THE ZIKA PROGNOSIS: DIAGNOSING EL SALVADOR'S UNIQUE STRUGGLE WITH ZIKA VIRUS

By Bailey MarsheckStaff WriterIn January of 2016, in response to the rapid spread of Zika virus in El Salvador and surrounding Latin American countries, El Salvador’s Health Ministry Department put out a statement suggesting that women should avoid conceiving children until 2018, or until progress could be made on a vaccine for Zika. Deputy Health Minister Eduardo Espinoza clarified the statement by explaining, “We [Ministry of Public Health] are giving a recommendation, it's not prohibition or a birth control measure. These children are going to need neurological help for the rest of their lives.” ("El Salvador Launches Fight…”) As the most recent mosquito-borne virus to infect the global population, Zika virus has emerged as a dangerous new public health issue for thousands of unborn children. However, Zika virus is not considered a life-threatening disease in the majority of instances. Most adult victims never know that they have been infected, and only one out of every five infected exhibit any of the disease’s effects. A fever is the most notable marker of the disease for the small percentage of those infected that show symptoms, but rashes, vomiting and muscle pains are also known indicators of Zika virus. It has been linked to cases of the autoimmune Guillain-Barre syndrome, which can be fatal. However, Zika’s typically mild symptoms often lead to its misdiagnosis as a more common illness (“Symptoms, Diagnosis…”).Although Zika virus is rarely fatal to adults, El Salvador’s governmental advisory was issued to address Zika’s potential to harm fetuses. The difficulty of identifying the disease makes Zika virus an especially significant threat to pregnant women. An infected mother could lack any symptoms while the virus passes unnoticed through her amniotic fluid to the unborn child. The outbreak of Zika virus has a strong correlation, confirmed to be a “causal relationship” by researchers, to the increasing number of babies born with the microcephaly birth defect. Zika slows fetal development by cutting off placental blood flow to the fetus and attacking the brain’s stem cells. Microcephaly causes a child to be born with a dangerously small brain and head, which slows brain development and makes it harder to function as the child matures. The perceived threat to El Salvador’s unborn population has revived debates surrounding the decision of women to avoid pregnancy altogether. This is bringing attention to the socially subordinate position of Salvadorian women and their limited capacity to make such choices in a sociopolitical context where women are disempowered by “Machismo” culture, anti-abortion laws and the strict beliefs of the Salvadorian Catholic Church. The government’s proposal is meant to reduce the country’s rate of reproduction in order slow the virus’s spread, and minimize the number of microcephaly-afflicted newborns whose needs will pose economic difficulties for the country throughout their lifespans. Although the Salvadorian government has not yet taken steps to incentivize or enforce any restrictive policies, the public recommendation that women should postpone becoming pregnant is noteworthy within the context of El Salvador’s extreme abortion laws and predominantly Roman Catholic culture.The simplest option for women choosing to heed the government’s Zika warning would be to delay pregnancy. But many women attempting anti-natalist action through abstinence or contraceptive-use face harsh consequences in the domestic sphere, where El Salvador’s “machismo” culture can be an even more restrictive force than the law of the state. Machismo accounts for a heightening of emphasis on gender roles. It shapes the concept of an ideal man as being hyper-masculine and dominant over women, often leaving women as a physical outlet for male frustration. In a household structure where men hold a great majority of the power, having children is seen as one of a woman’s main roles in society. Domestic abuse is becoming more prevalent, hinting at a culture of institutional oppression and violence against women. In 2011, El Salvador had the highest rate of femicide in the world (“Central America: Femicides and…”), revealing the intentional and inadvertent consequences of habitual domestic violence against women. Violence and rape is ignored because women are viewed as possessions, subject to the whims of their husbands, and because those in power to stop such abuse are often a part of the same culture that they are supposed to deter. Salvadorian policewomen have confirmed this by publicly criticizing judges and their male counterparts for contributing to damaging gender norms. Silvia Juárez of the Violence Observatory at ORMUSA claims that the impunity rate, or the proportion of crimes where the perpetrator is not brought to justice, for crimes against women is 98% (“El Salvador: Crisis of Masculinity…”). Many of the domestic violence cases that are reported result in authorities telling women to work it out with their partners, which often deters these women from going to the police in future cases of abuse. The institutional disregard for the health of women in society, demonstrated by the high occurrence rate of rape and violence against women, suggests that avoiding pregnancy might not be a viable course of action for Salvadorian women.Zika’s threat to fetuses may drive pregnant woman to seek anti-natalist action through an abortion. This is an impossibility from a legal standpoint, because abortion in El Salvador is illegal, even in cases of rape, incest, and concern over the health of the mother. El Salvador’s constitution had previously contained exceptions for protecting the health of mothers and for victims of rape. However in 1998, the constitution was amended to ban abortion in all cases. Many countries have trended towards more liberal abortion policies since 1998, but El Salvador is one of two countries in Latin America to have implemented more restrictive policies between 1998 and 2007 (“Global Trend of Expanding Legal…”). The ban has not had its intended effect of ending abortions in El Salvador; it has only led women to attempt abortions on their own, through less conventional means. There is no safe space for these women. Many of those who have been prosecuted for attempted abortion were reported by the very hospitals in which they sought personal safety. Illegal abortions can have severe criminal or fatal consequences in El Salvador, and any woman suspected of an attempted abortion can be tried for homicide and jailed without bail. Women have resorted to hazardous abortion methods utilizing clothes hangers