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Stewart A, Romero L, Kortsmit K, Hurst S, Powell R, Lathrop E, Whiteman MK, Zapata LB. Long-acting reversible contraception use and unmet desire among patients after the Zika Contraception Access Network Program in Puerto Rico. Contraception 2024; 135:110441. [PMID: 38552819 PMCID: PMC11264186 DOI: 10.1016/j.contraception.2024.110441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES To describe unmet desire for long-acting reversible contraception (LARC) after the Zika Contraception Access Network (Z-CAN) in Puerto Rico during the 2016-2017 Zika outbreak. STUDY DESIGN Z-CAN patients completed surveys about contraception experiences over a 3-year period. RESULTS Of 1809 respondents, 3% never used LARC but reported wanting it since their initial visit. As reasons for not getting LARC, nearly 50% indicated a provider-related reason and 25% reported cost. CONCLUSIONS Few Z-CAN patients who never used LARC had unmet desire. Provider training in contraception guidelines and strategies to address costs can expand access to the full range of reversible contraception. IMPLICATIONS Three years after a short-term program provided reversible contraception in Puerto Rico, few respondents had never used but wanted a long-acting reversible contraception method. Nearly half reported provider-related reasons for not receiving long-acting reversible contraception, and 25% reported cost. Provider awareness of contraceptive guidance and method availability can support client-centered care.
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Affiliation(s)
- Andrea Stewart
- Division of Reproductive Health, CDC, Atlanta, GA, United States; Epidemic Intelligence Service, CDC, Atlanta, GA, United States.
| | - Lisa Romero
- Division of Reproductive Health, CDC, Atlanta, GA, United States
| | | | - Stacey Hurst
- Division of Reproductive Health, CDC, Atlanta, GA, United States
| | - Rachel Powell
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eva Lathrop
- Population Services International, Washington, DC, United States
| | - Maura K Whiteman
- Division of Reproductive Health, CDC, Atlanta, GA, United States
| | - Lauren B Zapata
- Division of Reproductive Health, CDC, Atlanta, GA, United States
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Romero L, Acosta-Pérez E, Bednar H, Hurst S, Zapata LB, Torres SV, Powell R, Lathrop E. Perceptions of the Zika Virus, Contraceptive Access, and Motivation to Participate in the Zika Contraception Access Network Program: Qualitative Analysis of Focusgroup Discussions with Puerto Rican Women. PUERTO RICO HEALTH SCIENCES JOURNAL 2024; 43:46-53. [PMID: 38512761 PMCID: PMC11002974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVE During the 2016-2017 Zika virus outbreak in Puerto Rico, the Zika Contraception Access Network (Z-CAN) provided client-centered contraceptive counseling and access to the full range of reversible contraceptive methods at no cost to prevent unintended pregnancies and thereby to reduce Zika-related birth outcomes. METHODS To understand how Puerto Rican women's perceptions of the Zika virus affected contraceptive decisions and assess how they heard about the Z-CAN program and what influenced their participation, or lack thereof, 24 focus-group discussions were conducted among women of reproductive age who did and did not participate in Z-CAN. RESULTS Women who participated in the discussions often had heard about Z-CAN from their physician or friends; non-participants had heard about Z-CAN from Facebook or friends. Women expressed satisfaction on finding a Z-CAN clinic and valued the same-day provision of contraceptives. When a preferred contraceptive method or a first appointment was not readily available, women reconsidered accessing the program. Women's perceptions and trust of reproductive healthcare providers, their engagement in social networks, and their ability to choose a contraceptive method that best meets their needs can influence participation in contraception-access programs. CONCLUSION Focus groups can be used to understand women's knowledge of the Zika virus, barriers and facilitators to contraception access, and motivations for participation in the Z-CAN program.
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Affiliation(s)
- Lisa Romero
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333
| | - Edna Acosta-Pérez
- Third Mission Institute, Albizu University and Medical Sciences Campus, University of Puerto Rico, PO Box 10663, San Juan, PR 00922
| | - Hailey Bednar
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333
| | - Stacey Hurst
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333
| | - Lauren B. Zapata
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333
| | - Samaris Vega Torres
- Third Mission Institute, Albizu University and Medical Sciences Campus, University of Puerto Rico, PO Box 10663, San Juan, PR 00922
| | - Rachel Powell
- National Foundation for the Centers for Disease Control and Prevention, 600 Peachtree St. NE, #1000, Atlanta, GA 30308
| | - Eva Lathrop
- Emory University School of Medicine, Department of Gynecology and Obstetrics, 69 Jesse Hill Jr. Dr., Atlanta, GA 30303
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Acosta-Pérez E, Lathrop E, Vega S, Zapata LB, Mendoza Z, Huertas-Pagán X, Hurst S, Powell R, Romero L. Provider Perceptions of Facilitators of and Barriers to Implementation of the Zika Contraception Access Network: A Qualitative Evaluation. PUERTO RICO HEALTH SCIENCES JOURNAL 2023; 42:233-240. [PMID: 37709681 PMCID: PMC10513734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVE From May 2016 through September 2017, the Zika Contraception Access Network (Z-CAN) program increased access to contraception during the Zika virus outbreak in Puerto Rico by providing no-cost client-centered contraceptive counseling and (same-day) access to the full range of US Food and Drug Administration-approved reversible contraceptives to women desirous of not becoming pregnant. The purpose of this study was to identify areas for programmatic improvement and enhance the sustainability of services from the perspectives of participating Z-CAN physicians and other staff. METHODS From April through July 2017, 49 in-depth key-informant interviews were conducted with Z-CAN physicians and clinic staff. Twenty-five clinics participating in the Z-CAN program were selected through a cluster randomization process. A semi-structured interview guide was developed to explore the participants' perceptions of the Z-CAN program and examine facilitators of and barriers to said implementation. A thematic analysis of the emerging topics was conducted. RESULTS Our analysis encountered 4 common overarching themes: facilitators of the Z-CAN program; barriers to Z-CAN implementation; the perceived impact of Z-CAN on providers and communities; and the sustainability of contraception access after the Z-CAN program ended. The key findings were that provider training, mentor support, and communication campaigns facilitated program implementation and that delays in the acquisition and distribution of contraceptives were obstacles. CONCLUSION Lessons learned from the implementation of Z-CAN from the perspective of physicians and other staff can be used to work towards sustainable contraceptive services in Puerto Rico and inform other contraception-access programs' design and implementation strategies.
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Affiliation(s)
- Edna Acosta-Pérez
- Third Mission Institute, Albizu University, 151 Calle Tanca, San Juan, PR 00901, and the University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - Eva Lathrop
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA
| | - Samaris Vega
- Third Mission Institute, Albizu University, 151 Calle Tanca, San Juan, PR 00901, and the University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | | | | | - Xavier Huertas-Pagán
- Third Mission Institute, Albizu University, 151 Calle Tanca, San Juan, PR 00901, and the University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - Stacey Hurst
- US Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Lisa Romero
- US Centers for Disease Control and Prevention, Atlanta, GA
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Rezaei F, Amiri-Farahani L, Haghani S, Pezaro S, Behmanesh F. The impact of the COVID-19 pandemic on contraceptive methods, abortion, and unintended pregnancy: a cross-sectional study. BMC Womens Health 2023; 23:357. [PMID: 37403093 DOI: 10.1186/s12905-023-02512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND AND AIM By creating an international emergency, the COVID-19 pandemic may have led to compromised reproductive health care, including family planning services, and thus increased unintended pregnancies and unsafe abortions. This study was conducted to compare methods of contraception, abortion, and unintended pregnancies in those served by the health centers of Babol city in Iran, both before and during the COVID-19 pandemic. METHODS A cross-sectional study was conducted including 425 participants registered to the health centers of Babol city, Mazandaran province, Iran. Using a multi-stage method, 6 urban health centers and 10 rural centers were selected for inclusion. Proportional allocation method was used for sampling those who met the inclusion criteria. A questionnaire was used to collect data in relation to individual characteristics and reproductive behaviors via 6 questions focused upon methods and preparation of contraception, number and type of abortions, and number and causes of unintended pregnancy from July to November 2021. The data were analyzed using SPSS software version 26. Significance level was considered to be p < 0.05 in all tests. RESULTS Most participants aged between 20 and 29 years old had a diploma level of education, were housewives and lived in the city. Prior to the pandemic, 32.0% used modern contraceptive methods and 31.6% used these during the pandemic. No change in the combination of contraceptive methods used was observed between these two periods. Approximately two-thirds used the withdrawal method in both periods. The majority of participants in both periods purchased their contraceptives from a pharmacy. Unintended pregnancy increased from 20.4% prior to the pandemic to 25.4% during the pandemic. Abortions increased from 19.1% prior to the pandemic to 20.9% during the pandemic, although these findings were not found to be statistically significant. Contraceptive methods had a statistically significant relationship with age, education, spouse's education, spouse's occupation, and place of residence. The number of unintended pregnancies had a significant relationship with age, the educational level of both participants and their spouses and socio-economic status, and the number of abortions had a statistically significant relationship with the age and education level of the spouse (p > 0.05). CONCLUSION Despite there being no change in contraceptive methods compared to the pre-pandemic period, an increase in the number of unintended pregnancies, abortions and illegal abortions was observed. This may be indicative of an unmet need for family planning services during the COVID-19 pandemic.
