Estimating contraceptive needs and increasing access to contraception in response to the Zika virus disease outbreak — Puerto Rico, 2016
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Estimating contraceptive needs and increasing access to contraception in response to the Zika virus disease outbreak — Puerto Rico, 2016
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    On March 25, 2016, this report was posted as an MMWR Early Release on the MMWR website. Zika virus is a flavivirus transmitted primarily by Aedes species mosquitoes. Increasing evidence links Zika virus infection during pregnancy to adverse pregnancy and birth outcomes, including pregnancy loss, intrauterine growth restriction, eye defects, congenital brain abnormalities, and other fetal abnormalities (1,2). The virus has also been determined to be sexually transmitted.* Because of the potential risks associated with Zika virus infection during pregnancy, CDC has recommended that health care providers discuss prevention of unintended pregnancy with women and couples who reside in areas of active Zika virus transmission and do not want to become pregnant.† However, limitations in access to contraception in some of these areas might affect the ability to prevent an unintended pregnancy. As of March 16, 2016, the highest number of Zika virus disease cases in the United States and U.S. territories were reported from Puerto Rico.§ The number of cases will likely rise with increasing mosquito activity in affected areas, resulting in increased risk for transmission to pregnant women. High rates of unintended and adolescent pregnancies in Puerto Rico suggest that, in the context of this outbreak, access to contraception might need to be improved (3,4). CDC estimates that 138,000 women of reproductive age (aged 15–44 years) in Puerto Rico do not desire pregnancy and are not using one of the most effective or moderately effective contraceptive methods,¶,** and therefore might experience an unintended pregnancy. CDC and other federal and local partners are seeking to expand access to contraception for these persons. Such efforts have the potential to increase contraceptive access and use, reduce unintended pregnancies, and lead to fewer adverse pregnancy and birth outcomes associated with Zika virus infection during pregnancy. The assessment of challenges and resources related to contraceptive access in Puerto Rico might be a useful model for other areas with active transmission of Zika virus. CDC, the Puerto Rico Department of Health, and partners used a comprehensive approach, including key informant interviews and review of existing data, to gather information on contraception services in Puerto Rico, including information on rates of unintended pregnancy, contraceptive use, contraceptive access, and barriers to provision and use of contraception. Discussions were conducted with federal partners, including the Center for Medicare and Medicaid Services, the Office of Population Affairs, and the Health Resources and Services Administration (HRSA). Key stakeholders and family planning providers in Puerto Rico were also consulted, including the Puerto Rico Department of Health, the Puerto Rico Chapter of the American College of Obstetricians and Gynecologists (ACOG), Title X federal family planning grantees, and the Puerto Rico Health Insurance Administration. Suggested citation for this article: Tepper NK, Goldberg HI, Bernal MI, et al. Estimating Contraceptive Needs and Increasing Access to Contraception in Response to the Zika Virus Disease Outbreak — Puerto Rico, 2016. MMWR Morb Mortal Wkly Rep 2016;65:311–314. DOI: 27031817
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