The Zika epidemic and abortion in Latin America:a scoping review

Background:Latin America presently has the world’s highest burden of Zika virus,but there are unexplained differences in national rates of congenital malformations collectively referred to as Congenital Zika Syndrome(CZS)in the region.While Zika virulence and case detection likely contribute to these differences,policy-related factors,including access to abortion,may play important roles.Our goal was to assess perspectives on,and access to,abortion in Latin America in the context of the Zika epidemic.Methods:We conducted a scoping review of peer-reviewed and gray literature published between January 2015 and December 2016,written in English,Spanish,Portuguese,or French.We searched PubMed,Scielo,and Google Scholar for literature on Zika and/or CZS and abortion,and used automated and manual review methods to synthesize the existing information.Results:36 publications met our inclusion criteria,the majority of which were qualitative.Publications were generally in favor of increased access to safe abortion as a policy-level response for mitigating the impact of CZS,but issues with implementation were cited as the main challenge.Aside from the reform of abortion regulation in Colombia,we did not find evidence that the Zika epidemic had triggered shifts in abortion policy in other countries.Conclusion:Abortion policy in the region remained largely unchanged following the Zika epidemic.Further empirical research on abortion access and differential rates of CZS across Latin American countries is required.

The impact of anti-tobacco legislation on birth weight in Peru

Background:Tobacco exposure remains a significant issue for public health,especially for pregnant women.It increases the risk for premature labor,low birth weight and small for gestational age(SGA),among other effects.To reduce these risks,many countries have enacted public policies to curb tobacco exposure.Peru enacted anti-tobacco laws that forbid smoking in public places,require prevention text and images in products and publicity,along with restriction of sales to adults.We evaluated the effect of the implementation of this law on newborn outcomes:birth weight,prematurity and SGA.Methods:This was a quasi-experimental study that utilized data from the Peruvian Live Birth Registry.Children born to mothers from urban areas were the intervention group,while children born to mothers from rural areas were considered the control group.Only singletons with information on birth weight and gestational age,born to mothers aged 12 to 49 years were included in the study.In addition,newborns with birth weights greater than+4 standard deviations(SD)or less than−4 SD from the gestational age-specific mean were excluded.To measure the effect of legislation on birth weight we performed a difference in differences analysis.Results:A total of 2,029,975 births were included in the analysis.After adjusting for characteristics of the mother and the child,and contextual variables,the anti-tobacco law in Peru reduced the incidence of prematurity by 30 cases per 10,000 live births(95%CI:19 to 42).Conclusions:The reform had negligible effects on overall birth weights and on the incidence of SGA.This modest result suggests the need for a more aggressive fight against tobacco,prohibiting all types of advertising and promotion of tobacco products,among others measures.