Requests for Abortions in South American Rise Dramatically Since Zika, Especially in Brazil Interview with:

Abigail R.A. Aiken, MD, MPH, PhD Assistant Professor LBJ School of Public Affairs University of Texas at Austin Austin, TX, 78713

Dr. Abigail Aiken

Abigail R.A. Aiken, MD, MPH, PhD
Assistant Professor
LBJ School of Public Affairs
University of Texas at Austin
Austin, TX, 78713 What is the background for this study?

Response: As Zika began to emerge as an epidemic in Latin America and its links with microcephaly began to be realized, we were aware that women in the region who were already pregnant or who would become pregnant would have a very limited set of reproductive options. Research and media attention about the possible biological effects of Zika in pregnancy began to appear rapidly. But much less attention was been paid to the impacts of Zika on women. We followed the responses of governments and health organizations and when they began to issue advisories warning women to avoid pregnancy, we knew it would be important to investigate the impacts of those advisories. A country-wide policy that is impossible to follow if you are pregnant or cannot avoid pregnancy is an unusual and important public issue. Accurate data on abortion are very difficult to obtain in Latin America because in most countries, abortion is highly restricted. We wanted to provide a window on the issue of how women were responding to the risks of Zika and its associated advisories, so we worked with Women on Web (WoW), an online non-profit telemedicine initiative that provides safe medical abortion to women in countries where safe, legal abortion is not universally available. What are the main findings?

Response: We used five years of historical data to establish trends in abortion requests for each of 19 Latin American countries up until November 17th 2015, when the Pan American Health Organization (PAHO) issued an epidemiologic alert regrading Zika. We then used a regression discontinuity design to compare expected numbers of requests based on model forecasts from the historical data to actual observed requests between November 17th 2015 and March 2nd 2016. We found that in countries with active, local Zika virus transmission, restricted access to abortion, and which issued a public health advisory regarding Zika, requests for abortion to WoW increased 36-108% over baseline trends. The biggest increase occurred in Brazil. What should readers take away from your report?

Response: We cannot definitely attribute the rapid acceleration in requests to worries about Zika, but several findings are strongly suggestive.

  • First, the percentage of women in each country who reported Zika as their reason for seeking abortion matches or exceeds the observed country-specific increases over baseline trends.
  • Second, women described the fear and anxiety they felt regarding the Zika advisories from their governments to avoid pregnancy and their lack of access to reproductive choices through their own healthcare systems.
  • Third, we did not see increases in requests in the “control” countries we included, where no rise in requests due to Zika would reasonably be expected.

Our study therefore suggests that in countries where there is active, local Zika virus transmission, restricted access to abortion, and an official public health advisory regarding Zika, there is a demand for abortion that is not being met through the formal healthcare system, as well as anxiety and fear among pregnant women about their inability to follow such advisories. These women were left in an impossible situation. The main take-home message from our study is that public health advisories regarding Zika should be coupled with access to a full range of safe, legal and accessible reproductive options. What recommendations do you have for future research as a result of this study?

Response: Our study is subject to several important limitations, most notably the fact that we examined only one pathway to abortion (via WoW), which accounts for a relatively small share of all abortions taking place among women in Latin America each year. Future research could focus on a much broader analysis of the impacts of Zika and its public health advisories on demand for abortion in Latin America and could also provide more in-depth analysis, for example through qualitative interviews. Is there anything else you would like to add?

Response: Zika is expected to arrive locally in North America this summer and our study has important implications for the states most likely to be hardest hit by Zika, including Texas and Florida, where access to abortion has been limited by recent legislation. The WHO has advised women to consider delaying pregnancy, but not all pregnancies at risk of Zika exposure can or will be avoided. Women with the fewest resources are the least likely to be able to access contraception and also, if they do get pregnant, the least likely to be able to access the care required to diagnose Zika and, if necessary, to begin fetal monitoring. They are also the least likely to be able to access a full range of reproductive options due to the financial and logistical barriers to accessing abortion. Thank you for your contribution to the community.


Requests for Abortion in Latin America Related to Concern about Zika Virus Exposure
Abigail R.A. Aiken, M.D., Ph.D. et al
June 22, 2016DOI: 10.1056/NEJMc1605389

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on June 26, 2016 by Marie Benz MD FAAD