Zika Virus May Be Increasing Interest in Abortion Pills

Women in areas infiltrated by the Zika virus have been showing increased interest in abortion medications like mifepristone and misoprostol.

The New England Journal of Medicine recently published a correspondence that investigated women’s responses to the Pan American Health Organization’s (PAHO) alert last fall about the Zika virus in Latin America. The warning included information about microcephaly and advised that women avoid pregnancy.

“Yet, in most Latin American countries, abortion is illegal or highly restricted, leaving pregnant women with few options,” the study authors wrote.

However, one option for women is a resource called Women on Web (WoW), which offers abortion medications via telemedicine in countries where safe abortions aren’t available.

The study authors looked at WoW data from January 1, 2010, to March 2, 2016, in 19 countries. The following countries, where there has been indigenous Zika transmission, showed an increase in online requests for abortion medications through WoW:

1.

Brazil

2.

Colombia

3.

Costa Rica

4.

El Salvador

5.

Honduras

6.

Venezuela

7.

Bolivia

8.

Guatemala

9.

Nicaragua

10.

Panama

11.

Paraguay

These 11 countries saw increases between 36% and 108% over baseline in requests for abortion medication through WoW after the PAHO alert, according to the study authors.

Two other countries that don’t have autochthonous Zika transmission but do have legally restricted abortion showed small increases in requests for abortion medication were Argentina and Peru. One country that didn’t show increases in abortion medication interest, despite indigenous Zika transmission, was Jamaica.

The study authors noted that they couldn’t definitively determine that the widespread increase in abortion medication requests was only due to Zika concerns.

“However, the percentage of women in each country who reported such concern as their reason for seeking abortion correlates with the observed country-specific increases in requests over baseline trends,” they wrote.

The researchers also found that interest in abortion medications was especially prevalent in countries where information about pregnancy complications associated with Zika was distributed. In addition, they noted that their information on the interest in abortions may be underestimated, since women could be using misoprostol from pharmacies or the black market, or they may be resorting to “underground providers.”

“[O]ur results suggest that women were reacting not only to the potential risk of Zika virus in pregnancy, but also to the responses of their governments and health officials,” lead study author Abigail R.A. Aiken, MD, MPH, PhD, assistant professor at the University of Texas at Austin, told Pharmacy Times.

She noted that Jamaica was unique because it issued a pregnancy advisory before local Zika virus was confirmed. This may have contributed to some skepticism about the advisory, or it’s possible that Jamaican women started to avoid pregnancy at an earlier time, Dr. Aiken speculated.

“We were perhaps not surprised to see the biggest increase in requests in Brazil (where requests more than doubled), because women in Brazil had been exposed to the risk of Zika and the media attention it attracted for longest, and because an increase in cases of microcephaly had been confirmed,” she said.

Dr. Aiken said her study’s findings offered 2 main lessons for the United States.

“The first is that there is a need for timely and accurate information from health care providers and public health agencies about the risks of Zika virus in pregnancy,” she said. “The second is that women must be supported in obtaining safe, legal, abortion through their own health care systems.”

Dr. Aiken argued that this is hard advice to follow if women are told to avoid getting pregnant, but have few options to actually avoid it. She highlighted Texas, Florida, and Mississippi as states that are most likely to run into trouble with Zika and also have limited access to abortions.

Women with few resources have the hardest time accessing care like fetal monitoring, and they’re least likely to be able to access abortion care, she said.

“If women in the US are cautioned to avoid pregnancy the way women in some Latin American countries have been, and then are given no means to help them avoid pregnancy or any reproductive options should pregnancy occur, we could well see the same fear, anxiety, and desperation we observed in our study,” Dr. Aiken said.