Maria Mendoza of Miami was one of the first women in the U.S. to give birth to a baby with complications from Zika, as CNN reported Tuesday. She won’t be the last.
Although Mendoza made the decision to give birth, other Zika-infected pregnant women want to terminate their pregnancies. Depending on where they live, however, that might not be possible.
In Florida, where Mendoza gave birth, abortion is banned 24 weeks after a woman’s last period with exceptions for her life and health but not for fetal anomalies.
Mendoza was carefully monitoring her pregnancy from an early stage—she was infected with Zika at three months—but studies have shown that the virus can still cause severe defects even if a woman is infected during her third trimester. Zika has already hit 405 travelers from Florida and dozens of locals as well, after Miami mosquitoes began spreading the virus this summer.
Florida is not the only state where legislative barriers to abortion could soon find themselves under pressure from Zika-infected pregnant women.
In Texas, where there have been at least 108 travel-associated Zika cases so far, abortion is banned 20 weeks post-fertilization. Texas has an exception for fetal abnormalities, but only if they are “incompatible with life outside the womb.”
North Carolina has reported 35 travel-associated cases of the virus to the CDC. The state bans abortion 20 weeks after a woman’s last period, with exceptions for a pregnant woman’s life and physical health—but not for a fetal abnormality.
Other states with fewer reported Zika cases have bans on later abortion as well, with varying timelines and exceptions. And according to Guttmacher Institute data, most of the states that allow late abortion for a fetal anomaly, like Texas, require it to be “lethal.” But Zika-related complications are not always lethal, and as CDC Director Dr. Thomas Frieden noted, lifetime health care costs for a microcephalic child can fall between $1 and $10 million.
In all of the confusing Zika panic, one thing is clear: Abortion restrictions in the United States were not designed with a contingency like Zika in mind.
Most women who seek abortion after 20 weeks—a favorite cut-off point of abortion opponents—are doing so because of “logistical delays” and other exacerbating life circumstances, as a 2013 study in Perspectives on Sexual and Reproductive Health found. As that study noted, “data suggest that most women seeking later terminations are not doing so for reasons of fetal anomaly.”
But with Zika gaining a foothold in the continental United States, there could be an increase in women seeking abortion for that very reason.
Soon, women who might not have expected to navigate the messy patchwork of U.S. abortion laws will probably have to do just that.
There have been a handful of notable Zika-related abortion cases to date, like a 33-year old Finnish woman named Satu who spoke with NBC News about terminating her pregnancy at 21 weeks. Satu lived in D.C., where there are no restrictions on when an abortion can be performed.
But more complicated stories are sure to come. Per CDC data, there have already been 521 cases of pregnant women with laboratory evidence of a Zika infection. And even setting aside 20- and 24-week bans, the states in which Aedes aegypti mosquitoes live typically have several other abortion restrictions as well, as TIME pointed out.
A recent STAT-Harvard poll suggests that most Americans would support abortion access for the women most affected by Zika, even after 24 weeks. The poll of 1,000 respondents found that 59 percent believed women should have legal access to abortion after 24 weeks in the event of Zika-related microcephaly. That included 72 percent of Democrats and 48 percent of Republicans.
But so far, anti-abortion groups have been firmly opposed to Zika-based exceptions.
“Zika should not be used as a springboard for a search-and-destroy mission against disabled babies,” Susan B. Anthony List president Marjorie Dannenfelser told The Daily Beast after Marco Rubio voiced his opposition to abortions for women with Zika.
“Senator Marco Rubio is exactly right,” said Americans United for Life acting president Clarke Forsythe.
As the CDC notes, an anomaly ultrasound generally takes place between 18 to 20 weeks, which is already cutting it close for women living in states with 20-week abortion bans that don’t have exceptions for fetal abnormalities. Other tests, like a screen for Down syndrome, typically happen between 15 to 20 weeks.But Zika complications are not always detectable that early in pregnancy. Some may not be noticeable until after childbirth. As CNN reported, Maria Mendoza’s ultrasounds looked normal throughout her pregnancy, with doctors only discovering brain calcifications after performing an MRI on her newborn child. That diagnosis was unexpected.
“I cried a lot,” Mendoza told CNN. “It was terrible.”
And as the Atlantic noted, research in the New England Journal of Medicine and The Lancet found that Zika can cause complications in the third trimester, even after the 30-week mark.
And at that late stage in pregnancy, women in all but seven states and D.C. would be unable to access abortion unless there were an applicable fetal anomaly exception.
Research has already shown that Zika has driven up abortion requests in Latin America, and if the virus continues to spread in the United States, abortion requests will almost certainly rise here, too.
Whether or not those requests can be fulfilled, it seems, will be a different story.