Predictors of Pregnancy in Female Veterans Receiving a Hormonal Contraceptive Pill, Patch, or Ring

Abstract

This study successfully identified several predictors of pregnancy in female veterans starting a pill, patch, or ring form of hormonal contraception. Female veterans in the lowest socioeconomic quintile, aged 18 to 24 years, diagnosed with a mental health disorder, and of Christian faith were found to be at significantly higher odds of a pregnancy. Identification of these at-risk populations may help clinicians and policy makers choose strategies to identify which patients could benefit the most from more effective long-acting reversible contraception therapy.

The Association between Mental Health Disorders and History of Unintended Pregnancy among Women Veterans

“…Due to the retrospective and cross-sectional nature of our study, we are also unable to draw conclusions regarding the temporal relationship between mental health symptoms or diagnoses and unintended pregnancy. Similar to women in the general population, female VAusers with mental health disorders have also been found to have reduced rates of adherence to user-dependent contraceptive methods, 16,28 which could potentially account for the higher rates of unintended pregnancy observed in our study.…”

Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017

“…Fifteen manuscripts dealt with topics related to contraception and preconception care (Supplementary Table 2), including ten cross-sectional, four cohort, and one qualitative study. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Topics included description of pregnancy rates 25 ; beliefs, knowledge, and experience of contraception and pregnancy planning [26][27][28] ; determinants of receipt of and adherence to contraception [29][30][31][32][33][34][35][36] ; validity of administrative data for contraception research 37 ; and contraceptive counseling and prescribing for women Veterans receiving teratogenic medications. 38,39 All studies included only women Veterans using VA healthcare.…”

“…28 Eight studies examined determinants of receipt of and adherence to contraception. All relied exclusively on VA administrative data, six used national samples of all women Veterans using VA healthcare, [29][30][31][34][35][36] one was restricted to women Veterans deployed to Afghanistan or Iraq, 32 and one was limited to a single VA healthcare system. 33 In terms of determinants of receipt of contraception, military sexual assault was positively associated with documented contraception (aOR, 1.12; 95% CI, 1.07-1.18).…”

“…35,40 Factors associated with poorer adherence to hormonal contraception included having a mental health diagnosis, self-identifying as a Christian, being lower income, having a required copayment, receiving a prescription from an obstetrician/gynecologist (vs. primary care physician), and obesity. 30,31,33,34 However, one validity study indicated VA administrative data had low sensitivity and high specificity for oral contraceptives (sensitivity: 0.41, specificity: 1.0) and the contraceptive ring (sensitivity: 0.50, specificity: 1.0) and much higher sensitivity for IUDs (sensitivity: 1.0, specificity: 0.98) and injectable contraceptives (sensitivity: 1.0, specificity: 1.0). 37 Two separate studies examined contraceptive counseling and receipt of contraception among women Veterans receiving prescriptions for teratogenic medications in VA. Women Veterans prescribed teratogenic medications were slightly more likely than those without such a prescription to have a documented contraceptive method, contraceptive counseling, or pregnancy test (55.7 vs. 35.9%).…”

“…25 This may reflect patient or provider preferences for low-maintenance contraception, as mental health conditions and substance use disorders are highly prevalent in this population and may negatively impact adherence to hormonal contraception. 29,30 It might also reflect preferential use of VA for clinician-administered methods such as LARC, which outside VA might have higher patient costs, although the Affordable Care Act contraceptive mandate issued in 2012 may have minimized or eliminated these differences. 74 Policy and system level barriers to receipt of or adherence to hormonal contraception included financial barriers (e.g., copayments) 30,33,34 and limited availability of women's health clinics.…”