Meeting Summary: State and Local Implementation Strategies for Increasing Access to Contraception During Zika Preparedness and Response — United States, September 2016

Charlan D. Kroelinger, PhD; Lisa Romero, DrPH; Eva Lathrop, MD; Shanna Cox, MSPH; Isabel Morgan, MSPH; Meghan T. Frey, MA, MPH; Lee Warner, PhD; Kathryn M. Curtis, PhD; Karen Pazol, PhD; Wanda D. Barfield, MD; Dana Meaney-Delman, MD; Denise J. Jamieson, MD


Morbidity and Mortality Weekly Report. 2017;66(44):1230-1235. 

In This Article


Among the 12 state-level responses to the assessment, the majority indicated that their health departments are implementing strategy-specific approaches for facilitating partnerships among insurers and device manufacturers (eight states); removing logistic and administrative barriers for contraceptive services and supplies (nine); training health care providers (10); supporting youth-friendly services (11); and engaging smaller or rural facilities (nine). Fewer reported that their states are implementing strategy-specific approaches for reimbursing providers for the full range of contraceptive services (seven) or assessing client satisfaction and increasing consumer awareness (four).

In the context of Zika preparedness, reducing gaps in contraception access might help reduce the number of unintended pregnancies affected by Zika virus infection. States emphasized the importance of partnerships among state and federal health agencies, payers, device manufacturers, and clinics during an emergency response. Attendees also emphasized the importance of overcoming payment barriers to reimburse providers for the full range of services. Currently, many states bundle payment for contraception under one global fee, particularly for immediate postpartum LARC, limiting reimbursement for the full cost of a device and specific insertion procedures.[4] State policies that allow reimbursement for comprehensive client-centered counseling services are always important, but particularly during an emergency response,[5] as such policies are implemented in part to prevent coercion of clients to choose any method, including LARC, by supporting informed, autonomous client decisions based on women's individual needs and preferences.[6] §§§ During an emergency response, it is also especially important to have straightforward and replicable campaigns to increase access to contraception to prevent unintended pregnancy. These are needed to support consumer-focused understanding by presenting the full range of reversible contraceptive methods, while describing the low maintenance and acknowledging the potential for side effects with LARC,¶¶¶ to increase awareness of contraceptive method options among all women of reproductive age, including adolescents. CDC works to develop evidence-based, clinical guidance during emergencies. During facilitated discussion, states requested detailed CDC response plans for increasing access to contraception to prevent unintended pregnancy, a primary strategy to reduce Zika-related adverse pregnancy and birth outcomes.

Participants emphasized that provider champions can increase both provision of LARC and training of clinical fellows and residents in current insertion and removal techniques. As service providers in the health care system, provider champions are well positioned to educate Medicaid agencies about the benefits of immediate postpartum LARC,[7] take the lead in disseminating these practices to smaller and rural facilities, and serve as potential trainers and mentors to other providers. Participants discussed developing statewide provider networks to disseminate information and identify service providers who require additional training, and targeting training initiatives using evidence-based contraceptive guidance[8]–.[10] Similar assessments have identified "contraceptive deserts," defined as U.S. counties with fewer than one clinic for every 1,000 women in need of publicly funded contraception, further highlighting the need for contraceptive service availability.****

The findings in this report are subject to at least three limitations. First, information on contraceptive access was obtained from a relatively small number of persons from invited states; analysis and subsequent approaches developed from information gathered might not be generalizable to all jurisdictions. Second, data collected from participants were self-reported, and therefore, do not necessarily represent official state policies or all activities occurring in a state. Finally, approaches to increasing contraception access developed by participating states have not been evaluated by other states to ensure applicability in all settings. Some approaches implemented by participating states might not be appropriate or successful in other jurisdictions.

For women who choose to delay or avoid pregnancy during the Zika virus outbreak, access to the full range of reversible contraceptive methods in all health care systems increases their options to prevent unintended pregnancies. States are encouraged to include strategies to increase access to contraceptive services as a primary strategy in Zika preparedness plans, to prevent adverse pregnancy and birth outcomes associated with Zika virus infection in pregnancy.