Zika Contraception Access Network (Z-CAN) Worked to Prevent Zika-Related Birth Defects in Puerto Rico

During the Zika outbreak in Puerto Rico, the CDC Foundation was pleased to bring together a public-private partnership aimed at preventing Zika-related birth defects for women who wanted to delay or avoid pregnancy during the outbreak.


In early 2016 during the Zika virus outbreak, Puerto Rico had the highest number of Zika virus infections in the United States, a high rate of unintended pregnancy and limited access to contraception, including long-acting reversible contraception (LARC). Contraception access in Puerto Rico was limited by many factors, such as reduced availability of the full range of reversible methods and high out-of-pocket costs. Recognizing the importance of contraception access during the Zika virus outbreak, the CDC Foundation, with technical assistance from CDC and in collaboration with a diverse group of stakeholders and private donors, established the Zika Contraception Access Network (Z-CAN) in Puerto Rico in 2016. 

Z-CAN was built with a network of partners that included private corporations, domestic philanthropic and non-profit organizations, and federal and territorial health agencies, in the United States and Puerto Rico. Private donations through the CDC Foundation supported physician and staff training and proctoring, physician reimbursement, and infrastructure costs to ensure contraception counseling and methods were available to women at no cost.

Z-CAN established a chain of custody, including a licensed pharmaceutical distributor, for receipt and distribution of contraceptive products to Z-CAN clinics to comply with federal and territorial regulations. CDC Foundation established reimbursement rates for Z-CAN visits and procedures commensurate with Medicaid reimbursement rates in the continental United States. Reimbursement covered client-centered contraceptive counseling for women and their partners, if desired, and method provision. The reimbursement fee for LARC methods was bundled to include both insertion and removal fees to ensure that physicians’ fees are covered for future removals, even after Z-CAN ended and that women could have their LARC devices removed when desired at no cost.  

Donors and partners:

The success of the Z-CAN program was driven by the close coordination between partners, including the Puerto Rico Department of Health; the Puerto Rico Primary Care Association; relevant federal agencies, particularly CDC; the physicians and staff participating in the Z-CAN program and the CDC Foundation.

In addition, the CDC Foundation secured large-scale donations and offers of contraceptive products and services from a variety of organizations, including Bayer, Allergan, Church & Dwight, Americares and Janssen Pharmaceuticals, Inc., Medicines360, Merck & Co., Inc., Pfizer, Mylan, Teva Pharmaceuticals, RB, The National Campaign to Prevent Teen and Unplanned Pregnancy, Upstream USA, and MarketVision, Culture Inspired Marketing. Funding for Z-CAN was provided by the American College of Obstetricians and Gynecologists, the Bill & Melinda Gates Foundation, Bloomberg Philanthropies, Pfizer Foundation and The William and Flora Hewlett Foundation.

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