Zika outbreak puts focus on abortion access

The threat of a Zika epidemic of the virus in the U.S. is raising the ethical dilemma of presenting abortion as an option to infected mothers who may be likely to give birth to babies with significant developmental disabilities.

Some policymakers and anti-abortion activists have already rallied against easing or increasing access to abortion, and experts say the arrival of Zika in the U.S. during an election year makes it nearly impossible to have a conversation about abortion as a medical decision. And southern states, where climate and socio-economic conditions could invite an outbreak, also have some of the nation's toughest abortion restrictions.

“Abortion played a role in not getting funding to help control Zika, leading potentially to having to confront this question later about aborting Zika-impacted fetuses,” said Arthur Caplan, the founding head of the division of bioethics at New York University's Langone Medical Center.

Senate Republicans refused to pass a $1.1 billion measure without provisions to restrict federal funds to provide birth control. House Republicans wanted their chamber's bill to block Planned Parenthood from getting any funding. Neither body was able to pass a spending measure before Congress broke for summer recess.

Nearly 500 pregnant women in the U.S. are infected with Zika, according to the Centers for Disease Control and Prevention's latest report. That's resulted in 15 children born with birth defects and six lost pregnancies.

Researchers say the first indication that a fetus might have Zika-related birth defects such as microcephaly comes late in the second trimester or early in the third trimester. According to a July study in the New England Journal of Medicine, Brazil, Venezuela and Ecuador, which already experienced Zika outbreaks, have seen requests for abortions double.

Twenty states prohibit terminating a pregnancy after 24 weeks, which is late in the second trimester and when a fetus is considered viable. Twelve states, including potential Zika hot spots in Texas, Mississippi, Louisiana and Alabama, have laws banning abortion at 22 weeks or less.

The U.S., however, previously has seen a shift in attitude toward abortion as a result of viral epidemics. During the rubella outbreak in the 1960s, 20,000 children were born with physical and mental defects and 11,250 women had therapeutic abortions or miscarriages, according to the CDC. The concern over the long-term emotional and financial impact on families in the U.S. is credited with paving the way for legalization of abortion.

But that sea change came after more affluent women became infected, after many poor women had already been denied abortions.

Pro-choice activists worry that some of the same socio-economic and racial barriers will emerge with Zika.

Terry O'Neill, president of the National Organization for Women, says anti-abortion laws disproportionately impact women of color. “I think we need to have some thoughtful, intelligent decisionmakers saying since the wives and girlfriends within their social circles have access to safe, legal care it needs to be extended to all of the women in the United States,” she said.

Public views on the issue appear to lean toward allowing women to have greater access to abortion services in light of the current outbreak. A recent poll conducted by STAT and the Harvard T.H. Chan School of Public Health found that 59% of respondents felt women should have the right to terminate a pregnancy after 24 weeks if signs indicated a strong likelihood that a fetus had microcephaly as a result of Zika infection.

Florida has some of the toughest restrictions on abortion in the country. In March, state lawmakers passed a bill that essentially stripped state funding for any organization that received private funds for performing abortions. That prevents an estimated 16% of the state's safety net patient population from receiving contraception and prenatal care.

None of the five states that make up the Gulf Coast region—an area many experts say will be ground zero for a Zika outbreak—allow Medicaid to cover the cost of an abortion unless the pregnancy was the result of rape, incest or endangers the life of the mother, according to figures compiled by the National Women's Law Center. Kelli Garcia, senior counsel for the center, said the organization is hopeful that a debate about abortion access in light of Zika will lead to “a bigger conversation about what women need in terms of their health, which includes access to contraception and abortion.”