Women in areas of the Americas with endemic Aedes mosquito populations are at risk for exposure to Zika virus, which can cause fetal brain abnormalities and associated congenital microcephaly. Individual health care providers may encounter health system barriers to providing evidence-based care. We focus on Mexico and the state of Texas to highlight the role of health system factors in contraceptive access in the context of Zika and highlight efforts in Puerto Rico as an example of initiatives to improve access to contraception. In Mexico, states with the highest unmet need for contraception are low-lying coastal states. The government recently announced an investment to combat Zika but made no mention of family planning initiatives to assist women in preventing pregnancy. In Texas, the Department of State Health Services has issued recommendations to help women and men avoid mosquito bites; the issue of whether women should plan or avoid pregnancy is not addressed. Puerto Rico has the largest number of confirmed cases of Zika virus in the U.S. states and territories. Recently, the Centers for Disease Control and Prevention Foundation launched the Zika Contraception Access Network, which provides contraceptives at no cost to participating clinics in Puerto Rico. The Zika virus highlights weaknesses in health systems that make it difficult for women to use contraception if they want to delay births. Women across the globe, with or without Zika virus, need access to contraception to prevent unintended pregnancy, and health care providers require functioning health systems that offer support to ensure access is a reality.