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Limited reproductive care access in Fla., Texas could undercut Zika response efforts

Limited access to reproductive health care services in Florida and Texas could derail the states' efforts to address the Zika virus, which is expected to affect both states this summer, Kaiser Health News reports (Luthra, Kaiser Health News, 6/14).

Background on Zika virus

The Zika virus is a mosquito-borne disease that has spread across Latin America over the past year. Researchers recently learned that Zika can also be transmitted through sexual activity. The virus is not easily diagnosed, and it does not have a cure or vaccine. It is linked to the birth defect microcephaly, a condition in which an infant is born with an abnormally small head and brain. The condition is fatal for some infants, while others experience permanent disabilities.

Officials in Brazil and Honduras have issued guidance recommending that women avoid pregnancy. El Salvador's recommendation is that women not get pregnant until 2018. However, many countries in Latin America restrict access to contraception and often ban abortion. In addition, women have been advised to protect themselves against mosquitos, but insect repellant can be unaffordable for low-income women.

WHO has declared the outbreak and its link to microcephaly a public health emergency of international concern. Separately, the United Nations High Commissioner for Human Rights issued a statement directing nations affected by the Zika virus to remove bans on access to sexual and reproductive health care services (Women's Health Policy Report, 6/10).

U.S. response efforts

The White House has called for $1.9 billion to combat the virus. Amid congressional delays on the funding request, a senior administration official in April said the administration would transfer more than $500 million in funding allocated to combating the Ebola virus to Zika response efforts.

Congressional lawmakers currently are working to merge the House (HR 5243) and Senate (SA 3900) funding proposals, both of which fall short of the full $1.9 billion and include antiabortion-rights language.

In May, CDC announced that it will allocate more than $85 million to U.S. states and territories to combat the Zika virus (Women's Health Policy Report, 6/9). Separately, CMS in June announced that states may use Medicaid funding to cover preventive measures, including contraception and family planning services, to combat the virus' spread (Women's Health Policy Report, 6/2).

Fla., Texas response efforts fail to address risks for pregnant women

Health officials in both Florida and Texas are working on Zika prevention plans that focus on mosquito control. However, while the states have launched some campaigns designed to increase awareness of the virus, neither state legislature has allocated any specific funding for those efforts. Neither the Florida nor Texas legislature is scheduled to convene again until after the mosquito season has ended.

In addition, according to advocates, the response efforts in both states fail to account for how the virus endangers pregnant women. KHN reports that the states have not addressed barriers that hinder contraceptive access for low-income women or block care for women who do become pregnant.

Mara Gambineri, a spokesperson for the Florida health department, said state officials are sending several updates on the virus, featuring information on confirmed cases and mosquito control strategies, to interested media and community outlets every week. State health officials also have posted billboards, delivered informational fliers to residents in at-risk areas and distributed infographics on the virus to health care providers. Separately, Shelisha Coleman, a spokesperson for the state's Agency for Health Care Administration, said the state's Medicaid program is being encouraged to cover the cost of mosquito repellent.

Texas officials also launched a media campaign in English and Spanish that shares prevention information via advertisements, local radio spots and social media. According to Carrie Williams, a spokesperson for the Texas Department of State Health Services, officials are relying on local governments and health agencies to aid in prevention efforts. In addition, Bryan Black, a spokesperson for Texas' health and human services commission, said state officials are still assessing the use of Medicaid funds for Zika prevention efforts.

Reproductive health care access in Texas, Fla.

According to KHN, lawmakers' efforts in Florida and Texas to defund health care providers that offer abortion care have curtailed reproductive health care access.

In addition, Florida and Texas both opted not to expand Medicaid under the Affordable Care Act (PL 111-148), which means many women fall into a "coverage gap." Women in the coverage gap have incomes that are too high to qualify for Medicaid and too low to qualify for federal subsidies designed to help them purchase coverage through the state's insurance marketplace. Lacking coverage, these women might be unable to afford the cost of family planning services or prenatal care and face obstacles to accessing health providers who can aid their prevention efforts, KHN reports.

Linda Sutherland, executive director of Healthy Start Coalition of Orange County, said uninsured people in Florida can access health care at a community health center or clinic operated by the state health department. However, Sutherland said there likely are not enough affordable reproductive health care facilities to meet patient demand if there is an influx of concerned women seeking contraception following a Zika transmission in the state.

Moreover, according to KHN, state clinics facing budget cuts are smaller and less likely to be able to provide the full range of prenatal care. Christine Curry, an assistant professor of obstetrics and gynecology at the University of Miami Miller Medical School, said that as a result, "it is a daily occurrence that someone who has lived in this state her entire pregnancy presents for delivery having not interfaced with the public health system."

Curry noted that such health care services are particularly important in the face of the Zika virus, stating, "These are huge opportunities for preventive care."

Separately, Melissa McChesney, an outreach coordinator at the Center for Public Policy Priorities in Texas, said the state has facilitated Medicaid coverage for pregnant women. However, she noted that while most pregnant women have had at least one medical visit before giving birth, many do not access care in a timely fashion. According to McChesney, about 40 percent of pregnant women will not see a physician in the first trimester, likely because they cannot afford care or because they are unfamiliar with the health care system.

Black noted that improving women's access to prompt prenatal care is "a top priority in Texas," particularly given the Zika virus.

According to KHN, community health centers in Florida and Texas are working to educate women about the virus. However, Jose Camacho -- executive director and general counsel for the Texas Association of Community Health Centers -- noted that patients seeking care at such centers tend to be low-income and likely face difficulties outfitting their residences to combat mosquitoes. "We're extremely concerned that health centers, because of the housing and conditions around the housing that our patients live in, are going to start seeing quite a few of the Zika patients," he said.

Camacho added that while the centers are trying to inform women about how they can protect themselves against mosquitoes, many patients face challenges in trying to arrange transportation to a center and often have to wait several weeks for an appointment.

He noted that providers should instead try to reach women at their homes, which is difficult to arrange given the lack of funding and manpower. Most states rely on CDC's English and Spanish informational flyers, Camacho said, but he noted that patients might speak other languages.

Camacho said, "Are the proper things being funded that help at the local level? I'd have to say no ... And the communities our patients reside in are usually the last ones to get the attention" (Kaiser Health News, 6/14).