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Affiliation(s)
- Fatemeh Rezaei
- MSc in Midwifery, Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Shima Haghani
- Department of Biostatistics, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sally Pezaro
- PhD in Midwifery, The Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
- The University of Notre Dame, Fremantle, Australia
| | - Fereshteh Behmanesh
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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August EM, Powell R, Morris E, Romero L, Zapata LB, Lathrop E. Impact of a Health Communication Campaign on Uptake of Contraceptive Services during the 2016-2017 Zika Virus Outbreak in Puerto Rico. HEALTH COMMUNICATION 2023; 38:252-259. [PMID: 34182847 PMCID: PMC8712614 DOI: 10.1080/10410236.2021.1945198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Zika Contraception Access Network (Z-CAN) was established during the 2016-2017 Zika virus outbreak in Puerto Rico as a short-term emergency response program providing client-centered contraceptive counseling and same-day access to the full range of reversible contraceptive methods at no cost to women wishing to delay pregnancy. An evidence-based communication campaign, Ante La Duda, Pregunta (ALDP), was launched to encourage utilization of Z-CAN services. We assessed the effectiveness of campaign tactics in increasing awareness of Z-CAN among women in Puerto Rico. Data on campaign exposure and awareness were obtained through a self-administered online survey approximately two weeks after an initial Z-CAN visit, while the number of searches for participating clinics were obtained from monitoring the campaign website. Findings demonstrated that the most common ways survey respondents learned about Z-CAN were through friends or family (38.3%), social media (23.9%), a clinical encounter (12.7%), and website (11.7%). Nearly two-thirds (61.1%) of respondents had heard of the ALDP campaign. Over the campaign's duration, there were 27,273 searches for Z-CAN clinics. Findings suggest that evidence-based communication campaigns may increase awareness of needed public health services during emergencies. Word of mouth, social media, and digital engagement may be appropriate communication tactics for emergency response mobilization.
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Affiliation(s)
- Euna M. August
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention
| | | | - Elana Morris
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention
| | - Lisa Romero
- Division of Reproductive Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion
| | - Lauren B. Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion
| | - Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University School of Medicine
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Goodreau SM, Pollock ED, Wang L, Li J, Aslam MV, Katz DA, Hamilton DT, Rosenberg ES. Declines in Pregnancies among U.S. Adolescents from 2007 to 2017: Behavioral Contributors to the Trend. J Pediatr Adolesc Gynecol 2022; 35:676-684. [PMID: 35830926 PMCID: PMC9701145 DOI: 10.1016/j.jpag.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/15/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVES Adolescent pregnancies and births in the United States have undergone dramatic declines in recent decades. We aimed to estimate the contribution of changes in 3 proximal behaviors to these declines among 14- to 18-year-olds for 2007-2017: 1) delays in age at first sexual intercourse, 2) declines in number of sexual partners, and 3) changes in contraceptive use, particularly uptake of long-acting reversible contraception (LARC). DESIGN We adapted an existing iterative dynamic population model and parameterized it using 6 waves of the Centers for Disease Control and Prevention's Youth Risk Behavior Survey. We compared pregnancies from observed behavioral trends with counterfactual scenarios that assumed constant behaviors over the decade. We calculated outcomes by cause, year, and age. RESULTS We found that changes in these behaviors could explain pregnancy reductions of 496,200, 78,500, and 40,700 over the decade, respectively, with total medical and societal cost savings of $9.71 billion, $1.54 billion, and $796 million. LARC adoption, particularly among 18-year-olds, could explain much of the improvement from contraception use. The 3 factors together did not fully explain observed birth declines; adding a 50% decline in sex acts per partner did. CONCLUSIONS Delays in first sexual intercourse contributed the most to declining births over this decade, although all behaviors considered had major effects. Differences from earlier models could result from differences in years and ages covered. Evidence-based teen pregnancy prevention programs, including comprehensive sex education, youth-friendly reproductive health services, and parental and community support, can continue to address these drivers and reduce teen pregnancy.
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Affiliation(s)
- S M Goodreau
- Department of Anthropology, University of Washington, Seattle, Washington; Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington.
| | - E D Pollock
- Department of Anthropology, University of Washington, Seattle, Washington; Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington
| | - L Wang
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - J Li
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M V Aslam
- Program and Performance Improvement Office, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - D A Katz
- Department of Global Health, University of Washington, Seattle, Washington
| | - D T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington
| | - E S Rosenberg
- New York State Department of Health, Corning Tower, Empire State Plaza, Albany, New York; Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York
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Chang KT, Snead MC, Serrano Rodriguez RA, Bish C, Shapiro-Mendoza CK, Ellington SR. Condom use among women of reproductive age (18-49 years) in Puerto Rico during the 2016 Zika virus outbreak: secondary analysis of data from a cross-sectional, population-based, cell-phone survey. BMJ Open 2022; 12:e065592. [PMID: 35835533 PMCID: PMC9289039 DOI: 10.1136/bmjopen-2022-065592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Zika virus (ZIKV) can be sexually transmitted, and ZIKV infection during pregnancy can cause birth defects. Contraception is a medical countermeasure to reduce unintended pregnancy and ZIKV-associated birth defects. We estimated the prevalence of condom use and associated factors among women at risk for unintended pregnancy in Puerto Rico during the 2016 ZIKV outbreak. DESIGN Secondary analysis of a cross-sectional, population-based, cell-phone survey. SETTING AND PARTICIPANTS Women, 18-49 years, living in Puerto Rico during July-November 2016. We limited our analytical sample (n=1840) to women at risk for unintended pregnancy, defined as those who were sexually active with a man in the last 3 months and did not report menopause, hysterectomy, current pregnancy or desiring pregnancy. OUTCOME MEASURES We estimated the weighted prevalence of any condom use among women at risk for unintended pregnancy. We calculated crude and adjusted prevalence ratios (aPRs) to examine the association between condom use and ZIKV-related factors, stratified by use of more effective versus less effective or no contraception. RESULTS Overall, 32.7% (95% CI: 30.2% to 35.1%) of women reported any condom use in the last 3 months. Among women using more effective contraception, condom use was higher for women who received ZIKV counselling (aPR: 1.61, 95% CI: 1.15 to 2.25) and those worried about having a child with a ZIKV-associated birth defect (aPR: 1.47, 95% CI: 1.03 to 2.10). Among women using less effective or no contraception, condom use was associated with being worried (aPR: 1.20, 95% CI: 1.01 to 1.43) compared with those not worried about ZIKV infection or with a previous known infection. CONCLUSIONS During the 2016 ZIKV outbreak, one in three women at risk for unintended pregnancy reported any condom use. Counselling to promote consistent and correct condom use may address concerns regarding ZIKV among women of reproductive age, which may differ by use of effective contraception.
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Affiliation(s)
- Karen T Chang
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Margaret Christine Snead
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Connie Bish
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carrie K Shapiro-Mendoza
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sascha R Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Pliska ES, Barfield WD, Fraser MR. Connecting the Dots: Public Health, Clinical, and Community Connections to Improve Contraception Access. Am J Public Health 2022; 112:S508-S510. [PMID: 35767787 PMCID: PMC10490314 DOI: 10.2105/ajph.2022.306924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Ellen S Pliska
- Ellen S. Pliska and Michael R. Fraser are with the Association of State and Territorial Health Officials, Arlington, VA. Wanda D. Barfield is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Ellen S. Pliska is also a guest editor for this supplement issue. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Wanda D Barfield
- Ellen S. Pliska and Michael R. Fraser are with the Association of State and Territorial Health Officials, Arlington, VA. Wanda D. Barfield is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Ellen S. Pliska is also a guest editor for this supplement issue. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Michael R Fraser
- Ellen S. Pliska and Michael R. Fraser are with the Association of State and Territorial Health Officials, Arlington, VA. Wanda D. Barfield is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Ellen S. Pliska is also a guest editor for this supplement issue. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
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Kaya Senol D, Polat F. Effects of the pandemic on women's reproductive health protective attitudes: a Turkish sample. Reprod Health 2022; 19:106. [PMID: 35501810 PMCID: PMC9059458 DOI: 10.1186/s12978-022-01412-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This descriptive, cross-sectional study was performed to examine the effects of the COVID-19 pandemic on women's reproductive health protective attitudes. METHODS The study sample included 306 women and data were collected through a web-based, online questionnaire. The data were collected using the Personal Information Form, Determination of Married Women's Reproductive Health Protective Attitudes Scale. Descriptive statistics, independent samples t-test, ANOVA test were used to assess the data. RESULTS The mean scores for Determination of Married Women's Reproductive Health Protective Attitudes Scale significantly differed in terms of education, employment status, income, health insurance and perceived health status (p < 0.05). A total of 69.3% of women had their first pregnancy at the agerange of 21-34 years, 17.6% of the women had four or more pregnancies, 55.6% of the women gave birth 1-3 times, 13.4% of the women gave birth at home and 57.8% of the women did not use modern family planning methods. A total of 23.2% of women experienced a problem with their reproductive organs during the pandemic, 70.6% of them did not present to a health center for their problems and 74.5% of these women did not present to a health center to avoid the risk of COVID-19 transmission. A total of 40.2% of women used the methods they already know at home to relieve their problems and 16.0% of the women used them edications previously prescribed by their doctors. CONCLUSION The pandemic negatively affects there productive health of women. In the COVID-19 pandemic, health policies should be planned in accordance with the continuation of reproductive health and sexual health services.
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Affiliation(s)
- Derya Kaya Senol
- Department of Midwifery, Faculty of Health Sciences, Osmaniye Korkut Ata University, Osmaniye, Turkey
| | - Filiz Polat
- Department of Midwifery, Faculty of Health Sciences, Osmaniye Korkut Ata University, Osmaniye, Turkey
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Romero L, Corrada-Rivera RM, Huertas-Pagan X, Aquino-Serrano FV, Morales-Boscio AM, Sanchez-Cesareo M, Acosta-Perez E, Mendoza Z, Lathrop E. Access to Contraceptive Services in Puerto Rico: An Analysis of Policy and Practice Change Strategies, 2015-2018. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E506-E517. [PMID: 33729201 PMCID: PMC8435054 DOI: 10.1097/phh.0000000000001342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT During the 2016-2017 Zika virus outbreak in Puerto Rico, preventing unintended pregnancy was a primary strategy to reduce Zika-related adverse birth outcomes. The Zika Contraception Access Network (Z-CAN) was a short-term emergency response intervention that used contraception to prevent unintended pregnancy among women who chose to delay or avoid pregnancy. OBJECTIVE This analysis reports on the identified policy and practice change strategies to increase access to or provision of contraceptive services in Puerto Rico between 2015 and 2018. METHODS A policy review was conducted to document federal- and territorial-level programs with contraceptive coverage and payment policies in Puerto Rico and to identify policy and practice change. Semistructured interviews with key stakeholders in Puerto Rico were also conducted to understand perceptions of policy and practice change efforts following the Zika virus outbreak, including emergency response, local, and policy efforts to improve contraception access in Puerto Rico. RESULTS Publicly available information on federal and territorial programs with policies that facilitate access, delivery, and utilization of contraceptive coverage and family planning services in Puerto Rico to support contraceptive access was documented; however, interview results indicated that the implementation of the policies was often limited by barriers and that policy and practice changes as the result of the Zika virus outbreak were short-term. CONCLUSION Consideration of long-term policy and practice changes related to contraceptive access is warranted. Similar analyses can be used to identify policies, practices, and perceptions in other settings in which the goal is to increase access to contraception or reduce unintended pregnancy.
