**7. The past predicts the future**

In Latin America, the Zika virus pandemic has disproportionately affected women in the reproductive-age group and especially the most vulnerable members of society—those girls and younger women who live in conditions of poverty. It has brought renewed attention to the multifaceted human rights problems that, although predating the onset of the pandemic in 2015, have significantly been worsened by the spread of Zika virus infection. These include ethnic and socioeconomic health disparities, access to reproductive health education, restrictions on sexual and reproductive rights, inadequate access to water and sanitation, and stigmatization and criminalization of women seeking to terminate their pregnancies [35]. Data published in 2016 clearly indicate an increase in demand for abortions following the advent of the Zika epidemic, but because of the clandestine nature of both unsafe and safe abortions, criminalization of pregnancy termination, and the threat of penalties, the actual numbers of abortions occurring as a result of Zika in these countries are likely much greater. The Zika pandemic has caused several countries to rethink their reproductive health and education policies, including those on the criminalization and restriction of abortion [16, 42].

The situation of Zika virus infection during pregnancy, congenital infection, and malformation syndromes and abortion rights is not without precedent. Rubella is another virus causing congenital infection which, like the Zika virus, is a TORCH agent. TORCH is an acronym for those infectious agents which can cause congenital infections following vertical (motherto-fetus) transmission—**T**oxoplasmosis, **O**ther, **R**ubella, **C**ytomegalovirus, and **H**erpes) [29]. Between 1963 and 1965, rubella (also termed German measles) was epidemic in the United States. Similar to the Zika virus, pregnant women who became infected had relatively minor symptoms. However, the virus produced severe birth defects, and when maternal infection occurred during the first trimester, there was a 90% probability of passing the virus to the fetus [43]. The congenital rubella syndrome included microcephaly and brain damage, congenital heart disease, sensorineural deafness, ocular abnormalities, micrognathia, bone alterations, liver and spleen damage, and neurodevelopmental abnormalities. Miscarriage and stillbirth were also caused by the virus [44]. As the number of cases increased in the United States, the fear caused by the threat of having an infant with congenital rubella syndrome was not confined to any one ethnic or socioeconomic group—the virus could affect any nonimmune pregnant woman and her unborn child. During the epidemic there were approximately 20,000 surviving babies born with the congenital rubella syndrome, with many requiring intensive care or the possibility of lifetime institutionalization. During that time, abortion was illegal in the United States, but that did not stop women at risk for seeking terminations of their pregnancies. Approximately 11,250 pregnant women had miscarriages or, despite their illegality, therapeutic abortions during the epidemic. *Williams Obstetrics*, the standard obstetrical textbook at the time, recommended that abortion be performed in those cases of first trimester infection when the parents did not desire to assume responsibility of caring for an infant with congenital infection [45]. The rubella virus epidemic, and the public response to it, helped to facilitate the eventual 1973 US Supreme Court decision (Roe v Wade) that made abortion a fundamental right of a woman. Time will tell what effect, if any, that the Zika virus pandemic will have on abortion rights in Latin American countries.
