Expert review
General gynecology
Unintended pregnancy and contraception among active-duty servicewomen and veterans

https://doi.org/10.1016/j.ajog.2011.11.018Get rights and content

The number of women of childbearing age who are active-duty service members or veterans of the US 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.

Section snippets

Existing military health care structure

The DOD provides medical benefits for active duty personnel, retirees, Reservists, and National Guard members called to active duty, and certain dependents under the worldwide health care plan called TRICARE. Under TRICARE, most health care is provided by a military treatment facility.12 Military personnel covered by TRICARE may be referred to a civilian medical provider if care is unavailable at the local military treatment facility or if they live and work more than 50 miles from the nearest

Reproductive health needs of military women

Active-duty and veteran women are largely of childbearing age. Approximately 75% of new military recruits are younger than 22 years of age.19 In total, 42% of all female veterans are currently of childbearing age, and more than 90% of female veterans who served after Sept. 11, 2001, are between 18 and 44 years of age.18 These women have reproductive health issues that may not be typically thought of when considering military and veteran health care.

Because of its potentially high burden for

The burden of unintended pregnancy

Although all members of the US armed forces are prohibited from engaging in sexual intercourse outside marriage,24 when surveyed, unmarried service personnel do endorse sexual activity.25, 26, 27, 28, 29 The specific context of these sexual encounters is unknown but may occur in violation of military policy, during vacation from active duty,30 while under the influence of alcohol or drugs,29 or be forced.27 Because sexual intercourse is prohibited in most situations, active-duty personnel often

The burden of unintended pregnancy

Unlike in the active-duty population, there are no published data regarding the prevalence of unintended pregnancy among women veterans. However, women veterans share many of the risk factors for unintended pregnancy found among active-duty servicewomen and civilian women. Similar to active-duty servicewomen, women veterans are predominantly unmarried, have lower educational levels, and disproportionately represent racial and ethnic minorities, all of which are associated with unintended

Comment

The population of active-duty servicewomen and women veterans of child-bearing age is growing. Given the existing health care structure, health care providers in the military, at VA medical centers, and within the civilian community must work together to care for these women. Data reveal that, compared with the civilian population, military women are at relatively high risk for unintended pregnancy. This may be because women in the military are predominantly young, are unmarried, have lower

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  • Cited by (0)

    The project described was supported by Award K12HD050108 from the Office of the Director, National Institutes of Health, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

    The views expressed herein are solely those of the authors and do not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health.

    The authors report no conflict of interest.

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