Unmet contraceptive needs in rural communities in the Dominican Republic during an international Zika virus outbreak

Abstract

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

Knowledge and perceptions of Zika virus transmission in the community of Puerto Plata, Dominican Republic

“…Additionally, our findings show that only one person (2.9%) in our sample used condoms to prevent the spread of Zika. In a separate study conducted in rural Dominican communities, 93% of women were found to be aware of Zika but this awareness did not impact their contraceptive usage [47]. These differences indicate that there is notable variation in Zika knowledge across Dominican communities which may be a result of inaccessibility of medical services and products, such as contraceptives [47].…”

Zika virus knowledge, contraception use, and lessons learned from a Dominican Republic pilot study

“…To achieve research aims, a multi‐site, mixed‐methods, cross‐sectional study was conducted in which patients from four villages, known as bateyes, were surveyed immediately following their visit to the clinic. Methods employed were tested in a 2016 proof of concept study . The DMU and Timmy Global Health institutional review boards approved both the 2016 proof of concept study and 2017 pilot study.…”

“…Methods employed were tested in a 2016 proof of concept study. 7 The DMU and Timmy Global Health institutional review boards approved both the 2016 proof of concept study and 2017 pilot study.…”

Community Perspectives on Contraception in the Context of the Zika Virus in the U.S. Virgin Islands: Implications for Communication and Messaging

“…Thus, broader strategies should explore and be sensitive to these complexities in the context of Zika. Activities like provider training on assessing reproductive intentions have been called for in other studies in Zika-affected areas (Ali, Miller, & Gomez Ponce de Leon, 2017;Borges, Moreau, Burke, Dos Santos, & Chofakian, 2018;Shaw et al, 2017), but efforts also should prioritize strategies that more broadly situate a woman's own perspectives on achieving her reproductive goals and be mindful of new models that suggest methods for doing this (Aiken et al, 2016).…”