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Affiliation(s)
- Lisa Romero
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Romero); Graduate School of Public Health, Medical Science Campus, University of Puerto Rico, San Juan, Puerto Rico (Drs Sanchez-Cesareo and Acosta-Perez); Third Mission Institute, Carlos Albizu University, San Juan, Puerto Rico (Drs Corrada-Rivera, Aquino-Serrano, Sanchez-Cesareo, and Acosta-Perez, Mr Huertas-Pagan, and Ms Morales-Boscio); Department of Noninfectious Disease, National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Mendoza); and Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia (Dr Lathrop)
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11
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Powell R, Rosenthal J, August EM, Frey M, Garcia L, Sidibe T, Mendoza Z, Romero L, Lathrop E. Ante La Duda, Pregunta: A Social Marketing Campaign to Improve Contraceptive Access during a Public Health Emergency. HEALTH COMMUNICATION 2022; 37:177-184. [PMID: 33016136 PMCID: PMC8019432 DOI: 10.1080/10410236.2020.1828534] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
During the 2016-2017 Zika virus outbreak, preventing unintended pregnancy was recognized as a primary strategy to reduce adverse Zika-related pregnancy and birth outcomes. To increase awareness and uptake of contraceptive services provided through the Zika Contraception Access Network (Z-CAN) in Puerto Rico, a multi-strategy campaign called Ante La Duda, Pregunta (ALDP) was developed. The principal aim was to increase awareness of Z-CAN services, which included same-day access to the full range of reversible contraceptives at no cost to women living in Puerto Rico who choose to delay or avoid pregnancy during the 2016-2017 Zika virus outbreak. Using diverse strategies, ALDP increased exposure to and engagement with the campaign in order to raise awareness of Z-CAN services in Puerto Rico. The ALDP social marketing campaign played an important role in the overall Z-CAN effort. Of all the strategies utilized, Facebook appears to have reached the most people. While the importance of a social marketing campaign communicating to raise awareness and create demand has long been known, through the ALDP campaign efforts, it was shown that an effective campaign, built on formative research, can be developed and implemented rapidly in an emergency response situation without compromising on content, quality, or reach.
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Affiliation(s)
| | - Jackie Rosenthal
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | - Euna M. August
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Meghan Frey
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | | | | | | | - Lisa Romero
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | - Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University School of Medicine
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Perez M, Galang RR, Snead MC, Strid P, Bish CL, Tong VT, Barfield WD, Shapiro-Mendoza CK, Zotti ME, Ellington S. Emergency Preparedness and Response: Highlights from the Division of Reproductive Health, 2011-2021. J Womens Health (Larchmt) 2021; 30:1673-1680. [PMID: 34919476 PMCID: PMC10964214 DOI: 10.1089/jwh.2021.0553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This report provides historical context and rationale for coordinated, systematic, and evidence-based public health emergency preparedness and response (EPR) activities to address the needs of women of reproductive age. Needs of pregnant and postpartum women, and infants-before, during, and after public health emergencies-are highlighted. Four focus areas and related activities are described: (1) public health science; (2) clinical guidance; (3) partnerships, communication, and outreach; and (4) workforce development. Finally, the report summarizes major activities of the Division of Reproductive Health's EPR Team at the Centers for Disease Control and Prevention.
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Affiliation(s)
- Mirna Perez
- Division of Reproductive Health, Atlanta, Georgia, USA
| | | | | | | | | | - Van T. Tong
- Division of Birth Defects and Infant Disorders, Atlanta, Georgia, USA
| | | | | | - Marianne E. Zotti
- Association of Maternal and Child Health Programs (AMCHP) Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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13
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Li R, Ellington SR, Galang RR, Grosse SD, Mendoza Z, Hurst S, Vale Y, Lathrop E, Romero L. Economic evaluation of Zika Contraception Access Network in Puerto Rico during the 2016-17 Zika virus outbreak. Contraception 2021; 107:68-73. [PMID: 34748752 DOI: 10.1016/j.contraception.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/04/2021] [Accepted: 10/23/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE During the 2016-2017 Zika virus (ZIKV) outbreak, the prevention of unintended pregnancies was identified as a primary strategy to prevent birth defects. This study estimated the cost-effectiveness of the Zika Contraception Access Network (Z-CAN), an emergency response intervention that provided women in Puerto Rico with access to the full range of reversible contraception at no cost and compared results with a pre-implementation hypothetical cost-effectiveness analysis (CEA). STUDY DESIGN We evaluated costs and outcomes of Z-CAN from a health sector perspective compared to no intervention using a decision tree model. Number of people served, contraception methods mix, and costs under Z-CAN were from actual program data and other input parameters were from the literature. Health outcome measures included the number of Zika-associated microcephaly (ZAM) cases and unintended pregnancies. The economic benefits of the Z-CAN intervention were ZIKV-associated direct costs avoided, including lifetime medical and supportive costs associated with ZAM cases, costs of monitoring ZIKV-exposed pregnancies and infants born from Zika-virus infected mothers, and the costs of unintended pregnancies prevented during the outbreak as a result of increased contraception use through the Z-CAN intervention. RESULTS The Z-CAN intervention cost a total of $26.1 million, including costs for the full range of reversible contraceptive methods, contraception related services, and programmatic activities. The program is estimated to have prevented 85% of cases of estimated ZAM cases and unintended pregnancies in the absence of Z-CAN. The intervention cost was projected to have been more than offset by $79.9 million in ZIKV-associated costs avoided, 96% of which were lifetime ZAM-associated costs, as well as $137.0 million from avoided unintended pregnancies, with total net savings in one year of $216.9 million. The results were consistent with the previous CEA study. CONCLUSION Z-CAN was likely cost-saving in the context of a public health emergency response setting.
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Affiliation(s)
- Rui Li
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Sascha R Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Romeo R Galang
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Zipatly Mendoza
- National Foundation for the Centers for Disease Control and Prevention, 600 Peachtree Street NE, Suite 1000, Atlanta, GA, 30308
| | - Stacey Hurst
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yari Vale
- University of Puerto Rico, Department of Gynecology and Obstetrics
| | - Eva Lathrop
- Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA
| | - Lisa Romero
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
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Scoping Review on the Impact of Outbreaks on Sexual and Reproductive Health Services: Proposed Frameworks for Pre-, Intra-, and Postoutbreak Situations. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9989478. [PMID: 34541003 PMCID: PMC8443356 DOI: 10.1155/2021/9989478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
Introduction Recent experiences from global outbreaks have highlighted the severe disruptions in sexual and reproductive health services that expose women and girls to preventable health risks. Yet, to date, there is no review studying the possible impact of outbreaks on sexual and reproductive health (SRH). Methodology. Studies reporting outbreaks impacting sexual and reproductive health and pregnancy outcomes were identified using MEDLINE, Embase, and ISI-WoS. Reported impacts were reviewed at systems, community, and legislative levels. Results The initial run listed 4423 studies; the 37 studies that met all inclusion criteria were mainly from Latin America and Africa. Studies on outbreaks of diseases like Zika and Ebola have documented declines in facility-based deliveries, contraceptive use, and antenatal and institutional care due to burdened healthcare system. Service usage was also impacted by a lack of trust in the healthcare system and system shocks, including workforce capacity and availability. At the community level, poverty and lack of awareness were critical contributors to poor access to SRH services. Assessing the target population's knowledge, attitude, beliefs, and behavior and using health literacy principles for communication were fundamental for designing service delivery. Online resources for SRH services were an acceptable medium of information among young adults. In outbreak situations, SRH and pregnancy outcomes were improved by implementing laboratory surveillance, free-of-cost contraceptive services, improved screening through professional training, and quality of care. In addition, mobile health clinics were reported to be effective in remote areas. Knowledge Contribution. In outbreaks, the interventions are categorized into preoutbreak, during, and postoutbreak periods. The proposed steps can help to improve and do course correction in emergencies. Though conducted before the COVID-19 crisis, the authors believe that lessons can be drawn from the paper to understand and mitigate the impact of the pandemic on sexual and reproductive health services.
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15
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Steinert JI, Alacevich C, Steele B, Hennegan J, Yakubovich AR. Response strategies for promoting gender equality in public health emergencies: a rapid scoping review. BMJ Open 2021; 11:e048292. [PMID: 34385251 PMCID: PMC8361708 DOI: 10.1136/bmjopen-2020-048292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic threatens to widen existing gender inequities worldwide. A growing body of literature assesses the harmful consequences of public health emergencies (PHEs) for women and girls; however, evidence of what works to alleviate such impacts is limited. To inform viable mitigation strategies, we reviewed the evidence on gender-based interventions implemented in PHEs, including disease outbreaks and natural disasters. METHODS We conducted a rapid scoping review to identify eligible studies by systematically searching the databases MEDLINE, Global Health and Web of Science with the latest search update on 28 May 2021. We used the Sustainable Development Goals as a guiding framework to identify eligible outcomes of gender (in)equality. RESULTS Out of 13 920 records, 16 studies met our eligibility criteria. These included experimental (3), cohort (2), case-control (3) and cross-sectional (9) studies conducted in the context of natural disasters (earthquakes, droughts and storms) or epidemics (Zika, Ebola and COVID-19). Six studies were implemented in Asia, seven in North/Central America and three in Africa. Interventions included economic empowerment programmes (5); health promotion, largely focused on reproductive health (10); and a postearthquake resettlement programme (1). Included studies assessed gender-based outcomes in the domains of sexual and reproductive health, equal opportunities, access to economic resources, violence and health. There was a dearth of evidence for other outcome domains relevant to gender equity such as harmful practices, sanitation and hygiene practices, workplace discrimination and unpaid work. Economic empowerment interventions showed promise in promoting women's and girls' economic and educational opportunities as well as their sexual and reproductive health during PHEs. However, some programme beneficiaries may be at risk of experiencing unintended harms such as an increase in domestic violence. Focused reproductive health promotion may also be an effective strategy for supporting women's sexual and reproductive health, although additional experimental evidence is needed. CONCLUSIONS This study identified critical evidence gaps to guide future research on approaches to alleviating gender inequities during PHEs. We further highlight that interventions to promote gender equity in PHEs should take into account possible harmful side effects such as increased gender-based violence. REVIEW REGISTRATION DOI 10.17605/OSF.IO/8HKFD.
