>> you have no way of knowing if the next mosquito that bites your ankle carries the zika virus. and the link between the explosion of zika virus infections and birth defects is not completely tied down. some countries have told women, don't get pregnant for a while. will that work, and if it's already too late will this virus open a new conversation about

abortion and contraception in a partly of the world where that is still an open question? a pregnant pause, it's the "inside story." >> welcome to "inside story." i'm ray suarez. the emergence, the explosion really of the zika virus in latin america and its steady march to the united states is a straight-ahead medical story, sure. but its also a story about the decisions human beings have to make in real time, sometimes in the absence of complete information. in response to the possible link between zika infection and microcephaly, what can you do if you are early in a pregnancy or contemplating getting pregnant in a country that's turning up morens by the day?

terminating your pregnancy would be crime in many countries in latin america and the cri carib. prenatal care spotty and unavailable and there's no court of appeal, no cure no treatment for a baby born with the devastating condition. brazil has seen an enormous spike in microcephaly, that corresponds to the spike in zika virus infections. lucia newman reports. >> it's carnival time in brazil but nothing festive for scores of pregnant women whose babies are being diagnosed with microcephaly. rebecca who caught the disowks whezikavirus in her second monta primary suspect. >> your baby's head looks normal so far but it's too early to know for sure. we need to know seven weeks. >> reporter: every day more

and more people are being infected by zika virus and mothers are giving birth with to babies with microcephaly. the speculation about the consequences of the zika virus are spreading asking quickly as the epidemic itself. we traveled osa oto sao paulo. at the university of sao paulo are being injected with the zika virus. women all around the americas are anxious to know if a pregnant person can still be carrying the zika virus. >> could she pass it on to her

child? >> that is a very good question, we don't have an answer for that. for example for ebola you can find virus in the semen. nine or ten months after the in infection. >> you need army, the navy, everyone. >> optimistic that the virus's proximity to dengue could speed up the process. >> people start working right now and perhaps due to the fact that we know many things against dengue we could use it against zika and perhaps in the near future we could have candidates for a zika vaccine. >> reporter: but as researchers work round the clock to unraffl unravel the mysteries virus, they cannot rule identity

the virus could be sexually transmitted through semen, or if youngsters could be infected at a young age. rebecca puts on a brave face, as she sees a sonogram picture of julia. not flogge exactly what she will do whether she gives birth. >> a pregnant pause, this time on the program. paula avila, program specialist, gisele carano, and here in washington, josh micheau. paula let me start with you. what is the state-of-the-art advice to women who go to their

doctors in recefe, in lima in santiago, and say, what should i do? >> thank you very much for opportunity. i think it depends on each country and the state of loss in each country. he even though virus is attacking all countries. there is no sense of any women in brazil or colombia. for instance in the case of women in el salvador, where there is an absolute ban on abortion, not even to save a woman's life to protect her health or in the case of rape, the situation would be very complicated because she cannot receive any type of advice, she cannot get any options, if she's already pregnant. and also, there is no much access to contraception in general, in areas, in the rural areas. especially in colombia if the

woman is already pregnant she will are allowed to terminate her pregnancy if she decides to do so. but it's a general recommendation, putting women in a very difficult situation. the government is telling them not to get pregnant. but it's not given enough policies that will cover the full cycle of reproductive health services, from contraception, to emergency contraception in an area where unplanned pregnancy and high rates of sexual violence and then access to abortion in case women want to terminate their pregnancies. >> giselle, we heard abortion is not an option in some places but what options does microcephaly offer? does it show up early enough in a pregnancy that allows you some leeway in decision making or does it only show up in a certain way that leaves you

flirting with a more complicated, sometimes more dangerous second trimester abortion? >> ray, very much, thank you very much for having us here. i would say that the first thing that i wanted to tell you is that the government responds of avoiding pregnancy, puts women in a very difficult position, it is very condescending to the issue. we have about 23 million women that want access to contraception and cannot get it. the region with the most restrictive laws on abortion in the world. there is a country in the region, in that's honduras, where emergency contraception is banned. so we really, this is a great opportunity to advance in accessing contraception that are huge barriers for women who live in rural areas.

