Between May 2016 and August last year, a group organized by the CDC provided services to more than 21,000 women in Puerto Rico in an attempt to boost access to contraception, lower the rate of unintended pregnancy and lessen the number of Zika-related birth defects on the island.
Last week, The Lancet Public Health examined the initial results of the work done by the Zika Contraception Access Network and found that the group was able to mount a high-quality intervention in response to a public health crisis that is still troubling the nation.
The Centers for Disease Control and Prevention reported in April 2016 that 65% of pregnancies in Puerto Rico were unintended and nearly 138,000 women were at risk for unintended pregnancy. Access to contraceptives of all kinds is limited by high out-of-pocket costs, poor reimbursement, logistical obstacles and lack of education. Puerto Rico also faces a shortage of people trained in the insertion, removal and management of long-acting reversible contraceptives, like intrauterine devices.
To help improve access to contraception during the Zika outbreak, the CDC Foundation and a group of private donors put together Z-CAN with the help of local governments and healthcare systems in Puerto Rico.
“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,” president & CEO of the CDC Foundation, Dr. Judith Monroe, said in prepared remarks. “Strong partnerships from government, philanthropic, health and corporate sectors were essential to the success of Z-CAN and helped to protect more women in Puerto Rico, thereby reducing Zika-related birth defects.”
The group set up a network of doctors at clinics around Puerto Rico to provide FDA-approved contraceptive devices and medications at no cost to any woman who was looking to delay or avoid a pregnancy during the Zika outbreak.
Researchers studying the Z-CAN response noted that the organization’s model could be replicated or adapted for future emergency response efforts. The researchers also noted that almost 68% of women who participated in the program chose a long-acting reversible contraceptive and nearly one-fourth of women chose either oral pills, a transdermal patch, a vaginal ring or the depo medroxyprogesterone acetate injection. Just 2.9% of women elected for condoms alone and 4.5% chose not to receive a method of contraception.
“Z-CAN demonstrates that it is possible to rapidly design, implement and scale a high-quality contraception intervention as part of a response to a public health emergency,” lead author Dr. Eva Lathrop added. “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.”
“The Z-CAN program changed how medicine is practiced in Puerto Rico, providing contraceptive access, information and counseling to thousands of women on the island,” Dr. Gladysmaria Figueroa Rubero, a practicing obstetrician and gynecologist in Puerto Rico, said. “For the first time, I was able to offer patients the best contraceptive options without concern about cost or availability. We empowered women and made a healthier Puerto Rico.”