Adherence to no-cost oral contraceptives among active-duty servicewomen

Abstract

BackgroundWe aimed to evaluate the adherence to no-cost oral contraceptives (OC) among young single women and to identify factors associated with non-adherence.MethodsRetrospective cohort study included all single female soldiers who received free-of-charge OCs from military pharmacies in Israel between 2006 and 2015. Military pharmacies’ dispensing registries were queried to assess the number of OC packages dispensed. Women were included in the study if their service continued for a period of at least 12 months from the time of receiving their first OC pack. Study outcomes were twelve cycles medication possession ratio (MPR), which is defined as the number of OC packs dispensed over a 12-cycle period divided by 12, presented as a percentage, and factors associated with the OC MPR as evaluated by multivariable regression analysis.ResultsDuring the study period, there were 3 05 923 active servicewomen aged 18–24 years. A total of 82 203 (26.9%) women were dispensed at least one pack of OCs. The mean MPR was 51.8% (35.2%). Only 14% of women had good adherence (MPR ≥90%). Multivariate regression models showed that non-adherence (MPR <90%) was more common among servicewomen (adjusted OR (95% CI)): who failed to graduate from high school (1.9 (1.54–2.33)) and with combat or combat-support type of service (1.66 (1.30–2.13)). Other social/ethnic factors, including first-generation immigrant (1.13 (1.05–1.21)), sub-Saharan African origin (1.28 (1.04–1.58)), lower IQ scores (1.28 (1.22–1.34)) and combat-support type of service (1.22 (1.12–1.34)) were associated with non-adherence, but to smaller degrees. Neither income nor health status predicted adherence in this population receiving no-cost OCs.ConclusionsOverall, 12 cycles OC adherence was universally low among active servicewomen. Adherence demonstrated small, but significant, associations with sociodemographic factors, with the lowest levels of adherence predicted by low educational attainment and combat service.

Improving contraceptive choice for military servicewomen: better provision serves both women and deployment planning

“…The specific demographics and effect sizes presented by Rottenstreich et al 2 may not be generalisable outside Israel and this specific population of young women in compulsory military service, but the key finding that consistent and ongoing adherence to oral contraception is low is unfortunately common 3. The setting described presents a unique lens through which we can further appreciate the importance of access and choice in contraception.…”

“…In this journal issue, a situation far from this ideal is presented and explored in the work by Rottenstreich et al . entitled ‘Adherence to no-cost oral contraceptives among active-duty servicewomen’ 2. This study describes oral contraceptive use in the Israeli military, a young population in a particular situation where this method alone was offered by their healthcare system at no-cost.…”

Preservation of the reproductive health of military women: global experience and realities of Ukraine

“…Лише 11 508 (14%) жінок мали хорошу прихильність до ОК (MPR ≥90%). Через відносно низький MPR ОК, який спостерігався серед усіх військовослужбовиць, автори дослідження акцентують увагу на необхідності зробити методи зворотної контрацепції тривалої дії більш доступними для усіх жінок-військових, з огляду на те що вони не потребують контролю щоденного режиму приймання з боку жінки [17].…”

“…• З огляду на концепцію розширеного режиму застосування КОК та її прийняття жінками і клініцистами, виконано пошук у базі даних MedLine з метою визначення й узагальнення досліджень із застосування КОК за розширеною схемою, зосередившись на ставленні жінок і клініцистів до ефективності, безпеки/переносимості, меншої кількості запланованих епізодів кровотечі та інших потенційних переваг [17]. За його результатами, ефективність КОК за розширеною схемою лікування можна порівняти зі звичайними 28-денними (тобто 21/7) режимами контрацепції.…”