Community Understanding of Contraception During the Zika Virus Outbreak in Puerto Rico

Abstract

In response to the Zika virus outbreak in Puerto Rico (2015-2016), the Zika Contraception Access Network (Z-CAN) was established to provide same-day access to the full range of reversible contraception at no cost to women. Formative research was conducted to inform the development of a communication campaign about Z-CAN. Ten focus groups with women and men, aged 18 to 49 years, in Puerto Rico were conducted to collect data on contraception awareness, use, and decision making during the Zika outbreak, as well as culturally appropriate messaging and outreach strategies. Thematic analysis was conducted using the constant comparative method. Data showed that there was community awareness regarding Zika in Puerto Rico. However, it was not a motivating factor in contraception decision making; instead, economic factors were the major drivers. Most participants preferred to receive information on contraception, potential side effects, and where to access contraceptive services via Internet-based channels and health care providers. Based on these findings, the Ante La Duda, Pregunta [When in Doubt, Ask] campaign was launched to promote awareness of Z-CAN services among those who chose to prevent pregnancy during the Zika outbreak. Our results underscore the importance of conducting formative research to develop communication initiatives, while also demonstrating that it is feasible to perform these activities as part of an emergency response.

Community participation and community engagement in the response to the Zika-Virus-Outbreak in Latin America 2015-2019 - A Scoping Review

“…Of the 46 included documents, 45 were published in English and one in Spanish. Of the peer-reviewed documents there was heterogeneity in study designs (based on MMAT classification), which included twenty qualitative studies [8, 21-24, 26, 29, 32, 35, 36, 38, 47-54, 56] , nine cross-sectional mixed method studies [27, 30, 31, 37, 57-61] , one cluster randomised controlled trial [62] , four descriptive studies [63-66] two reviews [67, 68] , three surveys [34, 69, 70] , one cohort study [33] , one pre-post design study [71] , and, four opinion and commentary essays [28, 72-74] . The majority of the studies was performed in Brazil (n=10) and in Puerto Rico (n=6), moreover in Mexico (n=5) Colombia (n= 4), Peru (n=4), Dominican Republic (n=3), Guatemala (n=2), Honduras (n=2), Ecuador (n=2), Cuba (n=2), Nicaragua (n=1), French Guyana (n=1), Uruguay (n=2), Belize (n=1), Curacao (n=1) and Argentina (n=1).…”

“…[23, 25, 29-31] For this reason, mosquito vector control, access to reproductive healthcare services during pregnancy, appropriate fertility control, safe abortions, and sexual health education to prevent unintended pregnancies and sexually transmitted diseases in general are an important public health issue in the response to the Zika virus outbreak. [23, 26, 32-38] The application of community engagement principles targeting mosquito vector control and health education might improve maintenance of health outcomes, and therefore be a cost-effective approach in economic, political and social aspects. [13, 14, 39-43]…”

“…[8, 32-37, 54, 75] In 2016 a qualitative assessment was performed in Puerto Rico to examine the access to reproductive healthcare, to raise awareness about contraception during the Zika virus outbreak, attitudes towards contraception, and to find adequate risk communication strategies [32]. …”

Program Fidelity and Patient Satisfaction among Women Served by the Zika Contraception Access Network Program in Puerto Rico

“…These findings are consistent with qualitative data collected from women and men of reproductive age in Puerto Rico during the early phase of Z-CAN to inform the development of a health communication strategy. Those data found that women reported the economic crisis in Puerto Rico as a primary reason to prevent pregnancy and that Zika virus was a less considered factor when couples discussed pregnancy prevention (August et al, 2020). Other investigators have acknowledged how the Zika virus epidemic in Puerto Rico exposed failures in socioeconomic policies and protections of sexual and reproductive health rights in Puerto Rico (Rodriguez-Diaz, Garriga-Lopez, Malave-Rivera, & Vargas-Molina, 2017).…”

Access to Contraceptive Services in Puerto Rico: An Analysis of Policy and Practice Change Strategies, 2015-2018

“…In addition, long-standing barriers to access contraception also impacted women with private health insurance, in particular, high outof-pocket costs and limited access to long-acting reversible contraception (LARC). 4,6 To increase access to contraceptive services for women in Puerto Rico during the Zika virus outbreak, the National Foundation for the Centers for Disease Control and Prevention (CDC Foundation), with technical assistance from CDC, established the Zika Contraception Access Network (Z-CAN).The Z-CAN was a short-term emergency response intervention that used contraception to prevent unintended pregnancy to reduce Zika-related adverse birth outcomes during the Zika outbreak. 7,8 Between May 2016 and September 2017, a total of 29 221 women received Z-CAN services.…”