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Affiliation(s)
- Janina I Steinert
- TUM Schoool of Governance, Technical University of Munich, München, Germany
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Caterina Alacevich
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Bridget Steele
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexa R Yakubovich
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
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16
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Freed B, Hillman S, Shantikumar S, Bick D, Dale J, Gauly J. The impact of disasters on contraception in OECD member countries: a scoping review. EUR J CONTRACEP REPR 2021; 26:429-438. [PMID: 34126834 DOI: 10.1080/13625187.2021.1934440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Review evidence is lacking about how contraception is affected by severe social disruption, such as that caused by the COVID-19 pandemic. The purpose of this scoping review was to explore the impact of natural and man-made disasters on contraception in OECD member countries. METHODS Manual searches and systematic searches in six electronic databases were conducted with no language restrictions. All articles were screened by at least two researchers. The data were analysed thematically. RESULTS 108 articles were included. Most focussed on the Zika virus outbreak (n = 50) and the COVID-19 pandemic (n = 28). Four key themes were identified: importance of contraception during disasters, impact of disasters on contraceptive behaviour, barriers to contraception during disasters and ways of improving use of contraception during disasters. Despite efforts to increase access to contraception including by transforming ways of delivery, barriers to use meant that unmet need persisted. CONCLUSIONS To prevent adverse health outcomes and reduce health costs as a result of failure to have access to contraception during disasters, there is a need to intensify efforts to remove barriers to use. This should include increasing access and information on methods of contraception and their side effects (e.g., menstrual suppression) and making contraception freely available.
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Affiliation(s)
- Benjamin Freed
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Sarah Hillman
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Debra Bick
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Julia Gauly
- Warwick Medical School, University of Warwick, Coventry, UK
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17
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Romero L, Mendoza ZV, Croft L, Bhakta R, Sidibe T, Bracero N, Malave C, Suarez A, Sanchez L, Cordero D, Lathrop E, Monroe J. The Role of Public-Private Partnerships to Increase Access to Contraception in an Emergency Response Setting: The Zika Contraception Access Network Program. J Womens Health (Larchmt) 2021; 29:1372-1380. [PMID: 33196331 DOI: 10.1089/jwh.2020.8813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Zika Contraception Access Network (Z-CAN) program was a short-term emergency response intervention that used contraception to prevent unintended pregnancies to reduce Zika-related adverse birth outcomes during the 2016-2017 Zika virus outbreak in Puerto Rico. The Centers for Disease Control and Prevention (CDC) reported that a collaborative and coordinated response was needed from governments and private-sector partners to improve access to contraception during the Zika outbreak in Puerto Rico. In response, the National Foundation for the CDC, with technical assistance from CDC, established the Z-CAN program, a network of 153-trained physicians, that provided client-centered contraceptive counseling and same-day access to the full range of the Food and Drug Administration-approved reversible contraceptive methods at no cost for women who chose to prevent pregnancy. From May 2016 to September 2017, 29,221 women received Z-CAN services. Through Z-CAN, public-private partnerships provided a broad range of opportunities for partners to come together to leverage technical expertise, experience, and resources to remove barriers to access contraception that neither the public nor the private sector could address alone. Public-private partnerships focused on three areas: (1) the coordination of efforts among federal and territorial agencies to align strategies, leverage resources, and address sustainability; (2) the mobilization of private partnerships to secure resources from private corporations, domestic philanthropic organizations, and nonprofit organizations for contraceptive methods, physician reimbursement, training and proctoring resources, infrastructure costs, and a health communications campaign; and (3) the engagement of key stakeholders to understand context and need, and to identify strategies to reach the target population. Public-private partnerships provided expertise, support, and awareness, and could be used to help guide programs to other settings for which access to contraception could improve health outcomes.
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Affiliation(s)
- Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zipatly V Mendoza
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Croft
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Reema Bhakta
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Turquoise Sidibe
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nabal Bracero
- Puerto Rico Obstetrics and Gynecology, San Juan, Puerto Rico
| | - Claritsa Malave
- Health Resources and Services Administration, Office of Regional Operations, Region II, San Juan, Puerto Rico
| | - Alicia Suarez
- Puerto Rico Primary Care Association, San Juan, Puerto Rico
| | - Linette Sanchez
- Puerto Rico Obstetrics and Gynecology, San Juan, Puerto Rico
| | | | - Eva Lathrop
- Puerto Rico Primary Care Association, San Juan, Puerto Rico.,Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia, USA
| | - Judith Monroe
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Athni TS, Shocket MS, Couper LI, Nova N, Caldwell IR, Caldwell JM, Childress JN, Childs ML, De Leo GA, Kirk DG, MacDonald AJ, Olivarius K, Pickel DG, Roberts SO, Winokur OC, Young HS, Cheng J, Grant EA, Kurzner PM, Kyaw S, Lin BJ, López RC, Massihpour DS, Olsen EC, Roache M, Ruiz A, Schultz EA, Shafat M, Spencer RL, Bharti N, Mordecai EA. The influence of vector-borne disease on human history: socio-ecological mechanisms. Ecol Lett 2021; 24:829-846. [PMID: 33501751 PMCID: PMC7969392 DOI: 10.1111/ele.13675] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 01/14/2023]
Abstract
Vector-borne diseases (VBDs) are embedded within complex socio-ecological systems. While research has traditionally focused on the direct effects of VBDs on human morbidity and mortality, it is increasingly clear that their impacts are much more pervasive. VBDs are dynamically linked to feedbacks between environmental conditions, vector ecology, disease burden, and societal responses that drive transmission. As a result, VBDs have had profound influence on human history. Mechanisms include: (1) killing or debilitating large numbers of people, with demographic and population-level impacts; (2) differentially affecting populations based on prior history of disease exposure, immunity, and resistance; (3) being weaponised to promote or justify hierarchies of power, colonialism, racism, classism and sexism; (4) catalysing changes in ideas, institutions, infrastructure, technologies and social practices in efforts to control disease outbreaks; and (5) changing human relationships with the land and environment. We use historical and archaeological evidence interpreted through an ecological lens to illustrate how VBDs have shaped society and culture, focusing on case studies from four pertinent VBDs: plague, malaria, yellow fever and trypanosomiasis. By comparing across diseases, time periods and geographies, we highlight the enormous scope and variety of mechanisms by which VBDs have influenced human history.
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Affiliation(s)
- Tejas S. Athni
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Marta S. Shocket
- Department of Biology, Stanford University, Stanford, CA, USA
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, CA, USA
| | - Lisa I. Couper
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Nicole Nova
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Iain R. Caldwell
- ARC Centre of Excellence for Coral Reef Studies, James Cook University, Townsville, Queensland, Australia
| | - Jamie M. Caldwell
- Department of Biology, Stanford University, Stanford, CA, USA
- Department of Biology, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Jasmine N. Childress
- Department of Ecology, Evolution, and Marine Biology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Marissa L. Childs
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, CA, USA
| | - Giulio A. De Leo
- Hopkins Marine Station of Stanford University, Pacific Grove, CA, USA
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA
| | - Devin G. Kirk
- Department of Biology, Stanford University, Stanford, CA, USA
- Department of Zoology, University of British Columbia, Vancouver, BC, Canada
| | - Andrew J. MacDonald
- Bren School of Environmental Science and Management, University of California, Santa Barbara, CA, USA
- Earth Research Institute, University of California, Santa Barbara, CA, USA
| | | | - David G. Pickel
- Department of Classics, Stanford University, Stanford, CA, USA
| | | | - Olivia C. Winokur
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Hillary S. Young
- Department of Ecology, Evolution, and Marine Biology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Julian Cheng
- Department of Biology, Stanford University, Stanford, CA, USA
| | | | | | - Saw Kyaw
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Bradford J. Lin
- Department of Biology, Stanford University, Stanford, CA, USA
| | | | | | - Erica C. Olsen
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Maggie Roache
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Angie Ruiz
- Department of Biology, Stanford University, Stanford, CA, USA
| | | | - Muskan Shafat
- Department of Biology, Stanford University, Stanford, CA, USA
| | | | - Nita Bharti
- Department of Biology, Center for Infectious Disease Dynamics, Penn State University, University Park, PA, USA
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19
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Curtis KM, Zapata LB, Pagano HP, Nguyen A, Reeves J, Whiteman MK. Removing Unnecessary Medical Barriers to Contraception: Celebrating a Decade of the U.S. Medical Eligibility Criteria for Contraceptive Use. J Womens Health (Larchmt) 2021; 30:293-300. [PMID: 33370207 PMCID: PMC11283819 DOI: 10.1089/jwh.2020.8910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 2010, the Centers for Disease Control and Prevention (CDC) released the U.S. Medical Eligibility Criteria for Contraceptive Use, providing recommendations for health care providers on safe use of contraception for people with certain characteristics or medical conditions. Adapted from World Health Organization guidance, the goal of the recommendations is to remove unnecessary medical barriers to contraception. Over the past decade, CDC has updated recommendations based on new evidence, collaborated with national partners to disseminate and implement the guidelines, and conducted provider surveys to assess changes in attitudes and practices around contraception safety and provision. CDC remains committed to supporting evidence-based guidelines for safe use of contraception, as the basis for improving access to contraception and high-quality family planning services, reducing unintended pregnancy, and improving reproductive health in the United States.
