Assessment of contraceptive use in Puerto Rico during the 2016 Zika virus outbreak

• Type of Material: Article
• Authors: Sascha R Ellington, Centers for Disease Control and Prevention, Atlanta; Ruby Serrano Rodriguez, Puerto Rico Department of Health, San Juan; Howard Goldberg, Centers for Disease Control and Prevention, Atlanta; Jeanne Bertolli, Centers for Disease Control and Prevention, Atlanta; Regina M Simeone, Centers for Disease Control and Prevention, Atlanta; Amilcar Soto Mercado, Puerto Rico Department of Health, San Juan; Karen Pazol, Centers for Disease Control and Prevention, Atlanta; Denise Jamieson, Emory University; Margaret A Honein, Centers for Disease Control and Prevention, Atlanta; Andrea Swartzendruber, Emory University; Toni Miles, University of Georgia; Jose Cordero, University of Georgia; Carrie Shapiro-Mendoza, Centers for Disease Control and Prevention, Atlanta
• Language: English
• Date: 2020-06-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.contraception.2020.03.001
• Title of Journal or Parent Work: CONTRACEPTION
• Volume: 101
• Issue: 6
• Start Page: 405
• End Page: 411
• Keywords: Zika virus; Obstetrics & Gynecology; Contraceptive prevalence; Reproductive health survey; Population data; ACCESS; Public health emergencies; Puerto Rico; Science & Technology; Life Sciences & Biomedicine; UNITED-STATES

Abstract

Of states and territories in the United States, Puerto Rico was the most severely affected by the Zika virus (ZIKV) outbreak in 2016. A large number of studies have shown that infection of pregnant women with ZIKV can result in microcephaly, structural abnormalities of the brain and eye, and other severe birth defects. It was estimated that during the initial ZIKVoutbreak in Puerto Rico in 2016 up to 10,300 pregnant women would be infected and that, in the absence of preventivemeasures, 100 to 270 infants would be born with microcephaly. Given the lack of a vaccine or prophylacticmedication to prevent ZIKV infection in areas with this virus, effective contraception for women who want to avoid pregnancy is critical for prevention of ZIKV-associated fetal and infant outcomes. The Centers for Disease Control and Prevention recommended in 2016 that women of reproductive age who do not want to become pregnant and have had or anticipate ZIKV exposure should use the most effective contraceptive method available. The aims of this population-based survey were to estimate the prevalence of contraceptive use among women at risk of unintended pregnancy in Puerto Rico and identify correlates of contraceptive use among women with ongoing or potential need for contraceptive services during the 2016 ZIKV outbreak. A cell-phone survey was conducted between July and November 2016. Eligible participants were women aged 18 to 49 years living in Puerto Rico at the time of the interview. Among 3059 respondents who met eligibility criteria and completed the interview, the overall response rate was 69.2%. Weighted population-based prevalence estimates (using raking methodology) were calculated for overall contraceptive use among women at risk of unintended pregnancy and by contraceptivemethod type and age.Women at risk of unintended pregnancy included in this analysis were assessed for their ongoing or potential need for contraceptive services. Those who used permanent contraceptive methods were excluded. Most women at risk of unintended pregnancy reported using contraception (82.8%), and use increased with age. The most frequently reported contraceptive method among women was sterilization (40.8%) and in men was condoms (17.1%). Only one-quarter (24.7%) of women had ever talked to a health care provider about ZIKV, and 31.2% reported a change in childbearing intentions because of ZIKV.Most women were a little worried about getting infected with ZIKV (74.3%) or having a baby with a birth defect (80.9%), and 4.3%reported they were already infected. The only factors significantly associated with any contraception use were being very worried (compared to not being worried) about getting infected with ZIKV (adjusted prevalence ratio, 1.19; 95% confidence interval, 1.03-1.38) or reporting already having ZIKV (adjusted prevalence ratio, 1.32; 95% confidence interval, 1.01-1.72). These findings highlight the need for regular contraceptive prevalence studies to inform programs about needs of women for regular use of contraceptives, especially during public health emergencies, such as ZIKV. The data provide ongoing contraceptive prevalence estimates that can help decision makers understand how limited contraceptive use and gaps in contraceptive access, especially during public health emergencies, impact pregnancy and pregnancy outcomes.