“…In Puerto Rico, high levels of sexuality-related stigma, 12,13,14 poor quality sex education, 15 limited access to contraception, 16,17 and limited participation in the allocation of resources for prevention 18 make prevention of new Zika infections in accordance with these recommendations challenging, if not downright onerous. For example, researchers in Puerto Rico have evidenced that there is poor quality sex education available, 15,19 limited access to contraception, 16,17 low levels of reproductive planning, 20 high levels of gender-based violence, 21 and low rates of condom use among women. 17 Further, two thirds (65%) of pregnancies are unintended, 22 sexual abstinence is rarely practiced among sexually active adults, 17 and abstinence-based sexual education (on which public policies are mostly focused) has proven to be ineffective and morally problematic as it threatens fundamental human rights to health, information, life, and reproductive freedom.…”