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Affiliation(s)
- Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - H Pamela Pagano
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Antoinette Nguyen
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Reeves
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maura K Whiteman
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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20
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Final Program Data and Factors Associated With Long-Acting Reversible Contraception Removal: The Zika Contraception Access Network. Obstet Gynecol 2020; 135:1095-1103. [PMID: 32282596 DOI: 10.1097/aog.0000000000003835] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe characteristics of the full population of women who participated in the Zika Contraception Access Network program in Puerto Rico during the virus outbreak and to examine factors associated with removal of a long-acting reversible contraception (LARC) method by a Zika Contraception Access Network provider during the program's duration (May 2016-September 2017). METHODS We conducted an observational cohort study. The Zika Contraception Access Network program was designed to increase access to contraception services in Puerto Rico for women who chose to prevent pregnancy during the Zika virus outbreak as a primary strategy to reduce adverse Zika virus-related pregnancy and birth outcomes. Among program participants, an observational cohort of women served by the Zika Contraception Access Network Program, we describe their demographic and program-specific characteristics, including contraceptive method mix before and after the program. We also report on LARC removals by Zika Contraception Access Network providers during the program. We examined factors associated with LARC removal using multivariable logistic regression. RESULTS A total of 29,221 women received an initial Zika Contraception Access Network visit during the program. Ninety-six percent (27,985) of women received same-day provision of a contraceptive method and 70% (20,381) chose a LARC method. While the program was active, 719 (4%) women who chose a LARC at the initial visit had it removed. Women with a college degree or higher were more likely to have their LARC removed (adjusted prevalence ratio [aPR] 1.24); breastfeeding women (aPR 0.67) and those using a LARC method before Zika Contraception Access Network (aPR 0.55) were less likely to have their LARC removed. CONCLUSION The Zika Contraception Access Network program was designed as a short-term response for rapid implementation of contraceptive services in a complex emergency setting in Puerto Rico and served more than 29,000 women. The Zika Contraception Access Network program had high LARC uptake and a low proportion of removals by a Zika Contraception Access Network provider during the program. A removal-inclusive design, with access to removals well beyond the program period, maximizes women's reproductive autonomy to access LARC removal when desired. This model could be replicated in other settings where the goal is to increase contraception access.
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21
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Romero L, Mendoza Z, Hurst S, Zapata LB, Powell R, Vale Y, Lathrop E. Strategies and safeguards to ensure access to long-acting reversible contraception removal after the Zika Contraception Access Network ended: A prospective analysis of patient reported complaints. Contraception 2020; 102:356-360. [PMID: 32858052 DOI: 10.1016/j.contraception.2020.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The Zika Contraception Access Network (Z-CAN) was a short-term emergency response intervention that used contraception to prevent unintended pregnancy to reduce Zika-related adverse birth outcomes during the 2016 2017 Zika virus outbreak in Puerto Rico. Strategies and safeguards were developed to ensure women who chose long-acting reversible contraception (LARC) had access to no-cost removal, if desired, after Z-CAN ended. STUDY DESIGN We assessed the number of women who chose LARC at their initial Z-CAN visit who filed complaints regarding challenges with LARC removal within 30-months after the Z-CAN program ended. Complaints and program responses were categorized. RESULTS Of the 29,221 women who received Z-CAN services, 20,381 chose a LARC method at their initial visit (IUD = 12,276 and implant = 8105). Between September 2017 and February 2020, 63 patient complaints were logged, mostly due to LARC removal charges (76.2%) which were generally (71.4%) determined to be inappropriate charges. All complaints filed were resolved allowing LARC removal within an average of 28 days. CONCLUSION Safeguards to ensure prompt LARC removal when desired are critical to ensure women s reproductive autonomy. IMPLICATIONS Strategies and safeguards used by Z-CAN to ensure women have access to LARC removal might be used by other contraception programs to prevent reproductive coercion and promote reproductive autonomy to best meet the reproductive needs of women.
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Affiliation(s)
- Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, United States.
| | - Zipatly Mendoza
- National Foundation for the Centers for Disease Control and Prevention, United States
| | - Stacey Hurst
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, United States
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, United States
| | - Rachel Powell
- National Foundation for the Centers for Disease Control and Prevention, United States
| | - Yari Vale
- University of Puerto Rico, Department of Gynecology and Obstetrics, United States
| | - Eva Lathrop
- Emory University, Department of Gynecology and Obstetrics, United States
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22
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Horan H, Cheyney M, Nako E, Bovbjerg M. Maternal stress and the ZIKV epidemic in Puerto Rico. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1808189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Holly Horan
- University of Alabama, Tuscaloosa, AL, United States of America (USA)
| | - Melissa Cheyney
- Department of Anthropology, Oregon State University, Corvallis, OR, United States of America (USA)
| | - Eni Nako
- School of Medicine, Oregon Health Science University, Portland, OR, United States of America (USA)
| | - Marit Bovbjerg
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States of America (USA)
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Green C, Ntansah C, Frey MT, Krashin JW, Lathrop E, Romero L. Assessment of Contraceptive Needs and Improving Access in the U.S.-Affiliated Pacific Islands in the Context of Zika. J Womens Health (Larchmt) 2020; 29:139-147. [PMID: 32045325 DOI: 10.1089/jwh.2020.8302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Scientific evidence demonstrated a causal relationship between Zika virus infection during pregnancy and neurologic abnormalities and other congenital defects. The U.S. government's Zika Virus Disease Contingency Response Plan recognized the importance of preventing unintended pregnancy through access to high-quality family planning services as a primary strategy to reduce adverse Zika-related birth outcomes during the 2016-2017 Zika virus outbreak. The U.S.-affiliated Pacific Islands (USAPI) includes three U.S. territories: American Samoa, the Commonwealth of the Northern Mariana Islands, and Guam, and three independent countries in free association with the United States: the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. Aedes spp. mosquitoes, the primary vector that transmits Zika virus, are common across the Pacific Islands, and in 2016, laboratory-confirmed cases of Zika virus infection in USAPI were reported. CDC conducted a rapid assessment by reviewing available reproductive health data and discussing access to contraception with family planning providers and program staff in all six USAPI jurisdictions between January and May 2017. In this report, we summarize findings from the assessment; discuss strategies developed by jurisdictions to respond to identified needs; and describe a training that was convened to provide technical assistance to USAPI. Similar rapid assessments may be used to identify training and technical assistance needs in other emergency preparedness and response efforts that pose a risk to pregnant women and their infants.
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Affiliation(s)
- Caitlin Green
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | | | - Meghan T Frey
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Jamie W Krashin
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.,Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Eva Lathrop
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.,Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Pepe VLE, Albuquerque MVD, Osorio-de-Castro CGS, Pereira CCDA, Oliveira CVDS, Reis LGDC, Reis CDB, Dias HS, Miranda ES. Proposta de análise integrada de emergências em saúde pública por arboviroses: o caso do Zika vírus no Brasil. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-11042020e205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A mudança no padrão de ocorrência da microcefalia associada à infecção pelo Zika Vírus em gestantes no Brasil resultou na decretação de emergência em saúde pública de importância nacional e internacional. Esforços coordenados e multisetoriais foram demandados, mas nem sempre houve respostas efetivas ou preparação das populações afetadas. A epidemia de Zika repercutiu nas políticas públicas, incluindo a de saúde, seja na investigação científica, seja na proposição de medidas de controle, diagnóstico, prevenção e tratamento. Objetivou-se apresentar proposta de análise integrada para abordagem de futuras emergências sanitárias com foco nas arboviroses. Partindo da experiência brasileira da epidemia e literatura relacionada, articularam-se quatro dimensões: vulnerabilidades e risco; condições e impactos socioeconômicos na população; desenvolvimento e emprego de tecnologias e pesquisas; e resposta e reprogramação do sistema de saúde. Pretende-se viabilizar loci específicos de investigação, para mensuração de possíveis desfechos e geração de novas evidências sobre os efeitos da epidemia nos sistemas de saúde. O conhecimento científico e suas lacunas são considerados os principais elementos integradores dessas dimensões analíticas, de forma a contribuir com resposta mais oportuna e efetiva em futuras emergências. Além do conhecimento adquirido, faz-se necessário agregar capacidade de enfrentar futuras emergências relacionadas com as epidemias de arboviroses.
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Pepe VLE, Albuquerque MVD, Osorio-de-Castro CGS, Pereira CCDA, Oliveira CVDS, Reis LGDC, Reis CDB, Dias HS, Miranda ES. Proposal for integrated analysis of public health emergencies involving arboviruses: the case of the Zika virus in Brazil. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-11042020e205i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A mudança no padrão de ocorrência da microcefalia associada à infecção pelo Zika Vírus em gestantes no Brasil resultou na decretação de emergência em saúde pública de importância nacional e internacional. Esforços coordenados e multisetoriais foram demandados, mas nem sempre houve respostas efetivas ou preparação das populações afetadas. A epidemia de Zika repercutiu nas políticas públicas, incluindo a de saúde, seja na investigação científica, seja na proposição de medidas de controle, diagnóstico, prevenção e tratamento. Objetivou-se apresentar proposta de análise integrada para abordagem de futuras emergências sanitárias com foco nas arboviroses. Partindo da experiência brasileira da epidemia e literatura relacionada, articularam-se quatro dimensões: vulnerabilidades e risco; condições e impactos socioeconômicos na população; desenvolvimento e emprego de tecnologias e pesquisas; e resposta e reprogramação do sistema de saúde. Pretende-se viabilizar loci específicos de investigação, para mensuração de possíveis desfechos e geração de novas evidências sobre os efeitos da epidemia nos sistemas de saúde. O conhecimento científico e suas lacunas são considerados os principais elementos integradores dessas dimensões analíticas, de forma a contribuir com resposta mais oportuna e efetiva em futuras emergências. Além do conhecimento adquirido, faz-se necessário agregar capacidade de enfrentar futuras emergências relacionadas com as epidemias de arboviroses.
