In Brazil, Zika Fuels Abortion Debate

In Brazil, Zika Fuels Abortion Debate, de Reed Johnson e Luciana Magalhães.
Publicado originalmente por The Wall Street Journal, em 8 de março de 2016.

SÃO PAULO—As her homeland battles a viral epidemic that may cause babies to be born with undersized skulls and brains, Brazilian radiologist Juliana Salviano has a plan for giving birth to a healthy child: moving to Miami.

Ms. Salviano and her husband want to conceive a baby this year. But they have no confidence that their native country will soon tame the mosquito-borne Zika virus. Authorities strongly suspect that a surge in the number of Brazilian babies born with the congenital condition known as microcephaly is linked to pregnant women being bitten and infected with the virus.

So once Ms. Salviano becomes pregnant, the couple is contemplating spending around $15,000 on rent and other expenses while she stays temporarily in South Florida during her baby’s gestation.

“All my generation…are feeling this sadness, very afraid,” said Ms. Salviano, 30 years old, who lives in the prosperous central-western city of Goiânia. “Zika is taking the freedom of women to choose when to have their first child or raise their family.”

When Zika first surfaced two years ago in Brazil, the obscure virus seemed unlikely to spur anxious thoughts and heated discussion on issues of sexuality and reproductive rights. Then authorities began reporting a spike in cases of babies with microcephaly, and health authorities in the U.S. and elsewhere discovered evidence that the virus can be transmitted through semen.
Those developments, among others, have set off a chain reaction of debate on questions of public health and women’s reproductive freedom, including whether the use of contraceptives and even extending access to legal abortion are justifiable measures to stem the epidemic.

Pope Francis made headlines world-wide last month when he said contraceptives—which the Roman Catholic Church normally doesn’t condone—might be an acceptable “lesser evil” in the face of the Zika virus and its possible connection to microcephaly. The Pope also drew a sharp distinction between contraception and abortion, which he called “a crime, an absolute evil.”

Bishop Leonardo Ulrich Steiner, secretary-general of the National Conference of Brazilian Bishops, said the pope’s opposition to abortion couldn’t be clearer or firmer. “In relation to abortion, the Church is not going to change its position,” he said.

Other listeners had very different takeaways. Debora Diniz, an anthropologist and founder of a Brazilian women’s-rights group, thinks the pope’s remarks opened a space for examining whether Brazil’s strict antiabortion laws should be relaxed during the epidemic.

“It’s not a crime, it’s a health need,” said Ms. Diniz, who also is vice chair of the New York-based International Women’s Health Coalition.

Brazilian law currently permits abortion only in cases of rape, when there is a health threat to the mother’s life, or if the fetus has anencephaly, a disorder in which large parts of the brain are missing.

Ms. Diniz’s group, Anis, plans to petition Brazil’s Supreme Court to allow pregnant women who have contracted Zika to obtain abortions. The guiding principle in the debate, Anis maintains, should be women’s rights to dignity, health care, and freedom from psychological torture, which are enshrined in Brazil’s 1988 post-dictatorship constitution.

The controversy over Zika and birth control is spreading across Latin America, where more than 20 countries and territories have recorded the virus’s presence. Several Latin American countries afflicted by Zika, such as El Salvador and Ecuador, have antiabortion laws as restrictive as Brazil’s. In 2012, Uruguay became only the second Latin American country, after Cuba, to decriminalize abortion.

So far, suspected cases of Zika-related microcephaly have occurred only in Brazil and during an earlier outbreak in French Polynesia. But some 2,100 pregnant women are infected with Zika in Colombia, and health professionals warn that microcephaly cases there could soar later this year. Medical officials in several affected countries have advised women to postpone their pregnancies for months or even years.

The discussion over Zika’s relation to reproductive issues is fraught with uncertainty, not least because while many international health authorities say the link between Zika and microcephaly appears increasingly likely, it hasn’t been proven scientifically.

Further complicating matters, researchers say only a small proportion of Zika-infected mothers show symptoms of the virus, such as rashes or joint pain, making it hard to determine early in a pregnancy whether a fetus may be at risk. Microcephaly in fetuses is easiest to detect in the late term, when abortion becomes more challenging.

Proponents of a more liberal approach say abortion restrictions disproportionately harm poor young women with limited medical and personal options.

“Brazilian women are prisoners today of laws that are formulated and approved by men,” said José Gomes Temporão, a former Brazilian health minister. He said abortion is the nation’s fourth-leading cause of maternal mortality, citing restrictions that he says drive poor women to have unsafe, back-alley abortions or perform self-abortions.

Alvaro Ciarlini, a judge and constitutional law expert, said the chances of changing Brazil’s abortion law are remote. The Supreme Court made this clear in its 2012 ruling on anencephaly, Mr. Ciarlini said. In that instance, the court determined that abortion was permissible only when it was certain the mother’s life was endangered or the fetus would be stillborn, rather than disabled or deformed.

While some better-off mothers-to-be may have the means to give birth outside Brazil, most poor pregnant women have little choice but to wait anxiously and hope for the best.

Following a recent consultation with doctors at a health clinic in Paraisópolis, a São Paulo shantytown, 19-year-old Karina Silva Alves said she would never consider having an abortion, even if her fetus were diagnosed with microcephaly.

Each woman must make her own decision, she said, regardless of other people’s advice. “Everyone has their opinion,” Ms. Alves said.