| Perspectives on Texas

With the threat of Zika looming in Texas, preventive health care for women has never been more important.

The impacts of Zika have been devastating. Carried by the Aedes aegypti mosquito, the Zika virus has been linked to microcephaly, a condition that causes babies to be born with abnormally small heads and improper brain development. Zika has also been linked to other problems in infants, including eye defects, hearing loss and impaired growth.

More than 930 people in the United States, including 287 pregnant women, have been infected with Zika. In Texas there have been 53 reported cases, including one pregnant woman.

So far, all cases in the United States have been the result of patients contracting Zika while visiting a Zika-infected area or through sexual transmission from someone who had been infected abroad. But health experts tell us that it is only a matter of time before local mosquito transmission comes to Texas. Texas has taken important steps through training and public outreach campaigns, but there is more the state can do.

Texas is at risk. The Aedes aegypti mosquito is common here, and the state is entering mosquito season. Our wet spring has created mosquito-friendly conditions, especially in vulnerable communities in South Texas, the Gulf Coast and the Lower Rio Grande Valley, as well as urban areas like Dallas County.

In the face of this threat, ensuring that all Texans have access to resources to prevent Zika infection — and to prevent birth defects — is more important than ever. Access to public health information, insect repellants and preconception and prenatal care are all vital components of a Zika prevention strategy. So is access to contraception. About half of Texas pregnancies are not planned, which means a large portion of pregnant women in the state may not know to take precautions against mosquitos and are more likely to receive late or no prenatal care. The state’s women’s health care safety net is still recovering from family planning cuts and the exclusion of some of the state’s largest providers.

Texas is launching two new programs for low-income women, which may prove essential to the state’s preventive efforts. Both Healthy Texas Women and the Family Planning Program will provide contraception in addition to health screenings and treatment for selected conditions. The Family Planning Program will also provide limited prenatal care.

Whether the new programs will have enough provider capacity to meet this challenge is an open question. The state has a lot of work to do to ensure that women will be able to access information and preventive health care.

The Texas Women’s Healthcare Coalition (TWHC) has identified a number of policies that will help the state address the threat of Zika:

• Coordinate state and federal efforts with local health departments and other public health entities. Many of the poorest Gulf Coast counties will be impacted and can least afford coordinated preventive care efforts.
• Immediately improve access to and information on Zika testing resources. Texas needs to establish alternative arrangements with private labs to expedite testing statewide.
• Take advantage of the recent federal Centers for Medicare and Medicaid Services allowance to cover insect repellant as a benefit — not only in Medicaid but also in the Healthy Texas Women and Family Planning programs. Health and Human Services Executive Commissioner Charles Smith recently urged state leaders to cover repellant in these and other health programs.
• Increase access to contraception for Texas women, including access to the most effective, long-lasting forms (implants and intrauterine devices).
• Increase access to condoms and reimburse more providers that supply them. Because Zika can be transmitted sexually through infected semen, condoms are an essential component of prevention.
• Address technological glitches in the state’s eligibility and enrollment system that prevent currently eligible clients from accessing family planning services.

Finally, the state must recognize that Medicaid currently covers only a small proportion of women of childbearing age who would be particularly vulnerable to the effects of Zika. Texas has the highest uninsured rate in the country. Accepting federal funding to close the coverage gap will enable many more women to access a medical home where they can receive critical preventive care and family planning services.

These important, concrete steps can help Texas get in front of Zika and substantially limit its impact.