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Zika and reproductive rights: new geographies, similar concerns

As summer inches closer, growing mosquito populations and numbers of vacationers traveling South pose an increased threat of Zika virus transmission inside the continental United States – maybe even in our own backyard. While U.S. health officials don't expect the same size and scale outbreak as in Latin America, the same ethical issues are likely to emerge, particularly regarding Zika and pregnant women.

While Zika has typically been regarded as a relatively benign virus -- only about 20 percent of those infected develop symptoms -- the dramatic increase in babies born with Zika-linked microcephaly has led to an international public health emergency, explained Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health.

Speaking on an interdisciplinary panel of experts last week at Stanford Law School, Barry reviewed what’s known and unknown about the virus. In just the last few months, scientists’ clinical understanding of the disease has greatly improved, but many ethical questions around women’s reproductive rights remain.

“What’s really missing [from the national guidelines] is advice for women about what they can do [if fetal complications are suspected],” said panelist Paul Blumenthal, MD. “What are the options for women who are pregnant? What are the options for women who are pregnant but don’t want to be?”

Blumenthal, a professor of obstetrics and gynecology and reproductive rights expert, walked listeners through the current Centers for Disease Control and Prevention guidance for pregnant women. If a fetus is found to have microcephaly or intracranial complications, the CDC recommends serial fetal ultrasounds every three to four weeks to monitor fetal anatomy and growth throughout the duration of the pregnancy, as well as testing of the newborn baby. But, the guidelines are not clear about what happens next.

If a woman chooses to have an abortion, her options may be limited based on where she lives. In places like Texas and Louisiana -- two states at high risk for local Zika transmission -- abortion clinics are few and far between. It isn't uncommon for women to drive more than 150 miles to the nearest clinic and then be subjected to a required 24-hour waiting period, increasing the burden on those with limited resources.

Blumenthal commented that Zika has brought women's reproductive rights -- or the lack thereof -- in many Latin American countries into the limelight, but the situation in parts of the southern U.S., where Zika is most likely to spread, is not all that dissimilar. Restrictive policies limiting circumstances under which a woman can choose a pregnancy termination in southern states resemble those of some Latin American countries, raising ethical questions around access to contraception in those regions.

"It's really an issue of [overall] health equity,” said Barry, reminding listeners that the current outbreak began in one of the poorest regions of northern Brazil. As with many infectious diseases, the burden falls most on marginalized populations, she pointed out.

Barry and others urged Congress to allocate necessary funding to support a coordinated U.S. Zika response that will help protect pregnant women and their babies.

Stanford Law fellow Yanbai Andrea Wang, PhD, meanwhile, closed the panel by outlining the broader challenges in global pandemic response and preparedness amidst a dysfunctional and siloed global regulatory environment. “A country where Zika is already spreading faces very different incentives than a neighboring country that is at risk of importing the disease,” she said.

Previously: Zika is just one of many tropical viruses headed our way, says Stanford expert, Talking about the Zika virus and Zika outbreak shares key traits with Ebola crisis, Stanford experts point out

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