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Impact of Contraception Access Program to Prevent Zika-Related Birth Defects Highlighted

Judy Monroe

Photo above: Through the Zika Contraception Access Network, the CDC Foundation and partners rapidly established a network of physicians at clinics across Puerto Rico trained to provide the full range of FDA-approved, reversible contraceptive methods at no cost to women. Photo Credit: © Evelyn Hockstein/CDC Foundation

By Judy Monroe, MD, president and CEO of the CDC Foundation

How do you respond to a mosquito-borne virus with the potential to cause devastating birth defects? That was a central challenge facing health officials during the Zika outbreak in Puerto Rico in 2016. One strategy was to protect pregnant women from mosquito bites. Another was to assist women who did not want to get pregnant during the Zika outbreak. The impact of this second strategy was highlighted in a January Lancet Public Health article.

During the Zika outbreak in 2016, Puerto Rico had the highest number of Zika infections in the United States, a high rate of unintended pregnancy and limited access to contraception, including long-acting reversible contraception (LARC), like intrauterine devices and contraceptive implants.

Action was needed, and the CDC Foundation, with technical assistance from the Centers for Disease Control and Prevention (CDC) and in collaboration with a diverse group of stakeholders and private donors, established the Zika Contraception Access Network (Z-CAN). Z-CAN used contraception as a medical countermeasure in Puerto Rico to reduce the number of poor pregnancy and birth outcomes associated with Zika infection. The program did so by preventing unintended pregnancy among women who chose to delay or avoid pregnancy.

To ensure Z-CAN’s success, the CDC Foundation and partners had to rapidly establish a network of physicians at clinics across Puerto Rico trained to provide the full range of FDA-approved, reversible contraceptive methods at no cost to women. The program also included a health communications campaign, titled Ante la Duda, Pregunta, to engage women and make them aware of Z-CAN.

The Lancet Public Health article reports that Z-CAN provided services initially to more than 21,000 women in Puerto Rico between May 2016 and mid-August 2017. Importantly, the program also demonstrated the feasibility of implementing an effort to increase access to the full range of reversible contraception within a complex public health response.

“This feasibility program took place in one U.S. territory; the data and lessons learned here could help apply quick action in other public health emergencies,” said Eva Lathrop, MD, MPH, associate professor of gynecology and obstetrics at Emory University School of Medicine and the lead author of the article, who was also the deputy for contraception on the Pregnancy and Birth Defects Task Force during CDC’s Zika virus response efforts.

Additionally, Z-CAN in Puerto Rico increased physician and staff capacity in contraception knowledge and counseling, as well as management of contraceptive methods, including insertion and removal of LARCs.

We are very pleased with the impact of Z-CAN and extremely grateful to all the donors and partners who quickly stepped forward to support the program during the Zika outbreak in Puerto Rico. Strong partnerships from the government, philanthropic, health and corporate sectors were essential to the success of Z-CAN—and helped to protect more women in Puerto Rico.




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