Colombia is Hit Hard by Zika, but Not by Microcephaly

New York Times (Oct. 31): Colombia is Hit Hard by Zika, but Not by Microcephaly, by Donald G. McNeil and Julia Symmes Cobb:

Colombia has suffered the world's second largest outbreak of Zika after Brazil. Yet, while more than 2,000 babies with microcephaly have been born in Brazil, in Colombia there have been only 47.  What accounts for the difference? Colombia had more time to prepare for the virus, allowing Colombian women to delay pregnancy, but they may also have chosen abortion at greater rates. 

Dr. Fernando Ruiz, Colombia’s vice minister for public health, . . . says that it is “very possible” that abortions lowered the microcephaly rate here.

“Colombia has some of the most progressive laws and regulations in South America,” he said in an interview. With gynecologists alert to the threat, he said, many women had ultrasounds early enough to made decisions.

Even a very small increase in the abortion rate could account for a sharp reduction in microcephaly.

Abortion is legal in Colombia to protect the mother's health and the health ministry "considers a severely deformed baby a threat to maternal well-being."  Although only a small number of abortions are reported in Colombia (only 320 were reported in 2011), Guttmacher Institute estimates that there are more than 400,000 abortions in Colombia each year. Most abortions take place outside of the clinical setting through the use of misoprostol.  Doctor are not legally required to report prescriptions of misoprostol, and it is also available from illegal providers.  Health officials in Colombia also think that women may have delayed pregnancy although statistics are not yet available to confirm if there was a drop in the birth rate.