younger women to access contraception. that puts young woman on the front lines of the situation. >> i understand your answer, but in countries that can offer very little funding to their national health systems, don't have doctors in the smallest towns and villages, why is it condescending rather than just common sense to give women the vice to postpone, if they can, pregnancy? >> because that needs to come along with real tools to be able to do so. we believe women need to have access to the information available to them. and access to the means to actually exercise that right. and latin america and the caribbean has been a region that has made huge strides in the past years in access to contraception. and we feel that our response that only focuses on the

mosquito, it's important but it's important also to try too focus on the access to the actual tools to prevent the pregnancy. we see many women in -- we have clifntioclinics all over latin a and the caribbean. they are not sure how to deal with the news, and the information campaign giving women the information they need to make these decisions, whether that's continuing the pregnancy, whether preventing the pregnancy, whether they are already pregnant and they want to interrupt the pregnancy, that is very important. there are a number of countries where abortion is illegal, and talking to women about the possibility of interrupting that pregnancy if they don't want to take it to term. so we think that what is messing in the response is a real focus on women's needs to prevent that pregnancy, to carry that pregnancy to term if they want to and providing the women the

information and the tools to exercise that decision making right? >> josh michaud, when we come back i wand to talk to you about transmission the vectors and how that changes the transmission of zika. stay with us, it's "inside story." this is america tonight.

>> you're watching "inside

story," i'm ray suarez. we're looking at the uncomfortable questions raised for women contemplating getting pregnant or suspect they are already pregnant in the number of countries where zika virus is flourishing. connected with the rapid spread of the zika virus, with more researchers talking about the likelihood of sexual transmission, does the conversation around zika and pregnancy become even more urgent? josh michaud, paula avila and gisele carano are still with me. how does sexual transmission change the conversation? >> it's lard to know right now how common that sexual transmission occurs, we know that it does occur. there has been a documented case in dallas. there was documented cases before at a.

we know it happens but what we don't know is how often. the answer to the question which you just posed really depends on how often it does occur, and there needs to be much more research to ferret out that answer. >> isn't it up to a doctor who is giving primary care to a woman patient or an ob-gyn during the time there is a public health challenge to raise the possibility to women? >> absolutely. in fact the cdc came out with some guidelines both for general public and for doctors to talk to their patients about this problem of sexual transmission of zika. and for example, men who may have traveled in areas with zika infection or may have had a positive zika test, the cdc is actually recommending now that they use condoms, or obtain from sex, in order to not transmit, despite the fact that we don't know and can't quantify what

those risks might be. and for doctors, they're asking doctors and patients to speak to their doctors about this risk. >> paula avila, i'd like to hear from you again because we have been talking about underresources systems, about the areas that the legal system doesn't allow all options, what should be, but is, what the range of full options should be often to women given the reality of life in barrios, in central america, what should couples and what should women who seek to protect themselves and their future children be doing? >> i like a lot of your question it goes to the point that gisele was making that was very, very clear and why, the majority of the recommendations three are given by governments are to

women. be and women don't get pregnant on their own. there's a big responsibility also in men to use condoms which are usually a lot more available to don't prevent pregnancies. and it's important, the burden is not only women but is also shared with men. i think that's why couples need to make a rational decision and try oprevent these pregnancies. however -- to prevent these pregnancies. however in the realities of these countries and these areas where you were mentioning couples and women and girls and adolescents don't even know how to do that. we are talking about areas where sexual education has been lacking for years. where there are no women who feel completely empowered to ask their partners to use condoms or even trade to go to the doctor and ask for contraception. this responsibility is not only on women, it is also on

government. it is a responsibility that they have had for many years and they should have put in place years ago, and they have not. that is why we are in this crisis. this is the moment to try omitigate the crisis in a comprehensive way, that includes access to education so women know what to do and men feel responsible for using condoms, and also will help with unplanned pregnancies and access to all range of contraception. i want to highlight what gisele gist said. emergency contraception is super-keen in these problems because of the high rates of sexual violence, women may want to not get pregnant but that doesn't mean they necessarily have the means to do it and in some cases they don't get pregnant because of their own will. and governments need to respond to that in a comprehensive manner. >> gisele, i know there's not one answer that goes all the way from el paso down to tierra del

