Puerto Rican OB-GYNs Offer Free Birth Control To Fight Zika

Aug 6, 2016
Originally published on August 9, 2016 3:16 pm

In Puerto Rico, the local association of obstetricians and gynecologists has launched a new attack on Zika. Because the Zika virus primarily is a problem for pregnant women, 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 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 preventive 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.

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RAY SUAREZ, HOST:

As Dr. Frieden said, the Zika outbreak in Puerto Rico is exploding. The island is reporting more than a thousand new cases of Zika each week, and that's particularly troubling for pregnant women since Zika can cause birth defects. In an effort to strengthen prevention measures, a group of Puerto Rican obstetricians and gynecologists are making contraception free and available to any woman who wants it to cut down on pregnancies during this outbreak. NPR's Jason Beaubien reports from San Juan.

JASON BEAUBIEN, BYLINE: In a way, this free contraception plan seems very straightforward. Zika, primarily, is a threat to pregnant women, so do what's possible to reduce the number of pregnancies, at least until this outbreak subsides. The driving force behind this initiative is Dr. Nabal Bracero, the head of the local chapter of the American Congress of OB-GYNs.

NABAL BRACERO: 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 and on a same-day availability.

BEAUBIEN: Dr. Bracero says Zika is the dominant medical issue in Puerto Rico right now. The island has had nearly 9,000 confirmed cases. Nine hundred of those are pregnant women. And there's great fear among both expectant parents and their doctors about whether those fetuses will suffer potentially devastating birth defects, including neurological delays and underdeveloped heads. Right now transmission of Zika, according to officials from the CDC, is probably at or near its peak with well over a thousand new cases being reported each week. Bracero says, historically, access to contraception and use of birth control in Puerto Rico have been quite low.

BRACERO: We have 65 percent unplanned pregnancies compared to 50 percent in the States.

BEAUBIEN: Under Obamacare, many Puerto Ricans have access to contraception, but this new initiative offers birth control for free to any woman who wants it. It launched last month, and Bracero says the contraceptives are now available at OB-GYNs' offices all across the island.

And a key part of it 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, long-lasting implants and IUDs in addition to pills or condoms. He says the goal is...

BRACERO: Trying to empower women who do not want to conceive because they just don't want to or because they are afraid of conceiving with a Zika threat that there is a capacity to have access to better and improve methods of contraception.

BEAUBIEN: Dr. Ednise Roman, an OB-GYN in San Juan says Zika has changed her practice dramatically. She says Zika is one of the first things women who are trying to get pregnant want to talk about. And Dr. Roman says increasing access to free birth control here especially in the midst of this outbreak is a really good idea.

EDNISE ROMAN: I don't know. Here in Puerto Rico, contraception - I don't know why it's difficult in terms of you can get condoms everywhere. But people don't want to buy them, they want to have it for free...

BEAUBIEN: She says all she can offer her patients right now around Zika are preventative measures. There's no treatment, no vaccine, no magic bullet to keep from getting it. She encourages women who are pregnant or want to get pregnant to use insect repellent and avoid mosquitoes. But she says also delaying pregnancy is a precaution that should be available right now to all Puerto Rican women. Jason Beaubien, NPR News, San Juan. Transcript provided by NPR, Copyright NPR.