WASHINGTON, DC (July 12, 2017)—Before the first locally transmitted case of Zika was reported in the continental United States last summer, stakeholders from several Southern states were already working to strengthen family planning care to address this threat. The Editor’s Choice study in the latest issue of the journal Women’s Health Issues, “Facilitating State-Wide Collaboration around Family Planning Care in the Context of Zika,” describes the process by which the U.S. Office of Population Affairs (OPA) convened representatives from seven states and offered resources to address this issue, and how states then increased Zika screenings and provision of patient-centered family planning services incorporating guidance on Zika risks.
Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.
Study author Christine Dehlendorf, of the Program in Woman-Centered Contraception at the University of California, San Francisco, and her colleagues describe a two-day meeting OPA convened in June 2016 with representatives from seven states from the Southern part of the U.S., as well as from federal agencies and national organizations that address family planning. (The Aedes aegypti mosquito, which transmits the Zika virus, is found throughout the Southern portion of the country; the states represented at the meeting were California, Florida, Georgia, Louisiana, Mississippi, South Carolina, and Texas.) The meeting began with an overview of core competencies for clinicians and staff of providers offering family planning services in the context of Zika, including knowing how to screen for and educate clients about Zika and help clients to consider how potential for Zika infection may affect their pregnancy plans. Dehlendorf and her colleagues emphasize “the importance of maintaining a patient-centered approach to family planning services that prioritizes patient autonomy, even in the context of an emergency response.”
Meeting attendees also received information about relevant resources from OPA and other federal agencies, including a “Zika toolkit” to help providers educate their nonpregnant clients about the risk of Zika infection and offers of training and technical assistance programs to build capacity around counseling and provision of all contraceptive methods. Meeting discussions focused on development of state-specific plans to integrate Zika-related care into existing programs. At this initial meeting, Dehlendorf and her colleagues note, all of the states in attendance reported that contraception was not part of their states’ Zika response plans and routine screening of nonpregnant clients for possible infection was not promoted.
An August 2016 meeting allowed the seven states from the June 2016 meeting, plus Arizona, to discuss ways they had integrated family planning into their Zika responses. The study summarizes individual states’ activities and lessons, from Florida’s distribution of Zika prevention toolkits (containing condoms) in areas with local transmission to South Carolina’s work to expand access to postpartum long-acting reversible contraception (LARC). Dehlendorf and her co-authors report substantial progress across all attending states since the first meeting: “Family planning had been added to the state emergency response plans in several states, and more than one-half of the states reported that providers were now routinely screening nonpregnant clients of reproductive age for possible Zika exposure.” They also highlight several challenges that states faced, including the evolving nature of information on the Zika virus; a need for stronger communication networks between multiple state and federal agencies; and limited funding for family planning activities.
The study authors provide links to several resources and recommend specific actions state agencies and organizations can take to expand access to quality contraceptive care in the context of Zika: including family planning in state Zika plans; ensuring all clients of reproductive age are screened for potential Zika exposure at each visit and counseled about reducing risks; working to ensure clinics can offer access to a broad range of contraceptives (including LARC), ideally on a same-day basis; and removing financial barriers to providing contraceptive services. They write: “As these states and others continue to work to integrate family planning into their response to the Zika virus, it will be critically important to consider how to support these efforts financially, both through local and federal funding.”
“Given that local transmission of Zika has now been reported in Texas as well as Florida, this study can serve as a timely resource for clinicians and state leaders,” said Amita Vyas, Editor-in-Chief of Women’s Health Issues.
The study, “Facilitating State-Wide Collaboration around Family Planning Care in the Context of Zika,” was published today in the July/August issue of Women’s Health Issues.