The objective of this report is to assess knowledge, pregnancy attitudes and contraceptive practices in relation to the Zika virus outbreak in Brazil. They interviewed 526 women 18 to 49 years old in primary health services in a Northeastern capital of Brazil, in 2016. They provided information about their knowledge of Zika transmission and health consequences, their receipt of counseling related to sexual and perinatal transmission of Zika, their pregnancy intentions and reassessment of contraceptive options in the context of the Zika virus outbreak. Awareness about Zika congenital syndrome was high, but knowledge about sexual transmission was low. Few women had changed pregnancy intentions or contraceptive practices in response to Zika. Pregnant women were more likely to access counseling about family planning, condom use and pregnancy postponement due to Zika virus than non-pregnant women, which may suggest that health system responses followed pregnancy occurrence. We observed missed opportunities for prevention of perinatal transmission of Zika virus through behavioral change, including effective contraception to prevent pregnancy and condoms to prevent perinatal transmission, as a complement to vector control.