What Donald Trump’s win could mean for women with Zika

The Zika virus was already a threat to women before the election. But now that Americans have elected a man who campaigned on the promise of overturning Roe v. Wade, that threat could get even worse.

For the past several months, women in certain parts of the country, especially South Florida, have had to reckon with the effects of the Zika crisis on their fertility and reproductive rights. According to the Centers for Disease Control, more than one thousand pregnant women in the United States have shown signs of infection so far.

It’s been excruciating to think about the choices these women and their families have been forced to face as they’ve grappled with the notion of carrying a fetus that might be born with lifelong and debilitating birth defects.

In fact, we didn’t even get a full view of these defects until days before the election. On November 3rd, the Journal of the American Medical Association Pediatrics released a report identifying a pattern of birth defects appearing in children born to mothers infected with the Zika virus during pregnancy. This grouping is now officially called “congenital Zika syndrome.” It includes five types of defects seen all at once among babies born to Zika-infected women: severe microcephaly (abnormally small head size) with a party collapsed skull; decreased brain tissue with a specific pattern of calcium deposits indicating brain damage; damage to the back of the eye with a specific pattern of scarring and increased pigment; joints with a limited range of motion, such as clubfoot; and too much muscle tone, restricting movement soon after birth.

But five days after that report came out, former reality television personality Donald Trump and former Indiana governor Mike Pence, who has said that he wants to see Roe v. Wade “sent to the ash heap of history,” won the presidential election. And just like that, the circumstances around women’s reproductive rights got even more severe—especially in the wake of Zika.

Perhaps the most painful aspect of what pregnant women with Zika face boils down to timing. According to guidance issued by the Centers for Disease Control, microcephaly can typically be detected on an ultrasound between 18 to 20 weeks of gestation at the earliest, but it more often becomes apparent on an ultrasound during the late second and early third trimester, somewhere between 24 to 28 weeks gestation. By that point, it may be too late to make a decision. According to the Guttmacher Institute, a sexual and reproductive health research and policy organization, 14 states already ban abortions after 20 weeks except in cases of life or health endangerment to the woman. Another eight states ban abortion at 24 weeks, another two states at the start of the third trimester, and another 19 at the point of viability outside womb. Although there is no definitive gestational age that guarantees fetal viability, roughly 95% of babies born before 23 weeks gestation do not survive. Current data shows that between 67% and 76% of babies born at 25 weeks gestation survive until discharge from the hospital.

If he keeps his campaign promises, President-elect Trump will make it significantly more challenging for women at this stage of pregnancy to access a full range of reproductive options. He has been vocal about his intent to support a federal ban on so-called “partial birth abortion,” a term used by anti-choice advocates to describe the medical procedure of dilation and extraction commonly used for late-term abortion. Nineteen states already have laws on the books banning this procedure. Some states have even started banning the procedure known as dilation and evacuation, commonly used in abortions after the first trimester, as well. A federal ban on dilation and extraction would subtract from Zika-infected women’s already limited options.

That’s why American women are not wrong in thinking that they’re proverbially f*cked when it comes to their reproductive rights under Trump—especially because the Zika crisis isn’t over.

In Florida, the first place in the continental U.S. where people became infected with Zika through active local transmission, the Aedes aegypti mosquito that spreads the virus is abundantly present almost year-round throughout the entire state. That means all 3.5 million women of reproductive age in Florida are theoretically at risk, not just those in the greater Miami area. And while abortion after 24 weeks gestation—just around the time when a pregnant woman might learn if her fetus has been impacted by the Zika virus—is already banned in the state, that limitation might get stricter. Mike Pence has promised to help Congress pass legislation that would make abortion illegal after 20 weeks nationwide.

Florida isn’t the only state where women face the continuing threat of Zika—and real restrictions on their access to reproductive health care.

The National Institutes of Health have predicted that Texas and Louisiana will be the states to see active Zika transmission next. Both states ban abortion at 20 weeks postfertilization. They also have mandatory state-directed counseling requirements designed to discourage women from choosing abortion care, as well as mandatory ultrasound requirements for women seeking abortion.

“The Zika virus and the way it’s played out on a policy level is a perfect parable for the entire fight we have,” Ilyse Hogue, the president of of the reproductive rights advocacy group NARAL Pro-Choice America, told me shortly before the election. “What I mean by that is that you’ve got politicians—anti-choice politicians—who are completely intransigent, even [when] standing before an active public health crisis.”

When I spoke to Hogue on Wednesday, following Democratic presidential nominee Hillary Clinton’s concession to Trump, she told me that although polling suggests most Americans take a pro-choice stance, the challenge that lies ahead for groups like NARAL is making this an issue “important enough for people to vote on them.” She added:

To vote for a candidate who would decide that he or she knows better than you about what is best for your family better than you do, better than your doctor does, it is literally a vote against your confidence in yourself and your own values. We have to have this values conversation and bring these people with us. We have to have these conversations and have them now.

Our past—and future—living with the Zika virus, Hogue said, only makes that mission more urgent.

“Zika puts into focus what those of us who do this work every day already know—when it comes to making decisions, every circumstance is different and every individual is much more successful making their own decisions with their doctors,” she continued. “Politicians don’t know anything about how to make these decisions and shouldn’t have a voice in this decision making.”

Jen Gerson Uffalussy is a regular contributor to Fusion. She also writes about reproductive and sexual health/policy for Glamour, and television for The Guardian. She lives in Atlanta.