Unintended pregnancy and contraception among active-duty servicewomen and veterans

Abstract

The number of women of childbearing age who are active duty service members or veterans of the U.S. military is increasing. These women may seek reproductive health care at medical facilities operated by the military, in the civilian sector or through the Department of Veterans Affairs. This article reviews the current data on unintended pregnancy and prevalence of and barriers to contraceptive use among active duty and veteran women. Active duty servicewomen have high rates of unintended pregnancy and low contraceptive use which may be due to official prohibition of sexual activity in the military, logistic difficulties faced by deployed women and limited patient and provider knowledge of available contraceptives. In comparison, little is known about rates of unintended pregnancy and contraceptive use among women veterans. Based on this review, research recommendations to address these issues are provided.

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

“…First, these are the most common hormonal contraceptives utilized in both military and civilian populations. 8,11 Second, a goal of this analysis was to define factors that a provider or health system could utilize to identify the most ideal candidates for LARC therapy prior to hormonal contraception initiation. Identifying such candidates not receiving LARC therapy, but who could most benefit from it, could provide insight for future practice.…”

“…7 However, there remains a lack of evidence on the rate of unintended pregnancy among female veterans. 8 Addressing this gap in 607825A OPXXX10.1177/1060028015607825Annals of PharmacotherapyKazerooni et al research-article2015 the literature is critical given that 800,000 of the 4.5 million female veterans are of childbearing age. 9 Moreover, the demands to serve this population will increase as the female veteran population is expected to grow from 9% currently to 16% of all veterans by 2043.…”

“…9 There is additional concern that established risk factors of unintended pregnancy in active and reserve servicewomen also exist in female veterans, thus contributing to higher risk of unintended pregnancy in the female veteran population. 8 Risk factors for unintended pregnancy previously identified in military populations include: younger age, unmarried status, lower education level, and lower military rank. 6,10 A systematic review comparing contraceptive use among military and civilian women found the percentage of active duty and reserve women using oral contraception ranged from 16% to 34%, compared with 17% in the civilian population.…”

“…11 Oral contraceptives are the contraceptive methods most commonly used by military females. 8 It is estimated that unintended pregnancies associated with imperfect adherence cost $2.47 billion dollars in 2012. 12 Despite a growing female veteran population, there remains limited literature on incidence of pregnancy in female veterans.…”

Contraceptive adherence among women Veterans with mental illness and substance use disorder

“…Active duty military women have a 50% higher age-adjusted risk of unintended pregnancy compared to the general population [2], and this elevated risk may persist among Veterans, although unintended pregnancy rates have not been reported in the literature and are not captured in Veterans Affairs (VA) administrative medical records [3]. Women Veterans have high rates of medical and psychiatric comorbidities including obesity, depression, posttraumatic stress disorder (PTSD) and substance abuse [4][5][6], which further elevate their risk of morbidity associated with unintended pregnancy [7][8][9][10][11][12].…”