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Tepper NK, Zapata LB, Hurst S, Curtis KM, Lathrop E, Romero L, Acosta-Perez E, Mendoza Z, Whiteman MK. Physician and clinic staff attitudes and practices during implementation of the Zika Contraception Access Network. Contraception 2020; 102:34-38. [PMID: 32298716 PMCID: PMC10983029 DOI: 10.1016/j.contraception.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Zika Contraception Access Network (Z-CAN) provided women in Puerto Rico access to contraceptive counseling and the full range of reversible contraceptive methods, on the same day and at no cost, during the Zika virus outbreak. Because trained physicians and clinic staff were crucial to the program, we aimed to assess the implementation of and satisfaction with Z-CAN from their perspectives. STUDY DESIGN Physicians and clinic staff in the Z-CAN program participated in an online survey on program implementation (e.g., on-site and same-day contraceptive provision), program satisfaction, and knowledge consistent with program training (e.g., contraceptive initiation and safety, client-centered contraceptive counseling, intrauterine device [IUD] and implant insertion and removal). RESULTS Survey respondents included 63 physicians and 53 clinic staff members. A high proportion of physicians (>93%) reported providing IUDs, implants, pills, rings, condoms, and injections and most were very often or always able to provide same-day access to most methods. Over 90% of physicians were satisfied with the Z-CAN program, training, and ongoing support. Staff satisfaction with these program elements was similar but slightly lower. Knowledge about exams and tests needed for initiation and safety of methods varied but was generally consistent with guidelines on which physicians received training. Most physicians (>90%) reported confidence in skills on which they received training as part of the program. CONCLUSIONS From the perspectives of participating physicians and clinic staff, the program was generally implemented as intended and providers were largely satisfied with program strategies including training and on-going support. IMPLICATIONS Certain key components of the Z-CAN program, such as training, proctoring, and involvement of clinic staff were likely critical to Z-CAN's implementation and provider satisfaction. Results from this provider survey can inform implementation of similar efforts to increase access to contraception in both emergency and non-emergency settings.
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Affiliation(s)
- Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stacey Hurst
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kathryn M Curtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, United States
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Edna Acosta-Perez
- University of Puerto Rico, San Juan, Puerto Rico; Third Mission Institute, University Carlos Albizu, San Juan, Puerto Rico
| | - Zipatly Mendoza
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Maura K Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
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"Too Much to Ask, Too Much to Handle": Women's Coping in Times of Zika. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124613. [PMID: 32604943 PMCID: PMC7344537 DOI: 10.3390/ijerph17124613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/13/2022]
Abstract
Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences for pregnancies have made governments and both national and international agencies issue advice and recommendations to women. This study was designed to understand the impacts of Zika on women who were less directly affected and less vulnerable to Zika. Women were recruited from various locations in Brazil, Puerto Rico, and the United States. Data were collected through semi-structured interviews and analyzed using thematic analysis. Women perceived that public health systems placed an unfair responsibility for preventing health complications from Zika onto women who had limited ability to do so. They also stated that the measures recommended to them were invasive, while creating the perception that women were the sole determinant of whether they contracted Zika. The results indicate that women with higher levels of education understood the limitations of the information, government actions, and medical care they received, which ended up producing higher levels of anguish and worry. Gender inequality and discrimination must be recognized and rendered visible in the public health emergency response. The social effects of the epidemic affected women more than had been thought before and at deeper emotional levels.
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Ellington SR, Rodriguez RS, Goldberg H, Bertolli J, Simeone RM, Mercado AS, Pazol K, Jamieson DJ, Honein MA, Swartzendruber A, Miles T, Cordero JF, Shapiro-Mendoza CK. Assessment of contraceptive use in Puerto Rico during the 2016 Zika virus outbreak. Contraception 2020; 101:405-411. [PMID: 32194040 PMCID: PMC8530539 DOI: 10.1016/j.contraception.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objectives of this analysis were to 1) estimate prevalence of contraceptive use among women at risk for unintended pregnancy and 2) identify correlates of contraceptive use among women with ongoing or potential need for contraceptive services in Puerto Rico during the 2016 Zika virus (ZIKV) outbreak. STUDY DESIGN We conducted a cell-phone survey July-November, 2016. Women aged 18-49 years living in Puerto Rico were eligible. We completed 3059 interviews; the overall response rate was 69.2%. After weighting, the data provide population-based estimates. For this analysis, we included women at risk for unintended pregnancy, and assessed ongoing or potential need for contraceptive services in this group, excluding women using permanent contraceptive methods. RESULTS Most women reported using contraception (82.8%), and use increased with age. Female sterilization and male condoms were most frequently reported (40.8% and 17.1%, respectively). Among women with ongoing or potential need for contraceptive services, 24.7% talked to a healthcare provider about ZIKV, and 31.2% reported a change in childbearing intentions due to ZIKV. Most women were at least a little worried about getting infected with ZIKV (74.3%) or having a baby with a birth defect (80.9%). Being very worried about getting infected with ZIKV and already having Zika were significantly associated with use of any contraception (adjusted prevalence ratio: 1.19, 95% CI: 1.03-1.38 and 1.32, 95% CI: 1.01-1.72, respectively). CONCLUSIONS These findings underscore the need for regular contraceptive prevalence studies to inform programs about contraceptive needs, especially during public health emergencies. IMPLICATIONS When the 2016 Zika virus outbreak began in Puerto Rico there were no recent population-based data available on contraceptive prevalence. To fill this information gap, we conducted a population-based survey. Our findings provided baseline contraceptive prevalence estimates to support response planning and allocation of health resources.
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Affiliation(s)
- Sascha R Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States; Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States.
| | | | - Howard Goldberg
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jeanne Bertolli
- Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Regina M Simeone
- Division of Congenital and Developmental Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Karen Pazol
- Division of Congenital and Developmental Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Denise J Jamieson
- Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA, United States
| | - Margaret A Honein
- Division of Congenital and Developmental Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Andrea Swartzendruber
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Toni Miles
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Jose F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Carrie K Shapiro-Mendoza
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Program Fidelity and Patient Satisfaction among Women Served by the Zika Contraception Access Network Program in Puerto Rico. Womens Health Issues 2020; 30:268-276. [PMID: 32376188 DOI: 10.1016/j.whi.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Zika Contraception Access Network (Z-CAN) was designed to provide women in Puerto Rico who chose to delay or avoid pregnancy during the 2016-2017 Zika virus outbreak access to high-quality client-centered contraceptive counseling and the full range of reversible contractive methods on the same day and at no cost through a network of trained providers. We evaluated the implementation of Z-CAN from the patient perspective. METHODS An online survey, administered to a subset of women served by the Z-CAN program approximately 2 weeks after their initial Z-CAN visit, assessed patient satisfaction and receipt of services consistent with select program strategies: receipt of high-quality client-centered contraceptive counseling, same-day access to the contraceptive method they were most interested in after counseling, and no-cost contraception. RESULTS Of 3,503 respondents, 85.2% reported receiving high-quality client-centered contraceptive counseling. Among women interested in a contraceptive method after counseling (n = 3,470), most reported same-day access to that method (86.8%) and most reported receiving some method of contraception at no cost (87.4%). Women who reported receiving services according to Z-CAN program strategies were more likely than those who did not to be very satisfied with services. Women who received high-quality client-centered contraceptive counseling and same-day access to the method they were most interested in after counseling were also more likely to be very satisfied with the contraceptive method received. CONCLUSIONS A contraception access program can be rapidly implemented with high fidelity to program strategies in a fast-moving and complex public health emergency setting.
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Tang K, Gaoshan J, Ahonsi B, Ali M, Bonet M, Broutet N, Kara E, Kim C, Thorson A, Thwin SS. Sexual and reproductive health (SRH): a key issue in the emergency response to the coronavirus disease (COVID- 19) outbreak. Reprod Health 2020; 17:59. [PMID: 32326943 PMCID: PMC7179791 DOI: 10.1186/s12978-020-0900-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
The novel coronavirus disease (COVID-19) outbreak was first declared in China in December 2019, and WHO declared the pandemic on 11 March 2020. A fast-rising number of confirmed cases has been observed in all continents, with Europe at the epicentre of the outbreak at this moment.Sexual and reproductive health (SRH) and rights is a significant public health issue during the epidemics. The novel coronavirus (SARS-CoV-2) is new to humans, and only limited scientific evidence is available to identify the impact of the disease COVID-19 on SRH, including clinical presentation and outcomes of the infection during pregnancy, or for persons with STI/HIV-related immunosuppression. Beyond the clinical scope of SRH, we should not neglect the impacts at the health system level and disruptions or interruptions in regular provision of SRH services, such as pre- and postnatal checks, safe abortion, contraception, HIV/AIDS and sexually transmitted infections. Furthermore, other aspects merit attention such as the potential increase of gender-based violence and domestic abuse, and effects of stigma and discrimination associated with COVID-19 and their effects on SRH clients and health care providers. Therefore, there is an urgent need for the scientific community to generate sound clinical, epidemiological, and psycho-social behavioral links between COVID-19 and SRH and rights outcomes.
