States that have the most restrictive contraception and abortion laws may end up being hit the hardest when the Zika virus spreads.

The idea of morality plays a major role in public health from “sin taxes” on vices such as alcohol to sexually transmitted diseases.

We’ve seen the effects these moral stands can have, most notably in the stigma attached to people with HIV, which prevented many from getting adequate treatment.

How restrictions on women’s reproductive rights will play out in the face of the Zika virus has yet to be determined.

The U.S. Centers for Disease Control and Prevention (CDC) reported that 423 pregnant women in the United States and its territories have tested positive for the Zika virus as of June 9.

As the United States enters its annual mosquito season, experts are concerned about the potential range of Aedes aegypti and Aedes albopictus mosquitoes capable of spreading diseases like Zika.

The areas most impacted by these flying pests are those along the southern border of the United States, the Gulf of Mexico, and the east coast as far north as Connecticut. States in the Bible Belt may be affected the most.

The CDC is quick to point out the projections about how far the mosquitoes could spread are not meant to represent the risk for spread of disease. But the range does include states with some of the harshest restrictions on access to contraceptives and abortion services.

Elizabeth Nash, senior state issues associate with the Guttmacher Institute, says these types of restrictions have created unintended consequences, as highlighted by the threat of Zika.

“This is a really tough issue,” she told Healthline. “It crosses a lot of topics.”

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The virus, spread through mosquitoes and sexual contact, causes fever, rash, joint pain, and red eyes, although many infected people may not show symptoms.

Most importantly, it can cause birth defects such as microcephaly and other abnormalities that are collectively referred to Congenital Zika Syndrome. A child can be born with a smaller head and smaller brain, preventing proper development.

These types of birth defects can be diagnosed via ultrasound around 28 weeks.

One major problem is that many states that will be impacted more by the mosquitoes than others outlaw abortion after 20 weeks. Twelve states have already banned abortions at about 20 weeks after fertilization, and others are considering similar bans.

Some states, including Indiana and North Dakota, ban abortion in cases of potential inherited genetic defects. While Zika isn’t inherited, these laws may have a chilling factor, the Guttmacher Institute review found.

“For someone who may seek to terminate their pregnancy because of Zika may have difficulty doing so,” Nash said.

One of the earliest noted cases of Zika involved a pregnant woman in Slovenia, who had worked in Brazil the year prior.

While ultrasound showed normal growth at 20 weeks, doctors first noticed fetal abnormalities at 29 weeks. The woman chose to terminate her pregnancy at 32 weeks.

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According to a recent report in the Guttmacher Policy Review, many of the states that may be initially impacted by Zika aren’t well equipped to deal with the problems of the disease.

These troubles include insurance rates, access to reproductive care, and rates of accidental pregnancies.

States in the potential mosquito danger zone also have the highest rate of uninsured women of reproductive age as well as high unintended pregnancy rates. These include Florida, Georgia, Louisiana, and Mississippi.

The most potentially unprepared state, the Guttmacher paper found, is Texas. The U.S. Supreme Court is expected to rule this month on an abortion case stemming from Texas regarding access to abortion services in the state.

“Texas is emblematic of what’s occurring across the South,” Nash said.

Texas state legislators didn’t meet this year, so they couldn’t even consider the issue. But other states legislatures that meet every year still weren’t discussing the potential impact of Zika, which Nash found fascinating.

“Zika wasn’t on their radars,” she said. “Given the high profile of Zika, to see those connections aren’t being made is alarming.”

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So far, all confirmed cases of Zika in the continental United States have been due to people traveling to areas where the disease is present.

The CDC recommends people in the affected areas build a “Zika prevention kit.” The kit includes:

  • A bed net
  • insect spray
  • permethrin spray, used on yards and clothing
  • standing water treatment tabs (as well as getting rid of standing water around your home)
  • condoms, because the disease can be transmitted by bodily fluids through sex