Monday, February 15, 2016

Zika Virus in Colombia Presents Complicated Choice About Abortion
New York Times
FEB. 15, 2016

Marlenia Ortíz, center with blonde hair, at a camp for the homeless in Cúcuta, Colombia. She said that one of her five children had contracted Zika and that she feared the whole family would get the virus. Credit Juan Arredondo for The New York Times

CÚCUTA, Colombia — Margarita Rosa Barrios was six weeks pregnant when she began to feel the symptoms that every expecting mother here has come to dread: swollen eyes, aching joints, three days of fever. Just as she feared, she had the Zika virus.

Ms. Barrios, 24, knows that thousands of babies have been reported born with abnormally small heads during the Zika epidemic in neighboring Brazil and that researchers there say the virus is to blame.

And Ms. Barrios is not expecting just one child. She is carrying twins.

Nearly 3,000 pregnant women in Colombia are in Ms. Barrios’s agonizing position, having recovered from Zika only to be left in a terrible dilemma. Unlike in Brazil, in Colombia some expecting mothers are being given the choice to to end their pregnancies, under laws that allow abortions in some cases.

Colombia has emerged as the second front in the battle against Zika in the Americas. At least 25,000 Colombians have contracted the virus, a number officials say could surge to 600,000.

But unlike in Brazil — where there have been an estimated 1.5 million infections dating to 2014 — in Colombia the first cases of Zika were detected only in October. Most pregnant women who have contracted the disease in this country have not given birth yet, and no cases have been confirmed of infants born with abnormally small heads, a condition known as microcephaly.

This has put women here in Colombia in the difficult position of considering — and, in some cases, having — abortions even before any microcephaly cases have appeared in the country.

“There’s a lot we don’t know about this disease,” Fernando Ruiz Gómez, Colombia’s deputy health minister, said. “What we know is there’s a growing disparity between what we’re seeing in Colombia with Zika and the experience in Brazil.”

Colombia is one of the few nations in Latin America with abortion laws that allow women to terminate pregnancies under a variety of circumstances, including rape, birth defects that make a fetus unable to survive outside the womb or when there are risks to the pregnant woman’s physical or mental health.

While legal abortions remain rare in Colombia, there are signs that the law is undergoing a major new test. Some medical officials say that microcephaly is grounds for abortion and that they will offer the procedure to pregnant women if the fetus shows signs of the condition.

Others have gone further.

Ms. Barrios says her doctors offered to perform an abortion, even though there is no evidence that the babies she is carrying have microcephaly.

“The doctor asked me if I might be ready to have two deformed children,” she said. “How do you tell a mother that?”

Vanesa, a 28-year-old woman in the coastal city of Barranquilla, said she decided to end her pregnancy after she contracted Zika. An ultrasound showed what doctors said could be a deformity, possibly microcephaly.

“I cried a lot,” said Vanesa, who asked that her full name be withheld because she did not want others to know she had an abortion. “We are Catholics, and we prayed to God. We decided not to have the baby.”

The issue is all the more complex because the scientific link between Zika and microcephaly in infants has not been proved. International health officials say the connection is “strongly suspected,” but they warn that it may take months to know for sure.

Even if Zika does cause microcephaly, there is often no way to predict how a baby will be affected. Infants with microcephaly can endure a wide range of mental and physical disabilities, while some, about 10 percent, have no limitations.

Zika has already spread to 250 cities and towns in Colombia. It is here in Cúcuta, a city of 650,000 on the border of Venezuela that sits squarely in the range of the mosquitoes that transmit the virus, along with two other diseases, dengue and chikungunya.

On the streets here in Cúcuta, it is now difficult to find a person who has not had Zika or known someone who did. Entire families have come down with symptoms.

At the center of town is a large tent camp where dozens of homeless Colombians sleep after having been forced out of Venezuela last year for not having proper visas. Across the street is a culvert swarming with mosquitoes.

Two pregnant women live in the camp. Neither has contracted Zika yet, according to residents, but it is assumed that everyone will be infected here at some point.

Marlenia Ortíz, a 37-year-old mother of five, said one of her children had already contracted Zika. Last year, the entire family was infected with chikungunya, she said.

“Not one person in my family escaped it,” she said. “The same will happen with Zika.”

Scrambling for a response to the disease, Colombian officials have warned women to postpone getting pregnant for months, until more is known about the virus and its effects on infants.

But in recent months, the country has made progress on what could be an innovative way of controlling the disease. Iván Darío Vélez, a tropical disease specialist at the University of Antioquia in Colombia, said scientists there had successfully bred a mosquito that was resistant to Zika, dengue, chikungunya and yellow fever.

To create the strain, Dr. Veléz infected mosquitoes with bacteria that block the insects from picking up the virus. When the mosquitoes breed with ones that are susceptible to the disease, their progeny are shielded.

“The results are encouraging,” Dr. Vélez said, citing a recent pilot project near Medellín in which 80 percent of mosquitoes were rendered unable to transmit Zika.

At the main hospital here, more than 80 pregnant women have come in with the virus since October, said its director, Dr. Juan Agustín Ramírez.

About 35 percent of the women arrived in the first trimester, when microcephaly is most likely to develop, he said.

Why scientists are worried about the growing epidemic and its effects on pregnant women, and advice on how to avoid the infection.

Dr. Ramírez said the hospital had not performed any Zika-related abortions, but he was firm that any women whose fetuses showed signs of the condition would be offered the procedure.

No woman, he said, should be forced to carry “a child that, in a few words, is useless to society.”

Ms. Barrios ultimately did not find herself in that position.

After recovering from the virus, she discussed her pregnancy and the doctors’ offer of an abortion with her husband. An ultrasound showed that their twin fetuses were developing normally, she said, and the couple turned down the procedure.

But Ms. Barrios remains on edge.

She continues to have regular ultrasounds to check for birth defects. As a Catholic, she said, she will accept whatever is discovered when the babies arrive.

“If it’s something that God wants, then so be it,” she said.

Susan Abad contributed reporting.

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