Zika virus outbreak and reproductive rights.

Abstract

With the increasing distribution of the Zika virus, currently affecting 50 countries and territories (Oduyebo et al. MMWR Morb Mortal Wkly Rep 2016;65:739–44), associated with the potential occurrence of new cases of microcephaly and other neurological complications of the fetus or newborn, the world faces a major endemic disease-control challenge. Despite the fact that most pregnant women exposed to the Zika virus will have children without microcephaly, uncertainties about the possibility of congenital anomalies allows controversial information to be conveyed, which increases anxiety. These uncertainties bring a renewed focus on the debate of the rights of women to control their bodies and their reproductive decisions, including the right to pregnancy termination. In this sense, some countries are likely to reject measures that are necessary to ensure the sexual and reproductive health of women. The World Health Organization advocates that it is the responsibility of governments to review restrictive laws and policies, to increase access to sexual health and reproduction comprehensively, and to ensure access to information and the rights to health for all women, without discrimination. Although there are laws that recognise sexual and reproductive needs, there are still barriers to access and quality of care that can delay or even negate public health services, leading to unsafe procedures to terminate a pregnancy, with its inherent risks. In addition, the frequent absence of access to effective medical and social services for handicapped children borne by women living in poverty places a further impediment to their ability to make a decision against pregnancy termination. The need for clear information and the high demand for pregnancy termination, not currently being served by the health resources of many countries at potential risk for Zika infection, was recently demonstrated (Aiken et al. N Engl J Med 2016;375:396–8). The Pan American Health Organization (PAHO) has issued an epidemiological alert about the Zika virus (PAHO Epidemiological alert: increase of microcephaly in the northeast of Brazil. http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=32285, 17 November 2015). The authors highlight the fact that inequalities become more apparent in light of these publications, as most of the women affected may not implement the suggested recommendations, but will experience fear and anxiety. Unfortunately, families living in the worst socio-economic conditions will bear the largest cost and responsibility of caring for their children, thus highlighting the need for a public debate on the possibility of these women opting for termination of pregnancy. The reproductive rights of pregnant women living in areas at risk for Zika virus infection represents a major emerging need that health authorities around the world will have to face, and should be discussed not only in the medical context but also in social and legal contexts. Despite some resistance, this discussion should not be delayed to avoid embarrassment and injustice. So far no national or international health organisation has issued any guidance on the reproductive options that should be available to women where Zika transmission remains a risk. The decision on whether or not to terminate a pregnancy in the light of confirmed or possible Zika infection is very personal; however, it is clear that personal choices become matters of public policy when the ability to choose a particular option is not available, either by lack of a legal right or by a lack of ability to exercise that right. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.