Assessing Contraception’s Role in Slowing Zika and Other Infectious Diseases

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Living through a public health emergency always raises questions. Will a virus effect my health long term? Can I spread it to loved ones if I catch it? And for women of child-bearing age, the question is often, “Will it hurt my baby if I catch it while I’m pregnant?” COVID-19 raised many of these questions just this past year. Before COVID, however, the 2016-2017 Zika outbreak created a similar scare. 

In February 2016, the World Health Organization declared the Zika outbreak in the Pacific Islands and the Americas a Public Health Emergency of International Concerns. Research had already uncovered a relationship between Zika infection during pregnancy and birth defects such as microcephaly and other brain problems. The outbreak suddenly put the public health spotlight on women’s reproductive health. 

The U.S. government launched the Zika Virus Disease Contingency Response Plan to provide family planning services. The plan aimed to prevent unintended pregnancies and Zika-related birth outcomes in the U.S.-affiliated Pacific Islands (USAPI). USAPI includes American Samoa, the Commonwealth of the Northern Mariana Islands, and Guam. The plan also covered three independent countries associated with the U.S.: the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau. 

Between January and May of 2017, the Centers for Disease Control and Prevention conducted a rapid assessment of reproductive health data and discussed the availability of contraception with family planning groups across the USAPI. These efforts paid off and laid the groundwork for steps to take during future public health emergencies that may affect pregnancy outcomes.

Karna LLC contributed to a recent research publication called the “Assessment of Contraceptive Needs and Improving Access in the U.S.-affiliated Pacific Islands in the Context of Zika.” The article looked at the findings of the CDC assessments and the strategies they put in place to reduce pregnancies during the outbreak. The article was published in the Journal of Women’s Health last year. 

Rapid Assessment Findings

According to the publication, USAPI family planning providers did not collect data in a uniform manner nor did they report the reproductive health indicators routinely, limiting the study’s ability to compare across jurisdictions. Also, United Nation’s data was only available for married women ages 15 to 49. However, highlights of the findings showed that: 

  • Only 1 in 3 (approximately 33 percent of) married women in the Northern Mariana Islands and Palau used modern methods of contraception*
  • Less than half (approximately 44 percent) of women in Guam used modern contraceptives (the highest rate in the USAPI)
  • Another 22.1 percent of women in the Northern Mariana Islands did not use any contraceptive method but wanted to prevent or delay pregnancy (i.e., they had unmet needs for family planning)
  • The same was true for 22.9 percent of women in Palau, 17.2 percent in the Marshall Islands, 16.8 percent in Guam
  • Data for American Samoa and Micronesia were not available
  • Condoms, oral contraceptive pills, injectables, and female and male sterilization were available in all USAPI jurisdictions
  • America Samoa and the Northern Mariana Islands were the only jurisdictions to have “the full range of contraceptive methods,” including forms of IUDs
  • Injectables were the most common method used among all jurisdictions, except Guam, where the patch was the most common method used


After understanding the use and availability of contraceptive methods, the CDC sought to identify the barriers USAPI women faced in finding and using contraceptive methods. The researchers identified informants through a network of federal, regional, and territorial family planning partners. After questioning informants, the researchers found that: 

  • Most informants reported a limited number of contraception provisions sites and limited same-day access
  • Several noted limited access to transportation for family planning appointments
  • All reported a limited number of healthcare providers trained in client-centered contraceptive counseling
  • Most reported cultural norms limited the use of the full range of reversible contraceptive methods, especially among unmarried women and adolescents
  • More than half cited myths and misperceptions about contraceptive methods, had limited awareness of the full range of reversible contraceptive methods, leading to a high number either using no method or the moderate to least effective methods of contraception
  • Just under half was not aware that the Zika virus was a public health concern or the role contraception could play in preventing Zika-related adverse pregnancies 

Strategies for Tackling Barriers

Next, researchers questioned the informants on possible approaches to minimize barriers and improve access to contraception across USAPI jurisdictions. The informants suggested: 

  • Increasing the capacity of local clinics, dispensaries, and community health centers to provide contraception services and same-day access through the use of health assistants
  • Providing refresher courses for providers trained in the full range of contraceptive methods and more in-depth training for providers in rural areas
  • Implementing cross-jurisdictional training for increasing access to contraception during the Zika response
  • Adapting previously successful marketing campaigns for family planning services from other jurisdictions
  • Increasing communication between clinics, ministries/departments of health, and community outreach groups through mobile clinics
  • Training providers on long-acting reversible contraception (LARC) insertion and removal

In June 2016, the government team conducted a 3-day training for 21 participants, including program managers, coordinators, physicians, family planning nurse practitioners, nurses, and medical assistants. They discussed strategies to improve access to contraception and the jurisdictional level and how contraception can be used as a way to reduce adverse pregnancy and birth outcomes during the Zika epidemic. 

The authors of the assessment concluded that prioritizing access to contraception and educating women in an emergency response may help prevent adverse birth outcomes during a public health crisis. 

Here at Karna, our subject matter experts are knowledgeable of a wide array of public health concerns like Zika and other infectious diseases, and we have decades of experience in emergency response and preparedness. Both the Zika outbreak of 2016 and the recent COVID-19 pandemic highlight the need for identifying key populations affected by outbreaks, assessing ways to improve outreach efforts, and responding swiftly and effectively through improved statistical analysis, health communications, and technical assistance. Contact us, to learn more about our expertise in these areas. 

Read relevant articles:

Ebola, Zika, and Managing Foreign Audit Resolutions

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