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Affiliation(s)
- Kun Tang
- School of Medicine, Tsinghua University, Beijing, China.
| | | | | | - Moazzam Ali
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Nathalie Broutet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Edna Kara
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Caron Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Soe Soe Thwin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
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31
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Linde-Arias AR, Roura M, Siqueira E. Solidarity, vulnerability and mistrust: how context, information and government affect the lives of women in times of Zika. BMC Infect Dis 2020; 20:263. [PMID: 32245370 PMCID: PMC7118940 DOI: 10.1186/s12879-020-04987-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/24/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The public health response to Zika outbreak has mostly focused on epidemiological surveillance, vector control, and individual level preventative measures. This qualitative study employs a social-ecological framework to examine how macro (historical, legislative, political, socio-economic factors), meso (sources of information, social support, social mobilization) and micro level factors (individual actions, behavioral changes) interacted to influence the response and behavior of women with respect to Zika in different contexts. METHODS A qualitative study was carried out. Women were recruited through the snowball sampling technique from various locations in Brazil, Puerto Rico, and the United States. They were of different nationalities and ethnicities. Data were collected through semi-structured interviews. The data transcripts were analyzed using thematic analysis. RESULTS Women in this study deemed the information provided as insufficient, which led them to actively reach out and access a variety of media sources. Social networks played a vital role in sharing information but also resulted in the spread of hoaxes or rumors. Participants in our research perceived socio-economic inequities but focused on how to remedy their microenvironments. They did not engage in major social activities. Lack of trust in governments placed women in vulnerable situations by preventing them to follow the guidance of health authorities. These impacts were also a result of the response tactics of health and government administrations in their failed attempts to ensure the well-being of their countries' populations. CONCLUSIONS Our findings call for public health interventions that go beyond individual level behavioral change campaigns, to more comprehensively address the broader meso and macro level factors that influence women' willingness and possibility to protect themselves.
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Affiliation(s)
- Ana Rosa Linde-Arias
- Mauricio Gastón Institute for Latino Community Development and Public Policy, University of Massachusetts Boston, Boston, USA.
| | - Maria Roura
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Eduardo Siqueira
- Mauricio Gastón Institute for Latino Community Development and Public Policy, University of Massachusetts Boston, Boston, USA
- School for the Environment, University of Massachusetts Boston, Boston, USA
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Schrager S, Larson M, Carlson J, Ledford K, Ehrenthal DB. Beyond Birth Control: Noncontraceptive Benefits of Hormonal Methods and Their Key Role in the General Medical Care of Women. J Womens Health (Larchmt) 2020; 29:937-943. [PMID: 32155101 DOI: 10.1089/jwh.2019.7731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Contraceptives that contain estrogen and/or progestins are used by millions of women around the world to prevent pregnancy. Owing to their unique physiological mechanism of action, many of these medications can also be used to prevent cancer and treat multiple general medical conditions that are common in women. We performed a comprehensive literature search. This article will describe the specific mechanisms of action and summarize the available data documenting how hormonal contraceptives can prevent ovarian and uterine cancer and be used to treat women with a variety of gynecological and nongynecological conditions such as endometriosis, uterine fibroids, heavy menstrual bleeding, polycystic ovary syndrome, acne, and migraines. Contraceptive methods containing estrogen and progestin can be used for a wide variety of medical issues in women.
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Affiliation(s)
- Sarina Schrager
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Magnolia Larson
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jensena Carlson
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kathryn Ledford
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Deborah B Ehrenthal
- Department of Obstetrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Gynecology and Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Fourquet J, Zavala DE, Missmer S, Bracero N, Romaguera J, Flores I. Disparities in healthcare services in women with endometriosis with public vs private health insurance. Am J Obstet Gynecol 2019; 221:623.e1-623.e11. [PMID: 31226295 DOI: 10.1016/j.ajog.2019.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The goals of health disparities research are to identify facilitators and barriers to healthcare use to help eliminate health inequalities. There are few studies on disparities in healthcare access and use trends for patients with endometriosis that may lead to differences in appropriate care based on socioeconomic status. OBJECTIVE This retrospective, cross-sectional study was conducted to compare health services use patterns and prevalence of co-morbidities of women with endometriosis with public (government-based) vs private (purchased or provided by employer) health insurance. STUDY DESIGN A total of 342 deidentified datasets (171 randomly-selected cases per study group) from women with endometriosis 14-50 years old who were members of one health insurance company that provides both public and private health insurance coverage in Puerto Rico were analyzed. Patients were defined as having at least 1 endometriosis-related medical claim (ICD-9-617.xx; International Classification of Diseases, Ninth Revision, Clinical Modification) during the 3-year study period. RESULTS Medical service (eg, hospital, laboratory, pathology, and radiology) use trends were 3 times lower in the public vs the private sector. Women in the public sector were 3.5 times less likely to have a laparoscopy, 2.7 times more likely to be prescribed opioid/narcotics, and were the only study subjects reporting emergency department use. Obstetrics and gynecology services were used >2-fold less by women in the public (29.5%) vs the private sector (70.5%) (P=.087). CONCLUSIONS We report significant differences in the use trends of endometriosis-related medical services and prescriptions, indicating differences in healthcare access based on socioeconomic parameters. Our results support the development of public health programs to promote access to healthcare for patients with endometriosis irrespective of socioeconomic status and promote health disparity research in other healthcare systems.
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Romero L, Koonin LM, Zapata LB, Hurst S, Mendoza Z, Lathrop E. Contraception as a Medical Countermeasure to Reduce Adverse Outcomes Associated With Zika Virus Infection in Puerto Rico: The Zika Contraception Access Network Program. Am J Public Health 2019; 108:S227-S230. [PMID: 30192658 DOI: 10.2105/ajph.2018.304558] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Zika Contraception Access Network established a network of 153 physicians across Puerto Rico as a short-term emergency response during the 2016-2017 Zika virus outbreak to provide client-centered contraceptive counseling and same-day contraception services at no cost for women who chose to prevent pregnancy. Between May 2016 and August 2017, 21 124 women received services. Contraception was used as a medical countermeasure to reduce adverse Zika-related reproductive outcomes during the outbreak and may be considered a key strategy in other emergencies.
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Affiliation(s)
- Lisa Romero
- Lisa Romero, Lauren Zapata, and Stacey Hurst are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Lisa Koonin is with the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Zipatly Mendoza is with the National Foundation for the Centers for Disease Control and Prevention, Atlanta. Eva Lathrop is with Emory University, Department of Gynecology and Obstetrics, Atlanta
| | - Lisa M Koonin
- Lisa Romero, Lauren Zapata, and Stacey Hurst are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Lisa Koonin is with the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Zipatly Mendoza is with the National Foundation for the Centers for Disease Control and Prevention, Atlanta. Eva Lathrop is with Emory University, Department of Gynecology and Obstetrics, Atlanta
| | - Lauren B Zapata
- Lisa Romero, Lauren Zapata, and Stacey Hurst are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Lisa Koonin is with the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Zipatly Mendoza is with the National Foundation for the Centers for Disease Control and Prevention, Atlanta. Eva Lathrop is with Emory University, Department of Gynecology and Obstetrics, Atlanta
| | - Stacey Hurst
- Lisa Romero, Lauren Zapata, and Stacey Hurst are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Lisa Koonin is with the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Zipatly Mendoza is with the National Foundation for the Centers for Disease Control and Prevention, Atlanta. Eva Lathrop is with Emory University, Department of Gynecology and Obstetrics, Atlanta
| | - Zipatly Mendoza
- Lisa Romero, Lauren Zapata, and Stacey Hurst are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Lisa Koonin is with the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Zipatly Mendoza is with the National Foundation for the Centers for Disease Control and Prevention, Atlanta. Eva Lathrop is with Emory University, Department of Gynecology and Obstetrics, Atlanta
| | - Eva Lathrop
- Lisa Romero, Lauren Zapata, and Stacey Hurst are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Lisa Koonin is with the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Zipatly Mendoza is with the National Foundation for the Centers for Disease Control and Prevention, Atlanta. Eva Lathrop is with Emory University, Department of Gynecology and Obstetrics, Atlanta
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- Lisa Romero, Lauren Zapata, and Stacey Hurst are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Lisa Koonin is with the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Zipatly Mendoza is with the National Foundation for the Centers for Disease Control and Prevention, Atlanta. Eva Lathrop is with Emory University, Department of Gynecology and Obstetrics, Atlanta
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Shaw R, Baker E, Jie C, Adamian S, Andres S, Bachelor B, Hodges F, Mittra T, Viloria AR. Zika virus knowledge, contraception use, and lessons learned from a Dominican Republic pilot study. Int J Gynaecol Obstet 2019; 147:313-318. [PMID: 31479162 DOI: 10.1002/ijgo.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/13/2019] [Accepted: 08/30/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess knowledge of the Zika virus (ZIKV), use of contraceptives, and sources of health information in rural communities in the Dominican Republic. METHODS Over 4 days in March 2017, a research team traveled to four rural communities in the Dominican Republic to provide healthcare services. Overall, 90 men and women consented to a voluntary verbal 12-question survey. RESULTS Of the participants, 55% were not certain whether ZIKV is transmitted sexually; 75% of participants were either not sure or thought ZIKV was not present in their community. Charlas (informal discussions led by community health workers) were cited as the most common source for public health information. Prevalence of contraceptive use was 26.6% hormonal and 1.1% long-acting reversible contraception (LARC); 30.0% cited no use of contraception. CONCLUSION Significant deficits in ZIKV knowledge, underutilization of LARCs, and socioeconomic factors exist that constrain the application of WHO recommendations for preventing ZIKV infection. Additional and more robust surveys are needed to assess public health education and interventions, critical for disease prevention in communities facing current and future epidemics.
