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Abortion access could have contributed to relatively low rate of Zika-related microcephaly in Colombia

There is evidence that access to abortion care helped curb the rate of Zika-related microcephaly in Colombia, the New York Times reports (McNeil/Symmes Cobb, New York Times, 10/31).

The Zika virus is not easily diagnosed, and it does not have a cure or vaccine. It is linked to microcephaly, a sometimes fatal anomaly in which a fetus develops an abnormally small head and brain. The virus is most commonly transmitted by a bite from an infected mosquito, but it can also be spread through sexual activity (Women's Health Policy Report, 10/17).

Zika and microcephaly in Colombia

Colombia had the second-largest Zika outbreak of any country, the Times reports. The largest outbreak was in Brazil. However, while more than 2,000 infants have been born with Zika-related microcephaly in Brazil, only 47 cases of Zika-related microcephaly infants have been reported in Colombia.

Colombia's Zika epidemic peaked in February, and officials declared it over in July (New York Times, 10/31). At the time Colombia officials declared an end to the country's Zika epidemic, about 100,000 individuals had contracted Zika, including nearly 18,000 pregnant women. At that point, the virus had been linked to over 20 cases of microcephaly (Women's Health Policy Report, 7/26).

Officials in Colombia had predicted that women there could give birth to as many as 700 infants with Zika-related microcephaly. Fernando Ruiz, Colombia's vice minister for public health, said he now expects to see 100 to 250 cases at most.

Colombia's lower rate of Zika-related microcephaly could be due to differences in topography, Colombia's smaller population, more awareness of Zika and greater preparedness for fighting the virus, according to the Times. However, "all that does not seem sufficient to explain the disparity," the Times reports.

Women in Colombia seek abortion care

Officials say that women in Colombia, aware of the proliferation of Zika-related microcephaly in Brazil, may have sought ultrasounds early in pregnancy and, pending the results, sought abortion care.

In Colombia, a woman may seek abortion care if continuing a pregnancy compromises her health. The country considers severe fetal anomalies a threat to a woman's mental health and allows a woman to receive abortion care in such circumstances. The law does not specify when in a pregnancy abortion is no longer legal, but some insurers are "reluctant" to cover abortion care provided later in pregnancy, the Times reports.

Brazil allows abortion care only in cases of life endangerment, rape and incest, and police in the country began cracking down on illicit abortion care about 10 years ago, in response to pressure from religious conservative lawmakers. In addition, according to the Times, because of the unexpected emergence of Zika-related microcephaly in Brazil, women who might have otherwise sought illegal abortion care could have lacked time to do so.

According to Ruiz, it is "very possible" that abortion access reduced the rate of microcephaly in Colombia. He said OB-GYNs were aware of the Zika-microcephaly risk, which meant many women received ultrasounds in time to make decisions about whether to continue pregnancy. Women in the country receive about three ultrasounds over the course of a pregnancy, the Times reports, which can facilitate fetal diagnoses.

Miguel Parra-Saavedra, a leading high-risk pregnancy specialist in Colombia and the director of maternal-fetal medicine at the Cedifetal Clinic, has diagnosed 13 cases of Zika-related microcephaly. According to Parra-Saavedra, four of the women terminated their pregnancies immediately. He said four others, and possibly a fifth, sought abortion care, but were denied coverage by their health insurer.

In addition, the Times reports that some women in the country may have sought abortion care through means that were not officially reported as abortion. According to Guido Parra Anaya, the director of an assisted fertility clinic called Procrear, most abortion care in Colombia is done via misoprostol, one of two drugs used in a medication abortion. Any physician can prescribe the drug without reporting such a dispensation.

Women can also obtain misoprostol via the black market, according to the Guttmacher Institute. Women are often told to go to the hospital when heavy bleeding begins, as if they were experiencing miscarriage, the Times reports. Martha Lucia Ospina, director of Colombia's National Institutes of Health, said in July that fetal death reported as miscarriage has increased 8 percent. The numbers recently have started returning to normal, according to the Times.

The Times also reports that women's decision to wait for the outbreak to subside before becoming pregnant could also have contributed to the lower incidence of Zika-related microcephaly in Colombia. A decreased birth rate could confirm the trend. However, according to the Times, it takes the national health statistics office 18 months to calculate the annual birth rate (New York Times, 10/31).