Those With Unmet Need Had Double the Rate of Unintended Pregnancy
Staff Sgt. Kabriya Mason, a Pregnancy/Postpartum Physical Training Program exercise leader, assigned to the 52nd Brigade Engineer Battalion, 2nd Stryker Brigade Combat Team, 4th Infantry Division, leads a physical training session for pregnant and postpartum soldiers at Fort Carson, CO in 2024. U.S. Army photo by Sgt. Woodlyne Escarne
FORT LEWIS, WA — Nearly 20% of women in the U.S. Army with a need for contraception potentially had that need unmet for 12 months, resulting in twice the rate of unintended pregnancy compared to women whose contraception needs were met, according to a new study.
The retrospective cohort study published in Military Medicine identified contraception needs and pregnancy events in the MHS.1
Women are the fastest-growing demographic in the U.S. military and make up a considerable portion of military forces, but unintended pregnancy among active-duty servicewomen remains a public health and readiness challenge, with 97% of them being of reproductive age. While contraceptive counseling and ready access to walk-in contraceptive services have been priorities in DoD reproductive health policy, there’s limited data on effectiveness. Based on analyses, women serving in the Army were less likely to receive contraception than in other military branches, and gaps in family planning services within the MHS have been linked to unintended pregnancy and impacts on maternal and infant health.
Even with comprehensive coverage through the MHS, 72 of 1,000 servicewomen experience unintended pregnancy each year, and 41% report not using contraception at the time of conception. In this study, researchers sought to quantify the number of reproductive-aged women in the U.S. Army with a potentially unmet need for contraception based on their responses to the annual Periodic Health Assessment required by the DoD, as well as determine risk for unintended pregnancy.
“Overall prevalence of unmet need for contraception was 18.3%,” according to the study led by researchers from Preventive Medicine, Eisenhower Army Medical Center at Fort Gordon, GA. “Junior Officers were 2.24 times (95% CI, 1.89-2.64) more likely than junior enlisted to have contraception needs met after adjusting for other factors. Black/African U.S. Army Women had significantly lower odds (0.57; 95% CI, 0.50-0.65) of having their needs met compared to their non-Hispanic white counterparts. An unmet need was associated with increased risk of unintended pregnancy (adjusted OR = 2.46, 95% CI, 2.10-2.88).”
Using survey information, electronic health records and pharmacy records obtained from the Armed Forces Surveillance division, the investigators identified contraception needs and pregnancy events in the MHS. The study included 23,015 U.S. Army servicewomen who served between Aug. 31, 2021, and Aug. 31, 2023, and completed two Periodic Health Assessments during the study period. Data was collected until pregnancy or end of study.
Also participating in the study were researchers from Madigan Army Medical Center in Fort Lewis, WA; Fort George G. Meade Medical Center in Fort Meade, MD, the Walter Reed Army Institute of Research; and the University of Washington in Seattle.
The women in the study were 18-45 years old and had a need for contraception, which was defined as sexually active women with a uterus who don’t plan to conceive over the following 12 months.
The researchers divided that into a “met” or “unmet” need. A met need was defined as use of sterilization (permanent contraception such as vasectomy, bilateral salpingectomy or hysterectomy), long and short-acting reversible contraceptives, or barrier methods. A met need didn’t include nonpharmaceutical natural family planning methods (e.g., rhythm, calendar, basal temperature or cervical mucus monitoring) because these methods can’t be consistently verified in electronic health records, according to the researchers.
An unmet need was defined as women not desiring pregnancy and not using contraception.
The study cohort was racially diverse, with 43.7% non-Hispanic white, 24.4% non-Hispanic Black/African-U.S., and 20.2% Hispanic participants. More than 75% of the cohort was enlisted personnel, the study reported.
In addition, U.S. Army servicewomen who reported pregnancy uncertainty were nearly twice as likely to be in the potentially unmet need group (12.2%) compared to the met need group (6.4%).
The investigators identified 682 total pregnancies among the U.S. Army servicewomen with a potential need for contraception, which totaled 11,109 person-years-at-risk. Those with a potentially unmet need for contraception had a 2.46 times higher rate of unintended pregnancy when compared to those with a met need for contraception (11.99 pregnancies vs. 4.89 pregnancies per 100 person-years).
The analysis determined that pregnancy incidence rates were lowest in female soldiers endorsing sterilization (0.80 per 100 person-years) and highest in female soldiers endorsing the rhythm or withdrawal method (13.44 per 100 person-years).
The authors pointed out that almost 6% (650) of the Army servicewomen stated a desire for contraception services on their annual Periodic Health Assessment questionnaire, but less than half had a record of subsequent contraception counseling appearing in the electronic health record. In addition, the mean time from Periodic Health Assessment to the first counseling event was 114 days. Only 30% of U.S. Army servicewomen received counseling within the MHS goal for referrals.
“Twenty percent of USAW with a need for contraception potentially had that need unmet over 12 months, which resulted in twice the rate unintended pregnancy compared to those with a met need,” the authors concluded. “The military may consider using the Periodic Health Assessment and other proactive strategies to address this issue.”
Based on previous studies, effective contraception is essential for U.S. Army women, because unintended pregnancy was significantly associated with higher odds of pre/ perinatal depression, postpartum depression, maternal experience of interpersonal violence, preterm birth and infant low birth weight. Pregnancy also can affect readiness, especially during deployment. Earlier research has found that, of soldiers from a battalion deployed to Operation Enduring Freedom/ Operation Iraqi Freedom (OEF/OIF) who were medically evacuated, one of the top two reasons was female reproductive issues (16.8%). About 11% of U.S. Army servicewomen medical evacuations were secondary to unintended pregnancies, miscarriages and ectopic pregnancies, and at the time, each medical evacuation was estimated to cost $10,000, the authors explained.
- Mandia J LTC, Cruz L CPT, Keltner C CPT, Haynes R CPT, Drain P, Dalmat R. Preventing Unintended Pregnancy and Meeting Contraception Needs in the U.S. Army. Mil Med. 2026 Mar 21:usag090. doi: 10.1093/milmed/usag090. Epub ahead of print. PMID: 41863343.
