Contraception as a Medical Countermeasure to Reduce Adverse Outcomes Associated With Zika Virus Infection in Puerto Rico: The Zika Contraception Access Network Program

Abstract

The Zika Contraception Access Network established a network of 153 physicians across Puerto Rico as a short-term emergency response during the 2016-2017 Zika virus outbreak to provide client-centered contraceptive counseling and same-day contraception services at no cost for women who chose to prevent pregnancy. Between May 2016 and August 2017, 21 124 women received services. Contraception was used as a medical countermeasure to reduce adverse Zika-related reproductive outcomes during the outbreak and may be considered a key strategy in other emergencies.

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

“…A safety net was established that will operate through 2027 to ensure that women who participated in Z-CAN and chose a LARC method have access to no-cost LARC removal. The safety net included bundled LARC insertion and removal reimbursement at the time of insertion to cover future removal costs and ongoing communication efforts (e.g., website with Z-CAN clinic locator, hotline, email, Facebook page) to assist women with finding a Z-CAN provider for no-cost LARC removal (Romero et al, 2018).…”

“…Nonsterilized women of reproductive age were eligible to receive Z-CAN services. A total of 153 physicians were trained and the Z-CAN program was implemented at 139 clinics, including private practices, community health centers (CHCs), academic clinics, and public health clinics, across all five public health regions and 69% of municipalities in Puerto Rico between April 2016 and September 2017 (Lathrop et al, 2018;Romero et al, 2018). The number of initial Z-CAN visits by month rapidly increased between August 2016 and March 2017 (Romero et al, 2018), reflecting the program's rapid scale up; thereafter, the number of initial Z-CAN visits declined each month until the program end date.…”

The impact of disasters on contraception in OECD member countries: a scoping review

“…Nine articles [19][20][21][22][23][24][25][26][27], four of which were original research papers [19,21,24,26], gave insight into the importance of contraception during disasters. During the Zika epidemic, contraception was crucial to reduce Zika-related microcephaly [19][20][21] and related health care costs [21]. During the COVID-19 pandemic, access to contraception was deemed as particularly important because the impact of COVID-19 on maternal and foetal well-being were not clearly understood [22], and because women's plans for pregnancy may alter depending on personal experience, financial and/or medical concerns [23].…”

“…Twelve articles [28][29][30][31][32][33][34][35][36][37][38][39], six of which were original research papers [28,30,[33][34][35]37], gave insight into communication with the public during disasters. Health communication campaigns spread through billboards, the radio, newspaper adverts, and social media and sexual education programs were used by health providers to provide information on how the Zika virus spreads [21,31,32,[34][35][36]. However, message content for the public on the modes of transmission of Zika and recommendations to use condoms in Zika-affected areas was found to not be strong enough [36,37].…”

“…Nineteen articles [21,34,75,[98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113], eleven of which were original research studies [21,34,99,101,103,[106][107][108][109][110]113], considered how demand for contraception changed. There was conflicting evidence on whether the Zika outbreak led to increased demand for contraception [21,34,110]. Similarly, while some women reported that they wanted to delay childbearing during the COVID-19 pandemic and considered use of LARC, others did not change their views [75].…”