Few women in Zika-threatened states use highly effective birth control methods

A minority of women and girls living in states where there is a risk the Zika virus could spread use highly effective birth control methods, a new study published Tuesday reports. And in some states, nearly a quarter of girls and a third of women of childbearing age don’t use any birth control at all, the data suggest.

The report, from scientists at the Centers for Disease Control and Prevention, said states could remove barriers that impede access to what’s known as long-acting reversible contraception — intrauterine devices and contraceptive implants — as a means of increasing use of these highly effective forms of birth control.

That, in turn, would lower the risk of babies being born in the US with devastating birth defects because their mothers were infected with the Zika virus during pregnancy.

In essence, the authors are suggesting that planning of pregnancies is critical when there’s a risk a would-be mother might contract Zika. But in the US, nearly half of pregnancies — 45 percent — are unintended.

“Zika provides a context where preventing unintended pregnancy and planning pregnancies becomes even more critical,” Dr. Denise Jamieson, co-lead of the CDC’s Zika pregnancy and birth defects team, told STAT.  

“I think Zika really highlights the importance of providing the full range of contraceptive methods and making access to those methods for women and their partners who want them … readily available.”

Jamieson was one of the authors of the report, published in the CDC journal Morbidity and Mortality Weekly Report.

The main goal of the US Zika response is to prevent pregnant women from contracting the virus. That’s because while for most people Zika infection is virtually a non-event, infection of a fetus in the womb can trigger life-altering damage. The virus can move into the central nervous system of a developing fetus, destroying parts of its brain.

The CDC has been advising women who are pregnant not to travel to places where the virus is spreading. It also advises couples trying to conceive not to do so for a number of weeks after infection or possible infection. That’s eight weeks for women who have been infected and men who might have been infected but had no symptoms. Men who had Zika symptoms are advised not to try to father a child for six months. 

Inherent in that guidance is the understanding that women and couples should use effective birth control methods to prevent conception at times that are unsafe because of Zika exposures.

“Contraception to prevent unintended pregnancies should actually be considered a medical countermeasure for Zika,” said Jamieson.

But data from four surveillance systems that monitor contraceptive usage shows it is far from ideal, a notion backed up by the high rate of unintended pregnancies in the US.

One of the systems found that only between 5.5 percent and 19 percent women at risk for an unintended pregnancy used long-active reversible contraception — but between 12.3 percent and 34.3 percent used no contraception at all.

A system that monitors contraception usage among sexually active high school students found that between 7.3 percent and 23 percent reported using no contraception during their most recent sexual encounter, while between 1.7 percent and 8.4 percent used long-acting reversible contraception.

The CDC scientists said states could encourage greater use of highly effective birth control by implementing strategies that remove barriers such as limited reimbursements for health care providers and lack of training for providers on these options, and states could also increase access to services geared to adolescents. 

This story has been updated with comments from Dr. Denise Jamieson.