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November 5, 2016: Colombia Is Hit Hard by Zika, but Not by Microcephaly

“The tropical city of Barranquilla, Colombia, on the Caribbean coast may hold the answer to one of the deeper mysteries of the Zika epidemic: Why has the world’s second-largest outbreak, after Brazil’s, produced so few birth defects?

“In Brazil, more than 2,000 babies have been born with microcephaly, abnormally small heads and brain damage caused by the Zika virus. In Colombia, officials had predicted there might be as many as 700 such babies by the end of this year. There have been merely 47.

“The gap has been seen all over the Americas. According to the World Health Organization, the United States has 28 cases — almost all linked to women infected elsewhere. Guatemala has 15, and Martinique has 12.

“Had the rest of the Americas been as affected as northeastern Brazil, a tidal wave of microcephaly would be washing over the region. Most experts say that will not happen, but they are at a loss as to why.

“There are some obvious differences between Colombia’s epidemic and Brazil’s. The population here is less than a quarter that of Brazil, and almost half of its residents live at higher altitudes, where mosquitoes are rarer.

“And Zika circulated silently for much longer in Brazil. The virus arrived there by early 2014, and not in Colombia until late 2015. Having just fought a severe chikungunya epidemic in 2014, Colombia was more ready than Brazil to send forth the anti-mosquito battalions.

“But all that does not seem sufficient to explain the disparity. Increasingly, there is evidence for two other possibilities.

“Pregnant women here, alerted to the tragedy unfolding in Brazil, may have sought abortions in greater numbers, officials say. Others seem to have heeded the government’s controversial advice to delay pregnancy altogether.

“Dr. Miguel Parra-Saavedra, the director of maternal-fetal medicine at the Cedifetal Clinic in Barranquilla and one of the country’s leading high-risk pregnancy specialists, is among the experts who suspect many pregnant women in Colombia, alarmed by news reports, sought ultrasounds and aborted deformed fetuses.

“Some of his own patients have done so.

Dr. Parra-Saavedra heads a study of Zika-related birth defects in cooperation with the Centers for Disease Control and Prevention. In the course of the research thus far, he has diagnosed 13 cases of fetal microcephaly.

“Dr. Miguel Parra-Saavedra said many Colombian women had abortions after getting ultrasounds. Credit Katie Orlinsky for The New York Times
Four of the mothers terminated their pregnancies immediately, he said. Another four, and possibly a fifth, sought abortions but were turned down by their health insurance companies.

“Only four patients, Dr. Parra-Saavedra said, deliberately chose to have their babies.

Among those who tried to have an abortion was Zuleima, a 37-year-old mother of two healthy daughters.

“When she and her husband Jaime, 47, an unemployed mine-machinery operator, learned that their unborn daughter was microcephalic, they requested what is here called ‘pregnancy interruption.’

“Abortion is legal in Colombia to protect a mother’s health, and the health ministry considers a severely deformed baby a threat to maternal mental well-being.”

Source: New York Times

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