When Zika started spreading through Latin America earlier this year, a number of governments issued advisories recommending that women put off getting pregnant because the virus can cause severe birth defects. At the same time these countries kept in place strict laws that would prevent a woman from getting an abortion if she were already pregnant.
To Abigail Aiken — a health policy researcher at University of Texas, Austin — this felt like a "disconnect." On one hand, authorities were saying Zika is such a major health threat a woman shouldn't even get pregnant. On the other hand, they were implying that if a woman does become pregnant, Zika is not a serious enough health reason to consider an abortion.
That made Aiken wonder, "What are the impacts of these advisories and of Zika on what women want to do?"
After all, she adds, even before the outbreak, millions of women in Latin America had been getting abortions illegally each year. Has the epidemic prompted more women to do so?
Pinning down abortion rates in Latin America is notoriously difficult, notes Aiken. "It's happening almost completely under the radar. So it's very hard to collect data."
But there was one source that seemed uniquely well placed to offer some. It's a nonprofit called Women on Web that essentially offers an online portal through which women all over the world can log on and request abortion medication.
Based in the Netherlands, Women on Web has a small team of doctors at its headquarters who review the requests and email back and forth with each woman to determine whether there are any health issues that would prevent safe use of the drug. If there are none, the doctor then authorizes a partner group in India to ship two drugs designed to induce abortion during early pregnancy. They're mailed to the woman's home.
How is this legal? Rebecca Gomperts, founder of Women on Web, says the group "really analyzed every country's situation." And in the countries they serve, "for the women to actually get the medication is not illegal. These are medicines on the list of essential medicines of the World Health Organizations." (Indeed, the group says it does not send pills to women in the United States because it's one of the few nations that specifically prohibit importation of the drugs involved.
Of course, Gomperts notes, when a woman actually takes the medication to induce an abortion she often is breaking the law. "But we inform them that if they have complications and they want to see a doctor that they can just say that they had a miscarriage. The symptoms are exactly the same, and the treatment is the same."
The group works with women in over 120 countries — including South and Central America.
So Aiken and some other researchers teamed up with collaborators at Women on Web to run an analysis of every request for abortion pills that women in Latin America had made to the group over the last five years.
"We had a very large sample. We had 28,670 requests in total over those five years," says Aiken.
Their findings were published Wednesday in the New England Journal of Medicine. In the countries where access to abortion is limited and the government had issued advisories about Zika, the number of requests for abortion pills skyrocketed after the virus hit. In Brazil, requests over a three-month period more than doubled, from the 582 Women on Web would typically see during that time frame to 1,210. Ecuador, Venezuela and Honduras saw increases above 70 percent. The increase was about 30 percent in Colombia, El Salvador and Costa Rica.
By contrast, the study did not see an increase in countries where governments had not issued Zika warnings — Mexico, Guatemala and Nicaragua, for example.
"It seems as though as though women were responding not only to the threat of Zika but to the advisories issued by their governments," says Aiken.
Still, she concedes there's a limit to how much you can conclude from the study.
It's a caution echoed by other experts, including Gilda Sedgh, a researcher at the Guttmacher Institute and co-author of one of the most comprehensive studies on abortion rates in Latin America. For one thing, notes Sedgh, the abortions reported by Women on Web account for only a tiny fraction of the millions of the abortions that take place in Latin America each year — almost all of which are illegal.
Also, Women on Web clients are at least a bit more likely to live in cities and be better off than the average woman in Latin America.
"These are women who have access to the Web," says Sedgh.
So when it comes to Zika's impact on abortions, "we still really don't know. I think it's important that they've published this paper to give us a clue. But it's not definitive."
In a previous Web version of this story, we incorrectly quoted Rebecca Gomperts as saying that it is not legal for women to receive abortion-inducing medication in the countries served by Women on Web. In fact, she said it is not illegal.
KELLY MCEVERS, HOST:
Many women in Latin America are facing some tough choices. There's an outbreak of Zika, which is a virus that can cause severe birth defects. Several countries in the region say women should delay pregnancy. But what if they're already pregnant? Many live in places where abortion is not legal, although millions of women still have them.
NPR's Nurith Aizenman reports on a new study that asks whether the Zika epidemic is pushing more women toward illegal abortions.
NURITH AIZENMAN, BYLINE: When Zika started spreading through South America, several governments recommended that women avoid getting pregnant. Abigail Aiken is a health policy researcher at University of Texas at Austin, and she says she felt there was a disconnect. They were saying Zika was such a serious health threat you shouldn't even get pregnant, and yet if you were pregnant, they were saying Zika wasn't a serious enough health reason to consider an abortion. And that made her wonder.
ABIGAIL AIKEN: What are the impacts of these advisories and of Zika on what women want to do?
AIZENMAN: So she launched a study with a nonprofit called Women on Web. It's based in the Netherlands, and it's basically this online portal through which women all over the world can log on and request abortion medication.
AIKEN: Women on Web has doctors and a trained help desk team.
AIZENMAN: The doctor reviews the case and then potentially mails the woman drugs designed to induce abortion in early pregnancy. Aiken and her collaborators at Women on Web ran an analysis of every request for abortion pills that women in Latin America had made to the group over the last five years.
AIKEN: We had a very large sample. We had 28,670 requests in total over those five years.
AIZENMAN: And here's what they found. In the countries where Zika was getting the most attention and access to abortion is limited, the number of requests for abortion pills skyrocketed. In some cases, it more than doubled after Zika hit.
AIKEN: We did see an especially big increase in Brazil, and we suspect that that's partly because Brazil was exposed for the longest. You know, the epidemic happened there first.
AIZENMAN: Also up there were Ecuador, Venezuela, Honduras. The study did not see an increase in countries where governments had not issued advisories.
AIKEN: It seems as though women were responding not only to the threat of Zika but to the advisories issued by their governments.
AIZENMAN: The findings were published today in The New England Journal of Medicine, but Aiken and other experts caution there's a limit to how much you can conclude. Gilda Sedgh is with the Guttmacher Institute and co-author of one of the most definitive studies on abortion rates in Latin America.
GILDA SEDGH: About 6 and a half million abortions take place each year in the Latin America region, and the vast majority of them are illegal.
AIZENMAN: She notes that the abortions reported by Women on Web account for a tiny fraction, so their data offers only a glimpse of the full picture. So when it comes to abortions and Zika, she says, I think it's important that they've published this paper, but we really don't know. Nurith Aizenman, NPR News. Transcript provided by NPR, Copyright NPR.