Since the outbreak of Zika virus in Brazil in November 2015, over 8,000 babies have been born with confirmed microcephaly. The rapid spread of the disease has left millions of women and families living in fear and uncertainty as Latin-American public-health officials have scrambled to coordinate an emergency response.
In the United States, by contrast, the crisis is unfolding in slow motion. As mosquito season has slowly approached, Congress has had seven months to take decisive action. Yet here we are in July—with 287 pregnant women having confirmed or suspected Zika infection, and seven babies born with serious neurological anomalies—and we are still waiting for Congress to act.
This dithering is staggeringly irresponsible. Despite repeated calls from public health officials, and a request from the White House for $1.9 billion to fund mosquito control and increased access to contraception, Congress is nowhere near approving a Zika appropriations bill.
Last Tuesday, one of the final opportunities to pass such a bill before the seven-week summer recess ended in stalemate: Republicans attached a poison-pill amendment barring Planned Parenthood from receiving funds to provide contraception, and Democrats abandoned the bill.
This move is reminiscent of similar efforts to de-fund Planned Parenthood in state legislatures across the country. Once again, a critical effort to protect public health and ensure reproductive autonomy has been sacrificed in favor of a political agenda. As a result, millions of women and their families have been failed.
Without funding to provide timely access to contraception, advisories from the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) to delay or carefully plan pregnancy are meaningless. Such hollow advisories may also have the unintended consequence of harming women rather than helping them.
Our study, published last week in the New England Journal of Medicine, revealed the consequences of official advisories against pregnancy on Latin-American women who were already pregnant or unable to avoid pregnancy. These women experienced heart-breaking fear and anxiety due to their inability follow the official guidance. To make matters worse, abortion in these countries is completely illegal or highly restricted. As a result, these women were left with no means of preventing pregnancy, no means of avoiding mosquitoes, and no means of safely ending their pregnancies through their own healthcare systems.
The situation for women in the U.S. may not be much different. With no funding to support contraceptive access on the horizon, many fewer women at risk of Zika infection will be able to avoid pregnancy. With no funding to ensure mosquito control, many fewer women who do become pregnant will be able to avoid Zika exposure. It is now clear that microcephaly is the tip of the iceberg in terms of the range of fetal anomalies caused by Zika. Some neurotoxic effects are not visible on ultrasound scans and may not be apparent until after birth, or possibly even years later. In light of this reality, women may be left with no reliable information on whether or not their pregnancy will result in birth defects.
For those unwilling to take the risk of Zika-related fetal anomaly, current clinical guidance recommending serial ultrasound scanning and fetal monitoring is not sufficient. Yet neither the CDC nor the WHO has issued any guidance on the reproductive options that should be available to women who are already pregnant or who cannot avoid becoming pregnant while Zika transmission remains a risk.
The decision about whether or not to end a pregnancy in light of confirmed or possible Zika infection is no doubt a very personal one. But personal choices become issues of public policy when the ability to choose a particular option is foreclosed. In the United States, while women have a legally protected right to choose abortion, the practice of that right depends on socioeconomic circumstances and geographical location.
In many of the states expected to be hardest hit by Zika, including Alabama, Arizona, Florida, Louisiana, Mississippi, and Texas, a surge of laws restricting access to abortion has forced clinics to close and women to travel long distances and negotiate waiting periods. Consequently, many women are effectively unable to choose abortion, and low-income women and women of color are disproportionately affected. Moreover, recent convergence of the politics of abortion and contraception has meant that contraceptive access in many of these states has also been devastated by budget cuts, diversion of funds away from dedicated family-planning providers, and refusal to participate in Medicaid expansion.
The risk of Zika exposure is clearly not the only reason why women in the United States require access to abortion. But the Zika crisis brings the issue of reproductive rights sharply into focus. At the heart of Congress’ failure to ensure equitable access to contraception and abortion is a craven political choice: that reproductive autonomy and individual liberty matter less than ideological pandering. This posturing must stop. With such high stakes, those with the power to make public policy that places women in control of their own reproductive decisions must ensure safe, legal, and accessible reproductive choices.
Abigail R.A. Aiken is Assistant Professor of Public Affairs at the Lyndon B. Johnson School of Public Affairs and Faculty Associate the Population Research Center at the University of Texas at Austin.
James Trussell is Professor of Economics and Public Affairs, Emeritus at the Office of Population Research at Princeton University and an Honorary Fellow of the University of Edinburgh.