Zika Virus Revives Abortion Debate in Nicaragua

Virus linked to congenital malformations and microcephaly

By Wilfredo Miranda Aburto  (confidencial.com.ni)

HAVANA TIMES – The appearance of Zika in Latin America has placed all the regional health systems on high alert, especially since the virus in pregnant mothers is associated with congenital malformations and microcephaly. In countries such as El Salvador and Nicaragua, where the laws prohibit the interruption of pregnancy for any reason, the epidemic projected by the World Health Organization (WHO) has revived the debate on abortion.

As of last Thursday, First Lady Rosario Murillo, spokesperson for the government of Daniel Ortega, reported 29 confirmed cases of Zika, three of them in pregnant women. Though scientists haven’t established a direct causal link between Zika and microcephaly, El Salvador has recommended avoiding pregnancy, while Nicaragua has called for ”remaining calm.”

Science warns that microcephaly produces severe brain damage and in the worst cases the death of the fetus. If the baby survives, the individual can suffer permanent disability, with lifelong cognitive and motor challenges.

Martha María Blandón, with a master’s in the psychology of public health and the director of IPAS Central America (organization based in Managua since the late 1980s that works to protect women’s health and rights) poses a series of questions to Nicaragua, given the fact that abortions for health reasons are prohibited.

“Can the woman decide if she wants to have a child with a disability? Do they have the physical and economic capacity to carry out this special kind of maternity? Does adequate support – social, state or community resources – exist to accompany a woman with a child that will require specialized attention their entire life? Or are we simply obligating them to give birth, even when their life is at risk?”

In this interview with Confidencial, the specialist analyzes the Health Ministry’s capacity to confront a virus that is asymptomatic in 80% of cases, a fact that only increases the risk in pregnancy.

Zika has put the controversial topic of abortion back on the table. Though direct causality hasn’t yet been established, the virus has been linked to microcephaly. What’s happening in countries like El Salvador and Nicaragua where abortion is totally prohibited?

Martha Maria Blandon: In this epidemic of the virus, about which we know little although it’s been around for a long time, one of the few angles that’s been touched on is the direct incidence of malformations – as of now, principally that of microcephaly. We don’t know if any others are going to show up, nor do we know how many studies are being carried out in Latin America and what capacity we have to foresee other consequences. The Zika virus has exposed the fact that pregnant women are the ones most vulnerable to certain diseases that can affect either their own health or that of the baby they carry, including cancer, high blood pressure, and kidney problems. On the topic of microcephaly they say that this doesn’t necessarily imply a risk to the life and health of the mother, or fetus, because the future human being can survive with the malformation.

So – What’s going on? Where’s the big difficulty? Women are left with no voice to decide whether they have the emotional capacity, strength, human resources or support to take on the responsibility of a child who’s going to require specialized help for their entire life.

Those who oppose allowing the interruption of pregnancy for health reasons could claim that a person with microcephaly can develop sufficiently to fend for themselves, or even become independent. True, but what conditions are needed to reach this level of development? They need neurological attention starting at birth, with periodic exams until the day they die. How many women in this country – and they are the ones who have to submit to the ban against interrupting a pregnancy for any reason, even medical ones – have the physical and spiritual capacity and energy to dedicate to a son or daughter in those circumstances? Can they decide? Are they obligated to have it? Who’s going to help them? Where are the social, state and community resources to accompany a woman who has to make her way with a child who has a life-long disability.

Up until now, the recommendation in El Salvador is to avoid pregnancy and in Nicaragua they’ve called for “calm”.

MMB: Yes, I agree that we need to remain calm. This implies taking time to analyze the situation, understand the disease better in order to take the most appropriate measures according to the Nicaraguan reality. It’s a serious problem. Medical opinion and the decisions of the health and epidemiology authorities are important because 80% of people infected with Zika have no symptoms. When are you going to find out that the pregnant mother has Zika, and that there’s a problem with her baby? What protocol are you going to follow with all pregnant women, because those who are already pregnant can’t change that? And what about those who are going to get pregnant for some reason, either because they don’t believe in Zika or lack sufficient information? We need to see what special protections we could offer those women to avoid becoming infected with Zika. Do we have the capacity to do that?

Experts predict that Zika will advance more quickly than chikungunya. What would an epidemic like last year’s imply?

MMB: MINSA (the Nicaraguan health ministry) is making efforts to educate the community, to fumigate, to control household vectors, but hasn’t done the same with the vectors in the poorer areas. We’re still seeing unauthorized garbage dumps and puddles in the public streets, offering all the right conditions for the mosquito’s reproduction. You go to the hospitals and find a totally unhygienic environment; that’s the responsibility of the municipal authorities as much as those in charge of public health. How can it be that a hospital is neglecting prevention and allowing the larvae to develop? An epidemic of Zika would be so catastrophic!

Unfortunately, we’re never going to have the exact statistics on the magnitude of dengue, chikungunya, pneumonia or Zika. I believe that the report of seven thousands cases of chikungunya is a very low figure compared to what really occurred. This has to do with several things: people who don’t go to a health center and so are never registered; people who self-medicate; people who, like myself, went to a health center to follow the protocol, but the test came back negative. I didn’t enter in the statistics, although I’ve been suffering incapacitating residual effects from chikingunya for seven months now.

The WHO has warned that Zika could affect nearly 4 million people in one year. There’s a Dutch organization called “Woman on Web” which is supplying abortion pills on demand. If malformations were detected in Nicaragua, what would be the best way of dealing with the situation?

MMB: The topic of Zika and how it can affect the product of gestation has brought to the fore once again the need to review the restrictive laws that prohibit the interruption of pregnancy for health reasons. Zika is one more indication of situations that we who defend women’s lives have already brought up. We have denounced and offered concrete evidence of very dramatic cases of congenital malformations incompatible with life, such as an anencephalic fetus, but have received no response.

I’m troubled by the thought that if this malformation produced by the Zika virus doesn’t threaten the life of the woman or the fetus, then what’s going to be the response? We already have had cases where the woman is going to die, where the gestational product isn’t going to live, and yet there’s no option for not inflicting yet more torture on the woman.

In the case of Zika, I’m very uncertain of what the State’s reply will be. We’re here confronting a real problem, one that has also received a lot of media coverage and is currently front and center of our attention. Will that make a difference, so that those who make the laws, norms and sanitary policies will act decisively? I don’t know. But I believe that the only difference is the degree of attention, because if you want dramatic cases, we’ve had plenty: there are women who died, and others who saved themselves by looking for other alternatives outside the area of public health system.

Doctors have indicated that Zika can pass through the fetal barrier. Would the national health authorities have the capacity to attend to a number of pregnant women whose unborn babies present with malformations?

MMB: The resources of the Health Ministry are limited. I don’t know how great a capacity the public health teams possess to be able to detect malformations. Let’s say that they associate microcephaly with an infection from the Zika virus, and indicate that there’s some permeability: what do we gain by detecting that something is amiss? What would be the reaction if microcephaly is already in process? The point is – can a pregnant woman persevere with a child who has microcephaly? Do we have the economic and social conditions to facilitate this special kind of maternity?