Fear of Zika might have impacted number of births in 2016

In the second half of 2016 physician Sandra Valongueiro, a researcher at the Federal University of Pernambuco, began to hear reports of a decrease in the number of women in the maternity wards of Recife. As the state was one of the epicenters of the Zika emergency that started in November 2015, the observation caught the attention of the specialist, who is also part of the Microcephaly Epidemic Research Group.

At the same time, researcher Leticia Marteleto, a professor at the Center for Population Studies at the University of Texas in Austin began studying the possible impacts of Zika on reproductive behavior. Interviews that she and her team conducted with groups of women in Recife and Belo Horizonte revealed the fear of getting pregnant in the middle of the epidemic. Pregnant women infected with Zika are at increased risk of having babies with microcephaly. The two researchers came together to investigate whether the number of births would reflect these reports.

The issue also sparked the interest of Fredi Alexander Diaz Quijano, a professor at the Department of Epidemiology at the University of São Paulo's School of Public Health, who began a quest for up-to-date information on births in Brazil in 2016.

Preliminary data obtained by G1 suggests a nationwide reduction in the number of live births starting in the second half of 2016 in comparison to previous years. That was precisely nine months after the onset of the Zika and microcephaly health emergency.

G1 requested data on live births per month, from 2013 to 2016, to the Ministry of Health and state health departments throughout the country. The data obtained are shown in the infographic.

This dataset has a few limitations. The registration of births is not immediate: after a baby is born, it takes some time until the information is inserted into the national data system. Therefore, births occurred in 2016 may not yet be included, especially those occurring in the second semester.

Significant drop

If Brazil's consolidated birth data for 2016 remains stable even after accounting for late registrations, they will show a statistically significant decrease, according to Fredi Quijano. He points out that this reduction may have other factors involved, such as the economic crisis and political instability, which may make families feel more insecure about having children.

On the other hand, the fact that the states especially affected by occurrences of Zika and microcephaly had a more significant drop strengthens the hypothesis that Zika played an essential role in this phenomenon. "We still have to check the quality of the data and cannot rule out other explanations, but if that is the reason, it is a fascinating finding that speaks of the impact that situation of panic and alarm can have on the community after an epidemiological event like the Zika epidemic," says Quijano.

"Both the economic crisis and the political crisis can come as associated factors. On the other hand, there is the Zika factor, you cannot ignore the role of Zika," says Leticia Marteleto.

In an email, the Ministry of Health stated that "it is not possible at this time to establish a relationship between the number of live births and microcephaly" due to the preliminary nature of the data.

Nevertheless, in a state like Pernambuco, where the effect appears quite clearly, late records could hardly reverse the trend. According to Sandra Valongueiro, the state recorded about 15 thousand fewer births between August and December 2016 compared to previous years. "This drop happened at least in those months. We do not know if this will continue in the following months or if it is going to be something temporary," says Marteleto.

Pernambuco was the first state where the increase in cases has caught the attention of health authorities. "You have to remember that we were ‘breathing' Zika here. In health services, there were always women with babies with microcephaly. We were living the epidemic," says Sandra.

Fear of getting pregnant

In a study published on June 5 in the journal Population and Development Review, researchers Leticia, Sandra, and their team report the women's perception of how the Zika epidemic has impacted their plans to conceive. In discussion groups organized in Recife and Belo Horizonte, these women said that they saw Zika as a tragedy that could happen to anyone and that they, therefore, preferred to avoid pregnancy, or at least postpone the plans.

"They clearly said that they did not want to have a child, more strongly in Recife than in Belo Horizonte. They mentioned, for example, that they had seen on the bus a child who appeared to have microcephaly. The proximity of the disease made this panic and desire to avoid pregnancy much stronger in Recife," says Leticia.

Fear, according to the researcher, appeared in all social classes. Higher-class women, however, have shown more access to reliable information about the problem.

Even in areas that were not as intensely affected by microcephaly as São Paulo, fear was present. "The fear of microcephaly greatly frightened women, and it was the role of the doctors to explain that there were ways to prevent it, such as the use of repellent," says Zsuzsanna Ilona Katalin de Jármy Di Bella, a professor of gynecology at the Federal University of São Paulo and family planning expert.

Luciana de Souza Alonso Carvalho had plans to get pregnant and even started a fertility treatment early last year, but soon she heard the news of the Zika epidemic. "Although I live in São Paulo, I have relatives in other places, and I travel a lot to visit them."

She decided to postpone the plans. "It was a sad decision to make. Now it's time to try again. I did this just so I wouldn't be anxious, which I already am by nature, and that would only be an aggravating factor. Also, for safety." With the fall of cases in early 2017, they decided to resume the attempts.

Increased demand for abortion?

According to the researcher Greice Maria de Souza Menezes, a medical epidemiologist at the Institute of Collective Health of the Federal University of Bahia, it is necessary to take into account how much the Zika emergency may also have affected demands for abortion. As the practice is illegal in Brazil, except for some specific situations, it is difficult to measure this possible effect.

But a study published in The New England Journal of Medicine in July 2016 points to an increased demand for abortion medications through the NGO Women on Web in Latin American countries affected by Zika. In Brazil, the increase was 108% starting in November 2015, when the emergency started.

Original article published in Portuguese in G1.