Fearing the effects of the Zika virus on their unborn children, pregnant women in Latin America increasingly have sought out abortion pills online from a nonprofit aid agency, a new study has found.
The research, published on Wednesday as a letter in the New England Journal of Medicine, is the first to measure the response of pregnant women to Zika warnings in countries where abortion is limited or banned. First detected in Brazil last year, the current Zika outbreak has been linked to more than 1,400 cases of microcephaly, a rare birth defect that can lead to severe developmental problems.
As the Zika virus spreads through Latin America, several countries, such as El Salvador, advised women to avoid pregnancy, even if their access to birth control or abortion was restricted. The World Health Organization also recently advised couples living in areas with Zika transmission to consider delaying pregnancy.
“When you issue these kinds of advisories, but you uncouple them from pathways to safe and legal care, you create a really difficult situation for women,” said study co-author Dr. Abigail Aiken, a reproductive health expert at the University of Texas at Austin.
Aiken and colleagues analyzed requests for abortion services from Women on Web, a nonprofit that provides access to the abortion medications mifepristone and misoprostol, as well as online consultations to women in countries where legal abortion is limited. The group offers the pills in the first 10 weeks of pregnancy to induce a miscarriage.
The researchers compared abortion requests made after Nov. 17, 2015, when the region was first warned about Zika’s potential risk of birth defects, with expected requests to this same group based on five years of prior data.
They found statistically significant increases in abortion requests in seven out of eight countries where Zika is circulating, abortion is limited and the country had warned about the risk of Zika in pregnancy.
Requests for abortion medication between November and March 2016 doubled in Brazil, where abortion is outlawed except in cases of rape, when the mother’s life is at risk or the child is too sick to survive. Requests rose by 35.6 percent in El Salvador, 36.1 percent in Costa Rica, 38.7 percent in Colombia, 75.7 percent in Honduras, 93.3 percent in Venezuela and 107.7 percent in Ecuador.
Jamaica, where women had been advised to avoid pregnancy even before Zika transmission was ever confirmed, was the only country in this group not to see a major increase.
“Many of these women felt underinformed and very scared,” Aiken said, based on an analysis of women’s emailed comments to the group.
Abortion pills from Women on Web are only offered in the first trimester of pregnancy, which is often too early to confirm whether a fetus has been affected by Zika. Researchers have said signs of microcephaly may not appear until well into the second trimester, when abortion may be illegal in many places, including U.S. states.
In Colombia, where nearly 12,000 pregnant women have been reportedly infected with Zika, abortion is allowed when the fetus might not survive after birth – a category that includes microcephaly.
However, Dr. Juan Carlos Vargas, research director of Profamilia, a Colombian agency that provides abortion and family planning services, has not seen an increase in requests for abortions. His clinic only provides abortions through the first trimester.
Zika can take several weeks to diagnose in Colombia, so women often do not know they have been infected until their second trimester, when they must seek care in public clinics and hospitals, he said. Finding providers to perform the procedure can be challenging, Vargas said.
At the same time, requests for fertility services at Vargas’s clinic have fallen sharply in the past six months, suggesting that women are actively trying to avoid getting pregnant when they can, he said.
Dr. Thomas Gellhaus, president of the American Congress of Obstetricians and Gynecologists, said the study underscores the need for legal abortion.
“The Zika crisis makes it impossible to ignore that women around the world do not have access to this basic health care need,” he said.