fuego. but is the catholic church which is still very influential putting a brake on governments, about what some of these options are? is there a cultural interference speaking with two very different but very loud voices to people about what their choices are? >> yes, definitely. the church and the conservative movement in general plays an emphasis on governments. but you know, many of the polls that we have seen over and over the years from some of the organizations that work with religious communities show that catholic women when it comes to sex and sexuality and contraception, behave very much like nonreligious women. and in that sense, i think it's very important, i feel it is very important as the response to the virus to put at the forefront need to respond to that with information, with really truthful information about how women can exercise

their rights. i very much liked paula's idea of men being part of this equation. condom use, dwooul protection as we call idevelopmentalprotectioy important. the governments should deal with these effectively, this is here to stay. it is not going to go anywhere. we better deal with it in a good way that puts women and families and their needs at the forefront of this discussion. >> a pregnant pause. zika and childbirth in latin america. stay with us, it's "inside story."

♪ ♪ >> you're watching "inside story." i'm ray suarez. the rise of zika infections and the rise in birth defects in brazil which has large numbers of zika infections has raised uncomfortable questions about the access to terminations and birth control in much of latin america. we've been here before during earlier outbreaks of rubella, german measles.

with so little known and so much yet to be known, josh, how do you quickly put together a tool kit, a set of responses for a national health minutes, ministry, let's say, when we've got such a rapidly changing situation? >> it's a very difficult situation surely for ministries of health for cdc, to put together recommendations based on the fact that there is as you say not enough evidence to make very strong associations or to know for sure whether these associations are actually true between zika infection and these terrible birth defects. but they've taken cautio cautioe principle here and the world health organization has announced that this represents

this cluster of birth defects in brazil and its potential connection to zika, represents a world health emergency. many organizations in the area are taking it seriously, trying to get out in front of this by being cautious and they are very strong in their recommendations. the catch 22 that many women find themselves in is the recommendations based on the public health principle of just postpone pregnancy and the reality of them not being able to access the tools they need actually put that into practice is the difficulty that we find ourselves in here. >> but gisele, earlier, i understand your point about the conned sense. condid hconde desension postponx

to eight months, el salvador two years or more, to say look, we're going to rom out measures but right now, our best advice is don't get pregnant? >> well, i feel that many of these countries have good programs in place already. this is an opportunity to, i think what is missing in the conversation is, the link with -- in a structured effort to prevent the prevention around the virus is to talk about contraception and the different means in which women and families can do contraception. we -- i think many of these programcountries have programs,l health programs, to renew that words and bring it to the forefront of the conversation.

condoms are available, there are still many women who cannot access them and this is the time to bring it up. one thing i wanted to mention, i'm sure you know, latin america and the caribbean is an area of high inequalities. this is the time for ministries are going to be focusing on not only where the mosquito is hitting the hardest but where we know women have less information and less access to contraception. and i'm very confident that we, if we put together a response that is effective, we can really find this out until we have more clarity about how this will evolve. >> paula, there is an identity problem. putting women's equality on the national agenda is something that takes years, a generation, perhaps, where we have sort of different time lines that we're working with here. >> well, yes and no. because we are also talking

about equality in a specific measures, and the specific measures regard access to contraception and access to abortion and all the maternal streangt had wilstrength, we ale women who are more affected and already know, in colombia coincide with areas the mosquito develops more. areas where the tropical weather is worse, when women need to and families need to have the water for many days in recipient, that's where the mosquito is born. if you are already in the situation where you don't have access to water and that's why you are keeping the water in a particular recipient, you are already in a vulnerable situation, you have already identified which are the women who need the most help.

making a statement, making an effort to get to those women, in el salvador, where the situation is even more difficult, i think there is a matter of lifting laws which is not something that will take that much time. actually in a public emergency like this, a presidential decree that will allow women to terminate their pregnancy twh case owhenthe case of honduras s something that can be done very easy and will help us, in a sense to close the inequality gap among women a little bit. >> i want to thank my guests, paula avila, gisele carano, and josh michaud, i'm ray suarez, thanks for watching, have a good night.

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