January 2016
Brazilian scientists had recently demonstrated a link between infection with the zika virus during pregnancy and microcephaly—malformation of the fetal brain, which can induce neurological impairment and developmental delays.
According to the Brazilian Ministry of Health, a total of almost 3 thousand suspected cases of newborn babies with microcephaly have already been identified throughout Brazil through the end of 2015, compared to 147 diagnosed cases in 2014. Brazil faces a sanitary emergency and women are advised to postpone pregnancies.
In this interview to the HCS-Manguinhos blog, Professor Ilana Löwy, from the Institut National de la Sante et de la Recherche Médicale Paris, traces a parallel between the current zika epidemics in Brazil and past rubella outbreaks. Ilana also analyses the European decriminalization of abortion in the case of Rubella.
In Brazil, where abortion is only legal in cases of rape, anencephaly, or if the mother’s life is at risk, the possibility that a pregnant woman infected with zika might be permitted to have a legal abortion is not even up for discussion right now.
What are the parallels between zika epidemics and rubella outbreaks of the 1940s, 50s and 60s?
Rubella (German measles) in many ways resembles zika. Rubella is also a mild disease, manifesting itself as fever and rash, usually without any danger for the sick person, but very dangerous for the fetus.
Women infected with the rubella virus in the first trimester of pregnancy are at high risk of giving birth to a child with severe fetal impairments. The rubella virus attacks the fetus’s central neural system and can induce blindness, deafness (and not infrequently the combination of both), neurological problems and microcephaly.
It is impossible to predict the extent of such malformations: some children born to infected mothers are healthy, some have sensory impairment(s) but no additional health problems, some have severe neurological and cognitive problems.
What was the reaction of doctors to these outbreaks?
Many women who contracted rubella and were aware of links between this disease and high risk of fetal malformations wished to terminate their pregnancy. In the 1940s, 50s and 60s, abortion was criminalized in Western Europe; doctors who performed abortions risked prison and the loss of their medical license.
In spite of these legal restrictions, numerous British and French doctors provided abortions to pregnant women infected with rubella virus. Physicians held divergent opinions about abortion in the case of fetal impairment.
Nevertheless, British and French women who were infected with rubella when pregnant and who wanted to have an abortion were nearly always able to find a practitioner willing to brave legal interdictions and perform this act, either in a private practice, or, in the great majority of cases, in a public hospital.
An article published in the British Medical Journal in 1959— that is, ten years before the legalization of abortion in the UK— stated openly that abortion has became the routine treatment for women infected with rubella early in pregnancy.
What was the relation between rubella epidemics, and the decriminalization of abortion.
Rubella epidemics — and widespread acceptance of abortion for the stressed and scared women who caught rubella early in their pregnancy — helped to ‘normalize’ abortion and to bring it into mainstream medicine.
Abortion was seen earlier as practiced by ‘deviant’ women: those engaged in extramarital sex, ‘loose’ women, ‘oversexed’ ones, marginalized women, women of color. This view was entirely false. Then as now, abortion was extremely frequent, including among middle class women and married women with children. But since abortion was an illegal, shady activity, its high frequency among ‘respectable’ women remained invisible.
The rubella epidemics led doctors to perform abortions on women from their milieu and social class. The women they treated could have been their wife, sister, daughter—sometimes they were their wife, sister or daughter. Doctors had also realized that poor women suffered disproportionally from consequences of illegal abortions.
Termination of pregnancy for rubella infection helped to integrate abortion into mainstream medicine, changed the image of this medical act, and facilitated the legalization of abortion in Western Europe and North America.
Read the articles by Ilana Löwy already published in HCS-Manguinhos:
