CDC: Access to Better Contraception Needed for Zika Threat

Uptake of long-acting reversible contraception remains low among women in states facing the risk of active Zika virus transmission, a comprehensive review of data from several CDC surveys found.

Overall, long-acting reversible contraception (LARC) methods, including implants, were used by fewer than one-fourth of non-pregnant women, one-third of women who delivered a live birth and fewer than one-tenth of sexually active high school students, reported Sheree L. Boulet, DrPH, of the CDC, and colleagues.

Writing in an early edition of the Morbidity and Mortality Weekly Report, they found that LARC use varied among women, including postpartum women, and high school girls across states.

The range of the Aedes aegypti and Aedes albopictus mosquitoes, which can both transmit Zika virus, covers 41 states. With 45% of pregnancies unintended, a large number of women may be at risk of contracting the virus without access to effective contraception methods.

But the CDC estimates that lower income women have rates of pregnancy up to five times higher than women with higher incomes and publicly funded providers have only met 42% of contraceptive needs, though these needs vary by state.

"In the context of Zika preparedness, the full range of contraceptive methods approved by the [FDA], including LARC, should be readily available and accessible for women who want to avoid or delay pregnancy," the authors wrote. "Given low rates of LARC use, states can implement strategies to remove barriers to the access and availability of LARC, including high device costs, limited provider reimbursement [and] provider lack of knowledge and misperceptions about LARC."

CDC researchers examined data on contraceptive use among adult women and high school girls from four state-based surveillance systems, specifically states at risk of active Zika virus transmission. They also examined contraceptive methods, classifying them as highly effective (<1% of users experience pregnancy), moderately effective (5-10% of users), less effective (>10% of users), and no contraception.

In certain states at risk for active Zika virus transmission, highly effective methods, such as LARC and contraceptive implants, ranged from 5.5% to 18.9% among adult women, 6.9% to 30.5% among postpartum women, and <2% to 8.4% among high school girls.

"The Zika virus outbreak is a stark reminder that birth control is essential preventive medicine, and is one of our most effective weapons in our war on Zika," said Thomas Gellhaus, MD, president, American College of Obstetricians and Gynecologists in a statement. "Women must have urgent access to the full spectrum of reproductive health services to avoid the potentially tragic consequences of Zika exposure."

ACOG recently released a committee opinion recommending that LARC be offered to women immediately after giving birth or soon thereafter.

Among postpartum women, both LARC and moderately effective contraception use (hormone injections, the pill, contraceptive patches and vaginal rings) was lower among older women, and white and Hispanic women were more likely to use less effective contraception (condoms, diaphragm, cervical cap, withdrawal and fertility-based awareness methods) than black women.

The authors noted that LARC use doubled in recent years, but it remains below contraceptive pills and condoms, and "considerable barriers to access and contraceptive method ability remain."

Not surprisingly, rates of less effective contraception use ranged from over a third to almost 60% of high school girls.

While state rates varied, no contraception use was reported in 12.3% to 34.3% of adult women, 3.5% to 15.3% of women who recently had a live birth, and 7.3% to 22.8% of high school girls.

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CDC: Access to Better Contraception Needed for Zika Threat