By Annette M. Boyle
CAMBRIDGE, MA – Despite the availability of free contraceptives, unintended pregnancy among active-duty military servicemembers is on the rise and occurs at much higher rates than in the civilian population.
A survey of more than 7,000 women in the U.S. military found an unintended pregnancy rate 50% higher than among their civilian peers, according to a recent study published in Obstetrics & Gynecology.1
Rates increased from 9.7% of women in 2005 to 10.5% in 2008. The age-standardized rate was 7.8% compared with 5.2% in the general population. (With 97% of women in the service being of reproductive age, age standardization adjusts for the substantially higher proportion of young women on active duty than in the overall population).
“The increase in unintended pregnancy from 2005 to 2008 is alarming,” said lead researcher Kate Grindlay, senior project manager at Ibis Reproductive Health, an international advocacy group in Cambridge, MA. The numbers are especially surprising, given that contraception is free to women in the service, she said.
Researchers analyzed cross-sectional data from the 7,225 responses to the Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel.
The impact on deployments can be substantial, particularly if the trends continue as the number of women in the service rises.
“Half of the women with an unintended pregnancy in the prior 12 months and 11% of women overall in the 2008 Health Related Behaviors Survey reported being unable to deploy in the prior 12 months as a result of pregnancy,” the authors write.
The highest rates of unintended pregnancy were seen in active-duty women who were younger, less educated, nonwhite and cohabitating, rather than married. The rates of unintended pregnancy also are highest among those groups in the civilian population.
Rates By Branch
Only the Air Force had a reduction in unintended pregnancies in the three-year period, with the rate dropping from 7.4% to 6.7%. The Air Force and Coast Guard had the lowest rates overall, both at 6.7%. Rates for the Army stayed consistent at slightly under 12%. Researchers reported that rates of unintended pregnancy increased by 33% among female sailors (9.2% to 12.3%). Women in the Marine Corps had the highest rates in both years analyzed, 15% and 16.9% for 2005 to 2008, respectively.
The Navy’s 2010 Pregnancy and Parenthood Survey showed somewhat lower numbers. According to the Navy, 13% of sailors reported a pregnancy in the previous fiscal year. Nearly two-thirds of pregnancies among enlisted women, and 74% of those among junior sailors were unintended, as were one-third of those among female officers.
In response, the Navy’s peer mentoring program, The Coalition of Sailors Against Destructive Decisions (CSADD), has taken on the challenge of reducing unintended pregnancies through a family-planning program that discusses contraception, Navy policies, and the impact of pregnancy and parenthood for men and women in uniform.
“It is important that male and female servicemembers, to the best of their ability, plan a pregnancy in order to successfully balance the demands of family responsibilities with their military obligations,” said Chief Operations Specialist Jessica Myers, senior enlisted adviser to the Navy’s Office of Women’s Policy.
While most forms of contraception are covered by TRICARE, the majority of respondents reported that they were not counseled on pregnancy prevention or menstrual suppression prior to deployment.
“It is critical that women in the military have information about and access to the full range of contraceptive methods so they can select and use the method that will work best for them,” Grindlay said.
Military women also need specific counseling on the best options during deployment, as some preferred contraceptive methods are unsuitable in theater. The vaginal ring requires refrigeration, and the pill must be taken at the same time each day, both difficult conditions to meet when deployed. Other forms, such as the patch, may be affected by transportation delays.
In deployed settings, there also can be challenges with user-dependent methods, including the pill and condoms, and difficulty obtaining refills so other options may work better.
“Healthcare providers and women in the military should be educated on the availability and use of long-acting reversible contraceptives such as intrauterine devices and the contraceptive implant,” Grindlay urged.
In addition, some methods also suppress menstruation, she noted.
If long-acting contraceptives are not prescribed, women should receive sufficient supplies to last their full tour to avoid problems with refills and increase the likelihood of method continuation, she suggested.
-Photo by Staff Sgt. Kenneth Pawlak
Many servicewomen do not ask healthcare providers about contraception, particularly prior to deployment because they do not anticipate needing it, Grindlay said.
Consequently, a discussion of contraception should be a topic of discussion during a woman’s annual health examination and pre-deployment check-ups.
“Another factor deterring some women from seeking contraception was confusion about prohibition of sexual activity,” wrote the authors.
“Current regulations make sexual relationships a chargeable offence in a number of circumstances,” explained Grindlay, who added that “confusion or concern about these policies may put women at increased risk of unintended pregnancy, since some are led to believe they won’t need contraception and because they may be fearful of asking for contraception.”
Role of Sexual Assault
The high rate of sexual assault also contributes to the unintended pregnancy rate, according to Grindlay. “As many as 45% of servicewomen experience military sexual violence,” she said. DoD estimates that 86% of military rapes or attempted rapes go unreported.
To reduce the incidence of rape and resulting pregnancies, the services should follow the recommendations of the Institute of Medicine’s recent report, Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families, noted Grindlay.
The recommendations include strengthening policies to eliminate military sexual violence and reinforcing existing policies on military sexual violence by adding specific mandatory evaluation criteria concerning sexual assault into formal performance-appraisal and promotion systems issues for military leaders.
The latest Department of Defense Annual Report on Sexual Assault shows that some progress has been made in this area. In 2011, 3,192 reports of sexual assault resulted in disciplinary action against 791 subjects. Of those, 62% had courts-martial charges against them, up 10 percentage points from 2010, and more than twice the 30% rate initiated in 2007.
1 Grindlay K, Grossman D. Unintended pregnancy among active-duty women in the United States military, 2008. Obstet Gynecol. 2013 Feb;121(2 Pt 1):241-6. doi: http://10.1097/ AOG.0b013e31827c616e. PubMed PMID: 23344272.