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Affiliation(s)
- Rebecca Shaw
- Department of Specialty Medicine, Division of Obstetrics and Gynecology, Des Moines University, Des Moines, IA, USA
| | - Elizabeth Baker
- Department of Public Health, Des Moines University College of Health Sciences, Des Moines, IA, USA
| | - Chunfa Jie
- Office of Research, Des Moines University, Des Moines, IA, USA
| | - Shant Adamian
- Des Moines University College of Osteopathic Medicine, Des Moines, IA, USA
| | - Sarah Andres
- Des Moines University College of Osteopathic Medicine, Des Moines, IA, USA
| | - Brooke Bachelor
- Des Moines University College of Osteopathic Medicine, Des Moines, IA, USA
| | - Fiona Hodges
- Des Moines University College of Osteopathic Medicine, Des Moines, IA, USA
| | - Tricia Mittra
- Des Moines University College of Osteopathic Medicine, Des Moines, IA, USA
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August EM, Rosenthal J, Torrez R, Romero L, Berry-Bibee EN, Frey MT, Torres R, Rivera-García B, Honein MA, Jamieson DJ, Lathrop E. Community Understanding of Contraception During the Zika Virus Outbreak in Puerto Rico. Health Promot Pract 2019; 21:133-141. [DOI: 10.1177/1524839919850764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In response to the Zika virus outbreak in Puerto Rico (2015-2016), the Zika Contraception Access Network (Z-CAN) was established to provide same-day access to the full range of reversible contraception at no cost to women. Formative research was conducted to inform the development of a communication campaign about Z-CAN. Ten focus groups with women and men, aged 18 to 49 years, in Puerto Rico were conducted to collect data on contraception awareness, use, and decision making during the Zika outbreak, as well as culturally appropriate messaging and outreach strategies. Thematic analysis was conducted using the constant comparative method. Data showed that there was community awareness regarding Zika in Puerto Rico. However, it was not a motivating factor in contraception decision making; instead, economic factors were the major drivers. Most participants preferred to receive information on contraception, potential side effects, and where to access contraceptive services via Internet-based channels and health care providers. Based on these findings, the Ante La Duda, Pregunta [When in Doubt, Ask] campaign was launched to promote awareness of Z-CAN services among those who chose to prevent pregnancy during the Zika outbreak. Our results underscore the importance of conducting formative research to develop communication initiatives, while also demonstrating that it is feasible to perform these activities as part of an emergency response.
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Affiliation(s)
- Euna M. August
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Lisa Romero
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Meghan T. Frey
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Eva Lathrop
- Emory University School of Medicine, Atlanta, GA, USA
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Moço ACR, Guedes PH, Flauzino JMR, da Silva HS, Vieira JG, Castro ACH, Gomes ÉVR, Tolentino FM, Soares MMCN, Madurro JM, Brito‐Madurro AG. Electrochemical Detection of Zika Virus in Biological Samples: A Step for Diagnosis Point‐of‐care. ELECTROANAL 2019. [DOI: 10.1002/elan.201900068] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Anna C. R. Moço
- Institute of BiotechnologyFederal University of Uberlândia Uberlândia BrazilTel. +55 34 32182203
| | - Pedro H. Guedes
- Institute of BiotechnologyFederal University of Uberlândia Uberlândia BrazilTel. +55 34 32182203
| | - José M. R. Flauzino
- Institute of BiotechnologyFederal University of Uberlândia Uberlândia BrazilTel. +55 34 32182203
| | | | - Jussara G. Vieira
- Institute of BiotechnologyFederal University of Uberlândia Uberlândia BrazilTel. +55 34 32182203
| | - Ana C. H. Castro
- Institute of BiotechnologyFederal University of Uberlândia Uberlândia BrazilTel. +55 34 32182203
| | - Érica V. R. Gomes
- Adolfo Lutz InstituteRegional Laboratory in São José do Rio Preto Brazil
| | | | | | - João M. Madurro
- Institute of ChemistryFederal University of Uberlândia Uberlândia Brazil
| | - Ana G. Brito‐Madurro
- Institute of BiotechnologyFederal University of Uberlândia Uberlândia BrazilTel. +55 34 32182203
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Community Perspectives on Contraception in the Context of the Zika Virus in the U.S. Virgin Islands: Implications for Communication and Messaging. Womens Health Issues 2019; 29:245-251. [PMID: 30878263 DOI: 10.1016/j.whi.2019.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Between January and October 2016, 575 symptomatic confirmed cases of Zika virus infection were reported in the U.S. Virgin Islands (USVI). Zika virus infection during pregnancy can cause serious birth defects. Preventing unintended pregnancy among women who choose to delay or avoid pregnancy is a primary strategy to reduce these adverse outcomes. METHODS A rapid assessment, using one men's and five women's focus groups (N = 43), was conducted to inform communication efforts to increase awareness of contraception as a means for preventing unintended pregnancy in the context of a Zika outbreak in the USVI. RESULTS Findings showed that people of reproductive age were aware of the relationship between Zika virus infection during pregnancy and adverse birth outcomes. However, when discussing methods for prevention, participants did not include preventing unintended pregnancy as a strategy to reduce these adverse outcomes. When asked about family planning in the USVI, participants discussed that, for some, planning pregnancies is not common. Participants wanted communications about contraception to include available methods, side effects, costs, and safety. Optimal communication channels included social media and local spokespersons. Participants identified health care providers as a trusted information source. CONCLUSIONS Findings from this assessment informed the design of a culturally appropriate communication strategy to raise awareness of the prevention of unintended pregnancy as a primary strategy to reduce Zika-related adverse birth outcomes in the USVI.
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Arora N, Banerjee AK, Narasu ML. Zika outbreak aftermath: status, progress, concerns and new insights. Future Virol 2018. [DOI: 10.2217/fvl-2018-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Zika, a neurotrophic virus belonging to Flaviviridae family of viruses and transmitted by vector mosquitoes of Aedes species, took the world by storm during its recent outbreak. Its spread to newer territories, unprecedented pace of transmission, lack of existing therapeutic agents and vaccines and an empty drug pipeline raised an alarm. Uncertainty about full spectrum of diseases and its long-term consequences, newly discovered modes of transmission and controversies over vector status of mosquito species like Culex quinquefasciatus led to layers of complexity and presented new hurdles and challenges in Zika virus research. This review summarizes the progress and updates of efforts, concerns, financial burden and available resources in light of newly acquired knowledge in Zika virus research.
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Affiliation(s)
- Neelima Arora
- Centre for Biotechnology, Institute of Science & Technology (Autonomous), Jawaharlal Nehru Technological University-Hyderabad, Kukatpally, Hyderabad 500085, Telangana, India
| | - Amit K Banerjee
- Biology Division, CSIR-Indian Institute of Chemical Technology, Uppal Road, Tarnaka, Hyderabad 500007, Telangana, India
| | - Mangamoori L Narasu
- Centre for Biotechnology, Institute of Science & Technology (Autonomous), Jawaharlal Nehru Technological University-Hyderabad, Kukatpally, Hyderabad 500085, Telangana, India
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Linde AR, Siqueira CE. Women's lives in times of Zika: mosquito-controlled lives? CAD SAUDE PUBLICA 2018; 34:e00178917. [PMID: 29768589 DOI: 10.1590/0102-311x00178917] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/12/2018] [Indexed: 11/22/2022] Open
Abstract
Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences to pregnancies has made governments, national and international agencies issue advices and recommendations to women. There is a clear need to investigate how the Zika outbreak affects the decisions that women take concerning their lives and the life of their families, as well as how women are psychologically and emotionally dealing with the outbreak. We conducted a qualitative study to address the impact of the Zika epidemic on the family life of women living in Brazil, Puerto Rico, and the US, who were affected by it to shed light on the social repercussions of Zika. Women were recruited through the snowball sampling technique and data was collected through semi-structured interviews. We describe the effects in mental health and the coping strategies that women use to deal with the Zika epidemic. Zika is taking a heavy toll on women's emotional well-being. They are coping with feelings of fear, helplessness, and uncertainty by taking drastic precautions to avoid infection that affect all areas of their lives. Coping strategies pose obstacles in professional life, lead to social isolation, including from family and partner, and threaten the emotional and physical well-being of women. Our findings suggest that the impacts of the Zika epidemic on women may be universal and global. Zika infection is a silent and heavy burden on women's shoulders.
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Squiers L, Herrington J, Kelly B, Bann C, Becker-Dreps S, Stamm L, Johnson M, McCormack L. Zika Virus Prevention: U.S. Travelers' Knowledge, Risk Perceptions, and Behavioral Intentions-A National Survey. Am J Trop Med Hyg 2018; 98:1837-1847. [PMID: 29737272 PMCID: PMC6086162 DOI: 10.4269/ajtmh.17-0898] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Limited data exist about U.S. travelers’ knowledge, risk perceptions, and behaviors related to the Zika virus (ZIKV). Using an internet research panel, in March 2017, we surveyed 1,202 Americans in the continental United States and Puerto Rico who planned to travel to a ZIKV-affected country, state, or U.S. territory in 2017. We compared levels of knowledge and perceived risk of ZIKV, and intentions to practice ZIKV prevention behaviors across respondents from three regions: Puerto Rico, at-risk states, and other states. More than 80% of respondents correctly understood that a person could acquire ZIKV through a bite from an infected mosquito, and over 64% of respondents knew that a pregnant woman could pass the virus to her fetus. Less than half of the respondents from at-risk states and other states knew that ZIKV could be transmitted sexually, as compared with three-quarters of respondents from Puerto Rico. Compared with respondents from at-risk and other states, respondents from Puerto Rico were the most knowledgeable for almost all types of knowledge assessed. Knowledge about post-travel precautions was low across all three regions. Differences in perceived risk and intentions to practice specific prevention behaviors also varied among regions. Significant gaps exist in U.S. travelers’ knowledge about how to prevent ZIKV transmission both during and after travel. Input and collaboration from the travel industry, health care providers, and the media are needed to help educate travelers about how to prevent ZIKV infection and transmission.
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Affiliation(s)
- Linda Squiers
- Research Triangle Institute (RTI) International, Research Triangle Park, North Carolina
| | - James Herrington
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Bridget Kelly
- Research Triangle Institute (RTI) International, Research Triangle Park, North Carolina
| | - Carla Bann
- Research Triangle Institute (RTI) International, Research Triangle Park, North Carolina
| | - Sylvia Becker-Dreps
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Lola Stamm
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Mihaela Johnson
- Research Triangle Institute (RTI) International, Research Triangle Park, North Carolina
| | - Lauren McCormack
- Research Triangle Institute (RTI) International, Research Triangle Park, North Carolina
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Temmerman M, Nally C. Z-CAN: prevention of unintended pregnancy in an emergency setting. THE LANCET PUBLIC HEALTH 2018; 3:e59-e60. [DOI: 10.1016/s2468-2667(18)30005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/24/2022] Open
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