitely prove that government warnings about Zika caused women to try to terminate their pregnancies, authors say their results suggest this was the case.

Significantly, researchers found no increase in requests for abortion pills in Zika-affected countries where officials have not issued national pregnancy advisories, Aiken said. There was no increase in requests from Uruguay, where abortion is legal and there are no Zika cases. There was also no increase in requests for abortion pills from Chile and Poland, which have strict abortion laws but no Zika cases. Researchers used Poland as a comparison, even though it's not part of Latin America, because Women on the Web receives more requests from Poland than any other country.

These findings suggests that more women are looking to end their pregnancies not just because of Zika, but because of official government warnings about the virus, Aiken said. "Women were reacting to the advisories," Aiken said. "These women were pregnant and they couldn't follow the advice of their governments" not to conceive.

Zika highlights lack of access to contraception, abortion in Latin America

The Zika epidemic has caused many people to lobby for better access to contraception in Latin American and Caribbean countries.

In many Latin American and Caribbean countries, basic contraception, such as birth control pills and IUDs, are in short supply. That means even women with access to a doctor or clinic may not be able to get birth control, said Alejandra Colom, who works in Guatemala for the Population Council, which studies family planning.

The region's conservative culture often puts men in control of their family's size, rather than women, Colom said. Many women are unable to persuade their partners to use condoms.

"It makes very little sense to tell women not to get pregnant, but give them absolutely no means to prevent pregnancy or deal with pregnancies that might be severely affected by Zika," said Neil Silverman, a clinical professor of obstetrics and gynecology in the division of maternal-fetal medicine at the David Geffen School of Medicine at UCLA.

The study's findings suggest that government officials need to take care when talking to their citizens about Zika, Colom said. Government warnings may have frightened some pregnant women into terminating healthy pregnancies, she said.

Abortion pills can only be used during the first nine weeks of pregnancy. But ultrasounds and other tests typically cannot detect fetal brain defects until the middle of a 40-week pregnancy. So women may be opting for abortion before they know whether their fetuses are affected, Colom said.

Research suggests that up to 22% of fetuses infected with Zika in the first trimester could suffer neurological damage, including birth defects.

Governments should focus on giving women accurate information, Colom said, as well as helping them access family planning services, so that women are able to delay pregnancies if they wish.

The new study "provides alarming insight on how the Zika virus is affecting the lives of pregnant women," said Thomas Gellhaus, president of the American Congress of Obstetricians and Gynecologists, in a written statement.

“During the Zika crisis, health care providers must respect and support the reproductive rights of women and the decisions they make after appropriate counseling," Gelhaus said. "Women must have urgent access to the full spectrum of reproductive health services to avoid the potentially tragic consequences of Zika exposure.”