More than 2,000 babies in Brazil have been born with microcephaly since the Zika virus began spreading there. Colombia, which shares a border to the northwest of Brazil, is the second-largest Zika outbreak area, but surprisingly, they have not seen high numbers of babies born affected by the disease, according to The New York Times.
According to epidemiologists, Zika began spreading in Brazil by early 2014, but went mostly undetected at first. The virus arrived in Colombia in late 2015. But one of the key differences, experts say, is that Colombia was more prepared when it came to mosquito abatement due to a chikungunya outbreak there in 2014.
That can’t explain everything, though.
Officials in Colombia say that pregnant women there “may have sought abortions in greater numbers” after seeing the effects of the mosquito-borne disease in Brazil, and others likely avoided the government warnings about delaying pregnancy plans until the epidemic was over.
In Brazil, abortion is only allowed in instances of rape, incest or to save the mother's life, and it's exceptionally difficult to find a clinic to perform the procedure in any other case due to government crackdowns that began 10 years ago.
One of Colombia’s top high-risk pregnancy specialists, Dr. Miguel Parra-Saavedra, is one of the experts who believes many women in that country sought out additional prenatal care to determine whether their babies were affected, and terminated their pregnancies if ultrasounds showed deformities.
Parra-Saavedra, who heads up the study there of Zika-related birth defects in cooperation with the CDC, told The New York Times that in his own practice, he has diagnosed 13 cases of fetal microcephaly through the end of October this year.
Of those mothers, four decided to terminate their pregnancies right away. Four or five more patients of his wanted to terminate their pregnancies but were turned down by their health insurance for various reasons. Four mothers decided to give birth to their babies, knowing they would be born with microcephaly.
“In my 22 years as an ultrasound physician, I have never seen microcephaly like this,” Dr. Parra-Saavedra told the Times.
Colombia's vice minister for public health, Dr. Fernando Ruiz—who helped make the controversial decision to tell women to avoid pregnancy until the outbreak was over—told the New York Times that thanks to the country's progressive laws and regulations, and because OB-GYNs were made aware of the Zika threat and consequences, more women had access to ultrasounds early enough in their pregnancies to make informed decisions.
However, although abortion is legal in Colombia,
health insurance companies there have in some cases taken too long to decide whether they will pay for the procedure, leaving those mothers with no choice but to have the baby. Some of that hesitation is due to the fact that most abortions in Colombia are drug-induced rather than via dilation and curettage (D&C), and insurance companies are reluctant in later-term cases because if they baby is born alive, they have to pay for neonatal intensive care.
Since the fetal head deformity may sometimes not be detected until early in the third trimester, it makes for difficult choices on both sides—parents and insurance companies—with little time for thinking it over too much.
According to another doctor, the devastating brain damage caused by Zika can result in babies being born without frontal lobes and lack of connections between the hemispheres of the brain.
“When this happens,” he told the Times, “there is no intelligence, no coordination, no attention, no initiative, no calculation—and no memories at all.”
This can cause lifelong consequences for families in terms of financial obligations, appropriate medical care availability and affordability—all with little support from government.