Zika highlights lack of access to contraception, abortion in Latin America

The Zika outbreak spreading throughout Latin American and the Caribbean is shedding light on what women's health advocates call an equally important public health crisis: the lack of contraception and basic maternity care in much of the region.

Last week, the government of El Salvador advised women to postpone pregnancy for two years to reduce the risk of serious birth defects linked to the Zika virus, which has spread to 25 countries and territories in Latin America. The virus is associated with microcephaly, a birth defect in which babies are born with abnormally small heads and often suffer from intellectual disabilities.

"They are making these recommendations, as if this is something that is always a woman's choice," said Alejandra Colom, who works in Guatemala for the Population Council, which studies family planning. "These decisions are not necessarily in the hands of women."

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In many Latin American and Caribbean countries, basic contraception, such as birth control pills and IUDs, are in short supply. That means even women with access to a doctor or clinic may not be able to get birth control, Colom said.

The region's conservative culture often puts men in control of their family's size, rather than women, Colom said. Many women are unable to persuade their partners to use condoms.

Haiti has some of the worst access to contraception: 62% of women of reproductive age lack access to birth control, according to a report released Tuesday by the Kaiser Family Foundation. Women in Nicaragua fare the best, according to Kaiser's survey of 18 countries in Latin America and the Caribbean; just 20% of women there lack access to contraception.

In five countries — the Dominican Republic, El Salvador, Guatemala, Haiti and Honduras — clinics ran out of contraceptive supplies, in 2015, according to the Kaiser report.

Colom hopes the Zika virus outbreak — over which Honduras declared a state of emergency Monday just hours after the World Health Organization called it an international emergency — will change conversations around contraception and lead governments to make birth control more available.

Rates of sexual violence are high in many Latin American countries, Kaiser found. About 5-15% of women in Latin America or the Caribbean report having been the victim of violence from a sexual partner, according to the World Health Organization.

Latin America and the Caribbean have some of the world's most restrictive abortion laws, according to Kaiser.

The Dominican Republic, El Salvador and Nicaragua ban all abortions, according to the Kaiser report. Six others — Guatemala, Haiti, Honduras, Paraguay, Suriname and Venezuela — allow abortion only to save a woman’s life. Brazilian activists are petitioning the Supreme Court there to expand abortion access.

Strict laws haven't stopped women from ending pregnancies. About 4.4 million women had abortions in Latin America and the Caribbean in 2008. About 95% of those abortions were considered unsafe, because they were performed by people without adequate training or conducted in an environment that didn't meet medical standards, according to the Guttmacher Institute, a U.S.-based non-profit that researches family planning.

The abortion rate in Latin America and the Caribbean is 31 to 32 abortions per 1,000 women ages 15 to 44, compared to the U.S. rate of 28 abortions per 1,000 women the same age, according to Guttmacher.

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At least 10% of maternal deaths in Latin America and the Caribbean in 2014 were due to unsafe abortions, according to Guttmacher. About 760,000 women in the region were hospitalized due to complications from unsafe abortions.

An abortion rights group called Women on the Web has offered to help women in Zika-affected countries undergo medical abortions by sending free pills to women less than 9 weeks pregnant. Abortion rights opponents have criticized the practice as dangerous. Microcephaly is typically diagnosed with ultrasound around the 24th week of pregnancy.

Basic maternity care is also often lacking in Latin America and the Caribbean. While nearly all women from wealthy households give birth in health care facilities, nearly one-third of very poor women in the region deliver their babies at home or somewhere other than a medical facility, according to Guttmacher.

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Only half of women who need care for medical complications of delivery and pregnancy receive it, according to Guttmacher. These complications include high blood pressure, infection or obstructed labor, a condition treated with C-section in the USA. Such complications can be fatal for mother and baby if left untreated.

Latin America and the Caribbean could cut the number of maternal deaths by an estimated 65% — from 9,300 deaths per year to 3,300 — by providing effective contraception and adequate maternity care, including care for HIV. These improvements would also reduce newborn deaths by an estimated 70%, from 107,000 a year to 32,000, according to Guttmacher. Providing adequate contraception also would reduce the number of unintended pregnancies and unsafe abortions by 65%.