In Puerto Rico the local association of obstetricians and gynecologists has launched a new attack on Zika. Because Zika primarily is a problem for pregnant women, the doctors are trying to reduce the number of pregnant women by offering free contraception across the island to any woman who wants it.
"We have had ... historical barriers to contraception in Puerto Rico for a long long time," says Dr. Nabal Bracero, the driving force behind the initiative and the head of the local chapter of the American Congress of Obstetricians and Gynecologists.
Working with the Centers for Disease Control and Prevention and the Puerto Rico Department of Health, Bracero's group is distributing modern contraceptives to doctors' offices across the island.
"If the patient decides that she wants to practice contraception, the device or the method is going to be in the office of the physician on a same-day availability," Dr. Bracero says.
Puerto Rico is being hard hit by Zika right now. The island has had more than 8,700 confirmed cases. The CDC predicts that between 20 to 25 percent of the island's estimated 3.5 million population will be infected with Zika before the end of the year. More than 900 of the already confirmed cases are pregnant women. Dr. Bracero says there's great fear among both expectant parents and their doctors about whether those pregnancies could be severely affected by Zika.
For women who are already pregnant, all doctors can offer is to monitor the women. There's no treatment, no cure, no magic bullet to protect the developing fetus from potentially devastating birth defects. Yet Bracero says birth control use remains quite low in Puerto Rico.
"We have a 65 percent unplanned pregnancies [rate] compared to 50 percent in the States," he says. This new free contraception program helps women to delay their pregnancies if that's what they decide to do.
A key part of the program is that doctors are not just handing out condoms and birth control pills — which Bracero calls low-efficiency, low-compliant methods. The program is offering women more expensive and long-lasting implants and intrauterine devices in addition to pills or condoms.
"We are trying to empower women who don't want to conceive, because they just don't want to or because they are afraid of conceiving with a Zika threat," he says.
Dr. Ednise Roman, an OB-GYN in San Juan, says increasing access to free birth control, especially in the midst of this outbreak, is a really good idea.
"Here in Puerto Rico, I don't know why, [but] contraception is difficult," she says. "In terms of condoms, you can get them everywhere, but people don't want to buy them. They want to have them for free."
Dr. Roman says Zika has changed her practice dramatically. It's one of the first things women who are trying to get pregnant want to talk about.
But Dr. Roman says there's little she can offer her patients right now for Zika except preventative measures. She encourages women who are pregnant or want to get pregnant to use insect repellent and avoid mosquitoes. But, she adds, delaying pregnancy is also a precaution that should be available to all Puerto Rican women in the midst of this outbreak.