Servicewomen Face Multiple Barriers to Contraceptive Access During Deployment, Study Finds

November 29, 2012 — Summary of "Contraception Access and Use Among U.S. Servicewomen During Deployment," Grindlay/Grossman, Contraception, Nov. 2, 2012.

About 12% of U.S. servicewomen have an unintended pregnancy annually, but few studies have examined their level of access to and use of contraceptives, particularly during deployment.

Study authors Kate Grindlay and Daniel Grossman of Ibis Reproductive Health noted that unintended pregnancies affect not only "servicewomen's health and well-being," but also "troop readiness, as pregnant women cannot be deployed and, if already overseas, must return from theater."

Methods

The researchers created an online survey that asked open and closed questions about servicewomen's access to and use of contraceptives before and during deployment, their interaction with medical providers, reasons for contraceptive use or nonuse, and ease of refills during deployment.

The anonymous survey was conducted from April 2010 to November 2010 and included 281 current and former U.S. servicewomen who had been deployed overseas at some point since 2001.

Results

Participants on average were 30.7 years old, had served for 8.2 years and had been deployed two times. The demographics and ranks of study participants were similar to those of the overall military population, although there were slightly more women in the sample who served in the Army compared to the military as a whole.

The majority of respondents (58%) said contraception was very or somewhat easy to obtain for deployment, and about three-fourths noted that it is available at no or low cost through TRICARE.

However, prior to deployment, 59% of respondents did not discuss birth control options with a military health care provider, while 78% did not discuss menstruation suppression options. Some respondents reported that they were unaware that birth control was available to them, they were unaware of the range of available methods or they did not have time to obtain contraception because of a short deployment notice.

Additionally, some respondents said that policies prohibiting or discouraging sexual activity among service members prevented them or health care providers from initiating conversations about contraception. As a result, a few respondents thought that contraception was completely unavailable.

Although TRICARE covers most contraceptive methods, 33% of respondents said they did not have access to a method they might have preferred for deployment. Respondents noted that certain long-acting contraceptive methods, including intrauterine devices and sterilization, were either discouraged or not offered to certain women. For example, women were incorrectly told they could not use an IUD unless they had a child.

Fifty-three percent of respondents used birth control throughout the entirety of their last deployment, while 10% used birth control for part of their deployment. The vast majority of birth control users (71%) said they used the method for menstrual cycle control, while 35% used it for pregnancy prevention.

Birth control pills were the most popular method that respondents used during deployment (33%), followed by injectables (10%), sterilization (6%), patch (4%), IUDs (3%), vaginal ring (2%), condoms (2%) and implants (1%).

Women reported several barriers to accessing birth control during deployment, including insufficient supplies, stigma in the military against making medical appointments, and uncoordinated care between civilian doctors and the military. Forty-one percent of women reported difficulties obtaining refills for their birth control while deployed overseas.

Discussion

The "study highlights a number of challenges that some women face related to accessing or using contraception during deployment," Grindlay and Grossman wrote.

"While all women need comprehensive counseling on and access to contraception so as to determine whether and when to have children, it is particularly important in the military context" because of the high rate of unintended pregnancy among servicewomen and "the limited access to abortion in the military," they added. Women in the military also must contend with a high risk of sexual assault; in fact, 6% of respondents in the study said they used contraception because of fear of sexual assault.

Grindlay and Grossman suggested several ways the military can improve servicewomen's access to contraception. They recommended that the military require all women who are scheduled to deploy to receive contraceptive counseling, amend laws criminalizing sexual activity "to reflect the reality of sexual relationships between unmarried service members," and "focus on promoting policies and education that aim to reduce unintended pregnancy and encourage sexual health."

The military also should increase access to long-acting contraceptive methods, such as implants and IUDs, which offer women "continuous, discreet and dependable contraceptive coverage," they wrote. Another option is to provide women with a larger supply of birth control that will last through deployment.