FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Requests for medication abortions have risen significantly in nine Latin American countries since the Pan American Health Organization issued an epidemiologic warning about Zika virus in November 2015.
All of the countries have legal restrictions that make abortions impossible or very difficult to obtain. Nevertheless, women are seeking them in increasing numbers using Women on Web, a nonprofit, international group that supplies information on abortions and facilitates contact with physicians who provide abortifacient medications.
Dr. Abigail Aiken of the University of Texas, Austin, and her colleagues reported the findings June 22 in the New England Journal of Medicine (2016 Jun. doi: 10.1056/NEJMc1605389).
Most of the increased requests occurred in countries that issued a national advisory to pregnant women, the researchers noted. But increases also occurred in two countries with local Zika transmission but no national advisory.
“We cannot definitively attribute the rapid acceleration in requests … to concern about Zika virus exposure,” the researchers wrote in a letter to the editor. However, “In Latin American countries that issued warnings to pregnant women about complications associated with Zika virus infection, requests for abortion through [Women on Web] increased significantly. Our approach may underestimate the effect of the advisories on demand for abortion, since many women may have used an unsafe method, accessed misoprostol from local pharmacies or the black market, or visited local underground providers.”
The authors worked with Women on Web to assess requests for medical abortion consultations from women in 19 Latin American countries between Jan. 1, 2010, and March 2, 2016. They compared these numbers before and after the November 2015 Zika announcement from the Pan American Health Organization .
They divided the data into three groups: countries with local Zika transmission, legally restricted abortion, and a national advisory to pregnant women; countries with no Zika transmission and legally restricted abortion; and countries with local Zika transmission, legally restricted abortion, and no national advisory to pregnant women. The study also included three control countries with no Zika transmission anticipated (Chile, Poland, and Uruguay).
All of the eight countries with local Zika transmission, legally restricted abortion, and a national advisory to pregnant women showed significant increases in Women on Web requests, except Jamaica. The increases were highest in Brazil and Ecuador (108%) and lowest in El Salvador and Costa Rica (36%). The increases reported reflect the relative change between actual and expected requests for abortion medications.
Two of the four countries with no Zika transmission and legally restricted abortion also showed increases: Peru (20.5%) and Argentina (21.8%).
There were no significant increases in requests in any of the seven countries with local Zika transmission, legally restricted abortion, and no national advisory to pregnant women.
The findings suggest a difficult future for many women who desire pregnancy or who conceive in areas of Zika activity, the researchers wrote. “Models that were developed by the World Health Organization predict that 3 million to 4 million persons across the Americas will contract Zika virus infection through 2017, and the virus will inevitably spread to other countries where access to safe abortion is restricted. Official information and advice about potential exposure to the Zika virus should be accompanied by efforts to ensure that all reproductive choices are safe, legal, and accessible.”
Dr. Thomas Gellhaus , president of the American Congress of Obstetricians and Gynecologists (ACOG), said the study “presents alarming insight on how the Zika virus is affecting the lives of pregnant women.”
“ACOG has long recognized that access to reproductive services, including abortion care, is essential for all women,” he said. “All women, must have the legal right to abortion, unconstrained by harassment, unavailability of care, procedure bans, or other legislative or regulatory barriers. The Zika crisis makes it impossible to ignore that women around the world do not have access to this basic health care need.”
ACOG updated its Zika clinical guidelines on June 13.
Two of the researchers are affiliated with Women on Web.