Abstract
The Zika outbreak of 2015-7 is a lens to analyse the positioning of abortion within in global health security. The sequelae of the virus almost exclusively affected newborn children, manifested through Congenital Zika Syndrome (CZS), and a focus on women at risk of, planning or being pregnant. At the global level, debate considered whether Zika would provide impetus for regulatory change for reproductive rights in Latin America, a region with some of the most restrictive abortion regulation in the world. However, regulatory change for abortion did not occur. We analyse why the Zika health emergency did not lead to any changes in abortion regulation through multi-method analysis of the intersection between Zika, health emergencies and abortion in Brazil, Colombia and El Salvador. These case study countries were purposefully selected; each had Zika infected women (albeit with differing incidence) yet represent diverse regulatory environments for abortion. Our comparative research is multi-method: framework analysis of key informant interviews (n = 49); content analysis of women's enquiries to a medical abortion telemedicine provider; and, policy analysis of (inter)national-level Zika response and abortion policies. We consider this within literature on global health security, and the prioritisation of a particular approach to epidemic control. Within this securitized landscape, despite increased public debate about abortion regulatory change, no meaningful change occurred, due to a dominant epidemiological approach to the Zika health emergency in all three countries and prominent conservative forces in government and within anti-abortion rights movements. Simultaneously, we demonstrate that regulation did not deter all women from seeking such service clandestinely.
Highlights
Health emergencies, framed as global health security threats, create distinct policy pathways
Respondents consistently agreed that women in all three countries sought abortions for reasons related to Zika: “I have no doubt that women who had Zika or who thought they had Zika were looking to interrupt their pregnancy” (Activist, Brazil)
Zika provides a critical lens to analyse whether a health emergency response embedded within norms of global health security affects policy or practice of abortion
Summary
Health emergencies, framed as global health security threats, create distinct policy pathways They prioritise short term outcomes to end disease transmission, rather than systemic changes which may provide more sustainable capacity to manage outbreaks by addressing the causes of the fault-lines exposed during epidemics, such as poverty, inequality and discrimination. The dominant securitized policy response has been to place the responsibility onto women to prevent pregnancy (Ahmed, 2016). Such gendered policies have been criticised in contexts where up to 56% of pregnancies are unintended (Guttmacher Institute, 2016), where access to effective contraception is low, and the regulatory environment for abortion is restrictive (Hodge et al, 2016). Restrictive abortion laws are not associ ated with lower abortion rates, in Latin America (Zamberlin et al, 2012; Sedgh et al, 2016), with access dependent on women’s economic security (Ostrach and Cheyney, 2014), age (Shah and Åhman, 2012) ability to travel to seek termination (Jones, 2013), and if they are living in a union or married (Andersen et al, 2015)
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