Chart: Access To Contraception And Abortion In Zika-Affected Countries

Don't get pregnant.

That's the advice given to women by the governments of Brazil, Colombia, Ecuador and El Salvador in light of a possible link between the Zika virus, which is spreading in those countries, and a birth defect called microcephaly, which results in an abnormally small head and possible brain damage. Brazil has reported thousands of cases of microcephaly since the outbreak began there last spring; researchers are trying to determine whether the virus is the cause.

One thing is certain: The outbreak has sparked a public debate about issues of contraception and abortion.

More than half of pregnancies in Latin America are not planned. In this heavily Roman Catholic part of the world, women don't always have access to modern methods of contraception, and abortion may be restricted (see chart).

Use Of Contraceptives And Abortion Laws In Countries Affected By Zika

Notes: 1. Contraception prevalance rate: Estimated share of women 15 to 49 years old in marriages or unions who are using (or whose partners are using) some form of contraceptive. Figures are as of 2015. How this is calculated (PDF) 2. “Modern” contraceptive methods include birth control pills, intrauterine devices, condoms and sterilization. 3. Abortion laws (as of 2013): — Banned: Not allowed under any circumstance — Highly restrictive: Permitted only to save a woman’s life — Restrictive: Permitted only to save a woman’s life, in cases of rape or incest, and/or to preserve a woman’s mental or physical health — Some restrictions: Permitted only for one of the following reasons: economic, social, fetal impairment, rape, incest, woman’s mental or physical health, or to save a woman’s life — Least restrictive: Legal (typically up to a certain gestational age such as 20 weeks) Source: Kaiser Family Foundation; Pan American Health Organization; United Nations Population Division: Estimates and Projections of Family Planning Indicators 2015; United Nations Population Division: World Abortion Policies 2013 — Notes:
1. Contraception prevalance rate: Estimated share of women 15 to 49 years old in marriages or unions who are using (or whose partners are using) some form of contraceptive. Figures are as of 2015.
2. “Modern” contraceptive methods include birth control pills, intrauterine devices, condoms and sterilization.
3. Abortion laws (as of 2013):
— Banned: Not allowed under any circumstance
— Highly restrictive: Permitted only to save a woman’s life
— Restrictive: Permitted only to save a woman’s life, in cases of rape or incest, and/or to preserve a woman’s mental or physical health
— Some restrictions: Permitted only for one of the following reasons: economic, social, fetal impairment, rape, incest, woman’s mental or physical health, or to save a woman’s life
— Least restrictive: Legal (typically up to a certain gestational age such as 20 weeks)
Source: Kaiser Family Foundation; Pan American Health Organization; United Nations Population Division: Estimates and Projections of Family Planning Indicators 2015; United Nations Population Division: World Abortion Policies 2013 (Alyson Hurt/NPR)

But even if abortion is a legal option in a Zika-affected country, it's not always possible for a pregnant woman to know whether the fetus is affected. According to the Centers for Disease Control and Prevention, microcephaly "might be detected as early as 18 to 20 weeks" into a pregnancy by ultrasound but "can be challenging" to detect.

Some individuals and groups argue that a pregnant woman should have the right to abort a pregnancy if she is worried about the possible link to microcephaly. Violeta Menjivar, the minister of health in El Salvador, suggested this month that the country might consider legalizing abortion in response to the Zika crisis. In an essay for Time magazine, Jon O'Brien, head of Catholics for Choice, calls on Pope Francis to "lift abortion bans" as well as restrictions on modern contraceptive methods.

Those opposed to abortion believe it would not be appropriate to make any changes in abortion law. "Abortion is a tragedy," says Dr. Danelia Cardona, a psychiatrist and the director of the Department for the Promotion and Defense of Life at the Catholic Bishops Conference of Colombia. "Using Zika virus as the leeway to allow for abortion is to compound one tragedy with another." In Colombia, abortion is only permitted in cases of rape or risk to the mother's health.

Cardona told NPR that the government must "put in place policies that will offer real options to eradicating the virus" — for example, getting rid of reservoirs of standing water that are "perfect breeding" places for the mosquitoes that spread Zika. Delaying pregnancy as a response "doesn't solve the problem," she adds.

The Kaiser Family Foundation has compiled a chart that looks at abortion laws as well as the use of contraception in many of the countries affected by Zika. The foundation uses the terms "banned," "highly restrictive," "restrictive" and "some restrictions" to characterize abortion laws. See the notes in the chart for further explanation.

The chart uses data from the U.N. Population Division, which relies on surveys from the various countries. Josh Michaud, associate director of global health policy for the Kaiser Family Foundation, notes that the contraception statistic may "mask what are large disparities between rural and urban areas and across different income classes. Poor rural women have the least access to contraception."