or even battery acid. Because of the strict abortion laws and prosecution of those who attempt illegal abortions, women must do everything in their power to keep attempted abortions a secret within their households.One of the main factors for the ban on all forms of abortion is the Roman Catholic Church. Its influence is exemplified by a 2013 case involving a woman known by the pseudonym “Beatriz,” who became severely ill with lupus while pregnant. She received counsel from her doctors to terminate her pregnancy, since the fetus was confirmed to be missing part of its brain and skull and was not expected to live more than a few days. Beatriz went to court in hopes of being granted access to an abortion. The case went to the El Salvadorian Supreme Court, where the Roman Catholic Church lobbied heavily against Beatriz. The court eventually ruled against the legality of an abortion in these circumstances. Although Beatriz ended up living, the child survived all of a few hours. Even though the fetus couldn’t have survived for more than a few days, its life was valued over that of the mother, in the eyes of the court (“A High-Risk Pregnancy…”). With an influential force like the Catholic Church actively fighting against the legalization of abortion, pregnant women have little hope of protection within El Salvador’s judicial system.The Salvadorian government’s attempt to encourage women to delay pregnancy emphasizes both the severity of Zika’s effects on the population as well as the state’s failure to combat the virus’s spread through more comprehensive means. El Salvador is a country torn apart by violence and distrust of the government, making it nearly impossible to institute nationwide policies to combat the Zika virus. There were 2,474 new infections in the first three weeks of January alone, many of which surfaced in areas so afflicted by gang wars and violence that the government has had trouble providing aid to the infected. Some residents in gang-controlled areas even see the government’s attempts to educate the population as a conspiracy to re-establish authority in areas where it has lost control. Brazil’s attempt to eradicate the virus by eliminating still water breeding grounds for mosquitos has been endorsed by many experts as the most effective way of fighting the virus until medical research for some type of vaccine is completed. This promising potential solution is impossible to apply in regions of El Salvador where the government has relinquished control to gangs. Fear of violent retaliation from gang members leaves citizens both too afraid to cooperate with the government, and ignorant of the disease’s potential connection to the microcephaly birth defect. El Salvador’s lack of practical solutions to Zika virus makes the debate surrounding abortion and the use of contraceptives all the more relevant.The Health Ministry’s stance on pregnancy also serves to highlight a contrast of opinions between the country’s older and younger populations.Roman Catholicism is on the decline in El Salvador and the rest of Latin America, with younger generations turning towards Protestantism or atheism at an increasing rate. The change in religious demographics could lead to a revision of abortion laws as Roman Catholicism slowly loses influence in the population and the government. With Zika virus currently hurting newborns the most, the country’s struggle to prevent Zika’s spread could seriously affect the demographics of the next generation. El Salvador is in Stage Three of the Demographic Transition model, characterized by a slowing of population growth and birth rates along with an increase in age of the population (“Stage 5 of the Demographic…”). The Demographic Transition Model categorizes countries into stages one through five, using trends in birth and death rates to predict how the population demographic will change. If Zika virus and the government’s advisory were to have a significant effect on fertility rates in El Salvador, the country could feasibly skip directly to Stage Five, where death rates exceed birth rates and the country falls into a steady population decline. A decrease or complete cessation of pregnancies would have disastrous effects in 20 years, when the generation affected by Zika would reach adulthood and face a shrunken workforce and stunted economic growth. Despite the possible repercussions of decreasing birth rates, the government also can’t ignore the plight of pregnant women struggling with poverty in El Salvador. A notable percentage of these women are teenagers carrying children conceived through rape, who can’t afford to provide for the special needs of a child with the microcephaly birth defect, yet have no alternative because of the current abortion laws. Unless the government can slow the spread of Zika soon, which has proven resoundingly unsuccessful so far, it may have no choice but to institute a more effective anti-natalist policy.Some El Salvadorian women are taking the health warnings seriously and making conscious efforts to avoid conception through any possible means, but the effectiveness of government suggestions will remain minimal as long as the Roman Catholic Church and its pro-natalist religious beliefs retain power over a majority of the population. Most women simply don’t have the choice to avoid childbirth because of their subordinate positions in family and society, and their inability to access safe abortions. El Salvador is torn between old Roman Catholicism and younger, more progressive views, as the fates of future generations hang in the balance. Research on Zika virus is still in the beginning stages, and experts are still struggling to understand its transmission and spread. As Zika spreads further and countries exhaust their potential solutions to slow its advance, the call for reform of El Salvador’s abortion and natalist policies will only get more deafening.Bibliography"El Salvador Launches Fight against Zika - BBC News." BBC News. Web. 12 Apr. 2016."Symptoms, Diagnosis, & Treatment." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 2016. Web. 31 Jan. 2016."New Report: Global Trend of Expanding Legal Abortion Services Continues." Center for Reproductive Rights. N.p., n.d. Web. 20 Apr. 2016."Central America: Femicides and Gender-Based Violence." CGRS. Web. 16 Apr. 2016."El Salvador: Crisis of Masculinity in a Machista Society." OpenDemocracy. N.p., n.d. Web. 20 Apr. 2016.Zabludovsky, Karla. "A High-Risk Pregnancy Is Terminated. But Was It an Abortion?" The New York Times. The New York Times, 2013. Web. 16 Apr. 2016."Stage 5 of the Demographic Transition Model." Population Education. N.p., 2014. Web. 20 Apr. 2016.Image by Joshua E. Cogan