It’s early spring in London. Some of Britain’s leading medical researchers have convened to discuss alarming new evidence linking a virus long presumed to be harmless with a spate of defects in newborn babies. It’s not 2016, it’s 1946, and the disease is not Zika, but German Measles, or Rubella.
For most patients Rubella produces only a minor rash and fever. But when contracted by women during early pregnancy, the virus may result in miscarriage, infant death, or a range of often life-shaping disabilities, such as deafblindness. Increased awareness of the risk of maternal rubella in the mid-twentieth century, partly through vivid reports on the ‘crippling’ effects of this disease in the international media, had profound consequences including the development of highly successful mass immunization programmes.
70 years later, another little understood virus, which apparently uniquely threatens pregnant women and the developing embryo, has been thrust into the media spotlight. Brazilian health officials have linked a dramatic surge in cases of a relatively rare defect in newborns to an outbreak of the mosquito-borne Zika virus, recognized in central Africa since the 1940s, but first recorded in Brazil just under a year ago.
Zika and Rubella in the media
The Zika virus is transmitted by the bite of the Aedes aegypti mosquito, and is in most cases asymptomatic or, like Rubella, associated with a mild rash and fever. But there is mounting evidence of a connection between maternal infection and increased risk of having a baby with microcephaly (abnormally small head size), a defect associated with neurological impairment and developmental delays. As medical concern and media interest in Zika intensifies, the world is learning to see images of Brazilian babies born with this condition as portraits both of a terrifying disease, and pregnant women’s anxieties.
Every epidemic is frightening, and all the more so when played out so manifestly and consequentially on children’s bodies. As Rubella crossed the United States in the 1960s, with the thalidomide tragedy still fresh in the memory, media headlines similarly dramatized anxieties about a ‘silent infection’ predicted to ‘damage’ tens of thousands of babies.
Pregnant women in Latin America are understandably terrified by what they know about Zika, about mosquitoes, and about microcephaly, just as an earlier generation of women were alarmed by Rubella. Today, as in the mid-twentieth century, these fears are rooted not only in women’s hopes for their families and themselves, but also in an awareness of the material conditions and social barriers shaping the lives of people with disabilities, and those who care for them.
Online news and social media have allowed the Zika epidemic to explode into view. Medical consensus about, and lay knowledge of, maternal Rubella developed more slowly in a world in which pregnancy was nowhere near so medicalized and far less openly discussed. Nevertheless, by the 1950s, women in Britain and elsewhere had learned, through medical advice, newspapers and magazines, friends and family, to fear Rubella.
Zika, Rubella, and the abortion debate
As historian Ilana Löwy has recently written, a crucial factor unites those Rubella experiences with the experiences of women in contemporary Brazil faced with Zika – access to abortion. Through the 1950s and most of the ’60s, abortion was illegal in Britain, as it is in much of Latin America today. An expectant mother who had contracted Rubella was confronted with the emotional toil of imagining a future for, and the potential suffering of, a seriously disabled child, and what this might mean for her family. As one woman wrote in the Guardian in 1962,
both morally and intellectually it seemed to me that for the sake of the child, of myself, and of the family that it would be taking an unjustifiable risk to allow the child to be born.
In spite of the legal restrictions, she, like many women in the same situation, sought to terminate the pregnancy.
Such women, historian Leslie Reagan has eloquently argued, were ‘moral pioneers’. The accidental combination of pregnancy and disease put women in the complicated position of having to assess scientific information about the probability of foetal malformation, and confront the anxieties and uncertainties associated with either terminating a pregnancy or carrying it to term. Not all medical practitioners agreed that infection with Rubella in early pregnancy justified abortion. But many did, to the extent that termination had become the ‘recognised treatment’ for maternal Rubella in British hospitals at least a decade before abortion was made legal.
By negotiating these private dilemmas in public view, women such as the Guardian author, along with sympathetic doctors, helped transform the politics of abortion in Britain, Australia and the United States. Awareness of the dangers of Rubella put abortion, previously associated with criminality, deviance, and poverty, firmly on the agenda as something that any woman, of any class, might require under certain circumstances. Most Latin American women do not have this option.
Unlike Rubella, Zika is regarded as a ‘tropical disease’. Like other mosquito-transmitted infections such as Malaria, Zika carries the associated historical burdens of colonialism, poverty, and underinvestment that have shaped the distribution, management, and experience of these diseases. Yet many today pin hopes of tackling Zika on the rapid development of a vaccine, or on the success of mosquito control procedures. These, and other such technical solutions, may prove effective.
Likewise, as early as 1949 doctors anticipated a vaccine that would prevent Rubella, and put an end to the complicated legal, social and moral issues associated with birth defects and abortion. But it was more than twenty years before researchers were able to roll out an effective vaccine. Given the history of Rubella, it is reasonable to ask whether pressure for a social innovation—reproductive rights—may bear fruit quicker. As women’s health advocates critique the advice from some governments to delay pregnancy for up to two years, Zika, like Rubella in a different time and a different place, has reignited debate in Latin America about access to safe, legal abortion.
Salim Al-Gailani is a research and teaching associate on the Wellcome Trust ‘Generation to Reproduction’ project at the Department of History and Philosophy of Science, University of Cambridge.