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Maria Erlinda Guzman desperately wants a baby, and has been undergoing fertility treatments at El Salvador's largest women's hospital. But now, she fears her dream of motherhood may be dashed by Zika.
After her country took the extraordinary step of advising women to avoid pregnancies for two years due to concerns about the rapidly spreading virus, the 34-year-old now plans to start using contraception. She worries that she may be too old to conceive by the time it is considered safe to do so.
"I'm going to be left childless," Guzman said.
While Zika's exact link to the rare birth defect known as microcephaly is still unclear, warnings from El Salvador, at least six other countries and health officials across the Americas are raising anxiety for millions of would-be and could-be mothers in affected areas.
For some it's a dilemma pitting religious beliefs about abortion against the risk that their babies could be born with abnormally small heads and a short life expectancy.
World Health Organization officials said Thursday the virus is "spreading explosively" and the Americas could see up to 4 million cases of Zika in the next year. And as it expands to countries where abortion is strictly limited or outlawed altogether, doctors and health advocates fear that many women could resort to back-alley procedures that imperil their health.
Related: Five Things to Know About Zika
"What happens in a country where abortion is completely illegal?" asked Angelica Rivas of Acdatee, a Salvadoran nonprofit that advocates for decriminalization of the procedure. "What can be expected is an increase in the rates of illegal abortions, unsafe abortions and a mental health issue for women."
At least 4.4 million pregnancies were aborted in 2008 in Latin America, about 95 percent of them clandestinely and in unsafe conditions, according to the Guttmacher Institute, a U.S.-based nonprofit that promotes reproductive health rights.
"When women are desperate ... they will seek out their own solutions," said Carmen Barroso, Western Hemisphere director for the International Planned Parenthood Federation. In El Salvador, she said, half of all pregnancies are unplanned.
So far, only Brazil has seen a sharp rise in microcephaly cases suspected of a link to Zika.
Abortion is illegal in Brazil except in cases of rape, danger to the mother's life or anencephaly, another birth defect involving the brain. Authorities have said they don't plan to add a microcephaly exception, though the Folha de S. Paulo newspaper argued in an editorial that Zika raises a need to discuss decriminalization of abortion.
"It's illegal to abort -- they would throw me in jail."
Microcephaly usually occurs because of abnormal brain development that numerous conditions can trigger: genetic abnormalities, disorders such as Down syndrome, drug or alcohol use, other infections such as cytomegalovirus or even serious nutritional problems.
WHO officials say it may be six to nine months before a link between Zika and microcephaly is established or dismissed.
Even in countries where there have been no confirmed cases of microcephaly, such as El Salvador, nervous women are asking themselves tough questions.
"I can't say what I would do. It's illegal to abort -- they would throw me in jail," said Dinora Martinez, a 26-year-old Salvadoran woman who is not pregnant and who has a 5-year-old son.