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K E Y W O R D S : Contraception; Dominican Republic; Family planning; Long-acting reversible contraception; Zika virusZika virus infection during pregnancy is linked with adverse pregnancy and birth outcomes. 1,2 Therefore, women and their partners need education about the complications of Zika virus and reliable contraception in the context of this global health concern. Studies confirm the superiority of long-acting reversible contraceptives, which are desirable during Zika virus outbreaks to prevent unintended pregnancies and adverse outcomes. 3 The aim of the present study was to assess the unmet need for family planning in rural Dominican communities and to discern Zika virus awareness and its impact on contraception among community members. Des Moines University healthcare team (collaborating with TimmyGlobal Health) traveled to Monte Cristi, Dominican Republic, in March 2016. People in this region live in communities called bateyes, with populations of 250-300. Women were invited to participate in a survey with questions about reproductive health including contraception use and desires, and Zika virus awareness and influence on contraceptive choice. The institutional review board of Des Moines University granted the study an exemption. All participants provided informed consent.A total of 45 women aged 18-50 years were surveyed from four bateyes that were identified by Timmy Global Health as having the greatest need for healthcare services. Approximately three-quarters of the women had used contraceptive methods; most had used shortacting methods (Table 1). A large proportion of women expressed a desire for future family planning methods, more than half of whom indicated that they would choose long-acting contraceptive methods (Table 1). Of the 42 women who had heard of Zika virus, 16 (38%) wished to alter their contraceptive methods as a result. The proportion of women who wanted to alter contraceptive methods because of Zika virus differed vastly between communities (Table 1).Women in these rural Dominican communities had interest in long-acting contraceptive methods. However, none were using these methods at the time because of inaccessibility, largely because of cost and lack of transportation, highlighting unmet needs at the time of the survey. Additionally, two women reported prior tubal ligations, which are not reversible.Although most women had heard of Zika virus, few indicated that it influenced their contraceptive choice. Future investigations should explore Zika virus knowledge, its influence on contraceptive choices, and barriers to contraceptive access among members of these communities.The present study underscores the need for information about Zika virus and more reliable contraception during this global health epidemic. AUTHOR CONTRIBUTIONSAll authors contributed to the design, planning, and implementation of the survey, as well as data analysis and manuscript preparation. ACKNOWLEDGMENTS

Objective To assess knowledge of the Zika virus (ZIKV), use of contraceptives, and sources of health information in rural communities in the Dominican Republic. Methods Over 4 days in March 2017, a research team traveled to four rural communities in the Dominican Republic to provide healthcare services. Overall, 90 men and women consented to a voluntary verbal 12‐question survey. Results Of the participants, 55% were not certain whether ZIKV is transmitted sexually; 75% of participants were either not sure or thought ZIKV was not present in their community. Charlas (informal discussions led by community health workers) were cited as the most common source for public health information. Prevalence of contraceptive use was 26.6% hormonal and 1.1% long‐acting reversible contraception (LARC); 30.0% cited no use of contraception. Conclusion Significant deficits in ZIKV knowledge, underutilization of LARCs, and socioeconomic factors exist that constrain the application of WHO recommendations for preventing ZIKV infection. Additional and more robust surveys are needed to assess public health education and interventions, critical for disease prevention in communities facing current and future epidemics.

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Not only the direct effects of wars harm the planet. Also devastating can be the covert, indirect and often legitimized, actions of nations in securing their national sovereignty — silent-war actions ranging from secret nuclear installations, storage of chemical and biological weapons, militarized economic policy, biases in development expenditures, and ranging up to ethnocide and genocide. New ways of looking at warfare, national sovereignty, and the environment, take on urgency if only because the relationship between war-proneness, nation-building, and national sovereignty, appears to be an enduring one.