As the Zika virus bears down on the United States, federal health officials are divided over a politically and ethically charged question: Should they advise American women to delay pregnancy in areas where the virus is circulating?
Some infectious disease experts are arguing that avoiding conception is the only sure way to prevent the births of deformed babies, according to outside researchers who serve on various advisory panels.
Women’s health specialists, on the other hand, counter that the government should not tell women what to do with their bodies. Indeed, federal health officials have never advised all the women in a region of the country to stop having children. Moreover, they say, most babies conceived during Zika epidemics in Latin America have been born healthy.
Several federal experts central to the discussion declined to be interviewed for this article. Dr. Thomas R. Frieden, the director of theCenters for Disease Control and Prevention, described the internal debate as “a very long conversation.”
For now, “we do not have a recommendation to not become pregnant,” Dr. Frieden said at a “Zika summit” held recently at disease agency headquarters in Atlanta. “We do recommend access to contraception.”
On Wednesday, the agency confirmed what many experts already believed: that the mosquito-borne virus, which is usually mild in adults, can cause severe brain damage in infants.
In view of the gathering evidence, health officials in some countries struck by Zika epidemics, including El Salvador and Colombia, have urged women to avoid pregnancy.
Dr. Marcos Espinal, who directs the Zika response of the Pan American Health Organization, an arm of the World Health Organization, said in an interview that he thought advising women to avoid conception during an epidemic’s relatively brief peak months, as Colombia did, “is sound advice.”
Yet the W.H.O. does not follow that policy. Dr. Bruce Aylward, the agency’s head of emergency response, called avoiding pregnancy “a complicated decision that is different for each individual woman.”
Currently, the question affects Americans only in Puerto Rico, the United States Virgin Islands and American Samoa, where the Zika virus is circulating locally. But if the virus spreads as expected this summer, women in Hawaii and many Gulf Coast states may also be faced with tough choices.
Despite the C.D.C.’s stance, Puerto Rico’s health secretary, Dr. Ana Ríus, has been advising women to avoid pregnancy, although she has done so in public interviews, not in a large health campaign. Women on the island may be following her advice, she said; preliminary figures indicate that there are 8 percent fewer pregnancies than there were at this time last year.
For women living on those islands, the disease agency’s current guidelines do not advocate delaying pregnancy, instead calling the timing of conception a “deeply personal and very complex decision” and suggesting that women consult their doctors for “pregnancy planning.”
But tourists visiting the islands receive specific advice to avoid pregnancy for eight weeks after a visit, and for six months if male partners have had symptoms of Zika infection.
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One expert familiar with the debate, Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, described it as “two groups describing an elephant, one looking at the head and the other at the tail.”
Dr. William Schaffner, the chairman of department of preventive medicine at Vanderbilt University Medical School, who also described the outlines of the split, said that withholding conception advice might leave couples adrift.
“They have to think it through by themselves,” he said. “They may hear it from their doctors or mothers or friends at the beauty parlor, but not from the C.D.C.”
Advocates of delaying pregnancy give several reasons.
First, they do not believe that even the most aggressive mosquito-control efforts can protect pregnant woman 24 hours a day for nine months.
No country yet has stopped dengue or chikungunya, which, like Zika, are spread by the Aedes aegypti mosquito, and the disease agency itself has warned that reductions of 80 percent to 90 percent in those mosquito populations sometimes does not reduce disease transmission.
Second, no vaccine is expected to be ready for at least two years.
Third, evidence is mounting that Zika outbreaks are intense but brief. In French Polynesia in 2013, the virus infected 66 percent of the population within seven months and then disappeared.
Because women who recover from Zika appear to be permanently immune, experts argue that delaying conception spares them the risk of having a child with severe birth defects, along with the agonizing worry — and lets them conceive safely a year later.
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