The World Health Organisation’s decision to declare Zika virus a global emergency comes on the back of considerable concern over a suspected link to microcephaly, a condition that causes unusually small heads in newborn babies and which can lead to potentially devastating brain problems.
There is fear that this virus (if it is the cause) could spread throughout the Americas, including North America. There is no vaccine or treatment for the virus, and no known treatment for children who suffer brain damage in the womb. Officials in Columbia, Ecuador, El Salavador and Jamaica have recommended that women avoid or defer becoming pregnant to prevent their babies being affected. But is it ethical to use birth control to control Zika microcephaly?
In November, Brazil declared a state of emergency following a sudden and unprecedented surge in the number of newborns born with microcephaly. There are reports of almost 4,000 babies born in Brazil in recent months with it, compared with a normal rate of about 150 cases a year.
Microcephaly can be caused by a range of different factors and illnesses including genetic abnormalities or after exposure to drugs or radiation. In some cases intelligence later in life may be normal. However, there is a relatively high rate of intellectual disability, epilepsy and other developmental problems in children born with microcephaly. This is because the small size of the head often indicates a very serious problem affecting brain development in the womb.
There is some evidence that the surge in cases may be caused by the Zika virus. Zika is carried by mosquitoes, normally causes only mild illness in adults and hasn’t previously been reported to cause brain damage to foetuses. So it may take some time to confirm whether this theory is correct. We also do not yet know what problems these children will have, though many of the babies in this outbreak have already shown signs of brain damage, so it appears likely that a significant number of them will have serious degrees of disability later in life.
Controlling mosquitoes is one way to stem the virus, but there are significant challenges to doing this. Alternatively, one way of preventing Zika microcephaly may be to defer pregnancy. We don’t definitely know whether this is the case with Zika, but the period of highest risk for brain damage to foetuses from other virus infections is during the first three months of a pregnancy.
If Zika virus is the cause of this epidemic, it may be that becoming pregnant out of the rainy season (ideal breeding conditions for mosquitoes) would reduce or eliminate the risk of brain damage to the foetus. (Other viruses carried by the same mosquito – for example dengue – have a regular seasonal pattern of infection during the rainy season).
Deferring pregnancy for a longer period would also have the advantage of potentially giving scientists time to work on treatment or vaccines for the virus.
Benefits of contraception
Using birth control to prevent illnesses in foetuses raises both philosophical and ethical questions. Some reproductive rights advocates have argued that the advice to delay pregnancy is unrealistic and will be ineffective. As many as 50-60% of pregnancies in Latin America and the Caribbean are unplanned. There is a high rate of sexual violence. And people in rural areas often do not have access to birth control.
Yet, the high rate of unplanned pregnancies doesn’t provide a good argument against birth control recommendations. If 40% of pregnancies in these regions are planned, advice to defer pregnancy could lead to a 40% reduction in the rate of Zika microcephaly. In fact, the lack of access to birth control and the high rate of unplanned pregnancy means that paying attention to birth control may be especially important and would provide other significant benefits to women’s health and well-being; it can reduce infant and maternal mortality, help prevent sexually transmitted infections, reduce population growth and enhance women’s access to education. It would be of value even if it does not address the cause of the epidemic.
Another advantage of birth control (compared with measures focused on the virus) is that it may prevent cases of microcephaly even if there is something else that is causing the epidemic.
An alternative way of addressing the problem of microcephaly would be to increase the availability of pre-natal testing and offer the option of abortion if the foetus is found to have severe microcephaly. This approach would be a more targeted approach to Zika-microcephaly than birth control. It would affect a smaller number of women. However, there is currently very limited access to abortion in most of the countries affected by Zika (in Latin America especially, abortion is problematic because of a strong Catholic following) and low rates of ultrasound during pregnancy. While this provides a separate reason to advocate for reproductive rights and improved antenatal screening, it is highly unlikely that there will be major changes to this in the short term. By contrast, contraception (though not necessarily emergency contraception) is already legal across central and South America.
Birth control will not solve the problem of Zika microcephaly. But it has the potential to prevent a significant number of cases, even if our current theories turn out to be wrong. It is safe, accessible and well-tested, more than can be said for vaccines or anti-viral drugs. Investment in birth control, would also have a number of important benefits for women’s health and well-being.
If and when, international funds become available in response to the Zika epidemic, there should be a significant investment in birth control in Latin America. Governments in these regions should take seriously the need to address and remove barriers to contraception.
In conjunction with Oxford University’s Practical Ethics blog