Executive Summary
Results of a recent study indicate the rate of unintended pregnancy among active-duty women in the U.S. military remains higher than that of the general population.
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Data indicate 7% of servicewomen reported an unintended pregnancy during 2011, compared to 5% of women of reproductive age in the general U.S. population.
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Women in the U.S. military make up 15.7% of the active-duty and reserve forces and number more than 350,000. In 2016, the U.S. military will lift restrictions on women in combat, which makes access to effective contraception even more important.
Results of a recent study indicate the rate of unintended pregnancy among active-duty women in the U.S. military remains higher than that of the general population.1 Data indicate 7% of servicewomen reported an unintended pregnancy during 2011, compared to 5% of women of reproductive age in the general U.S. population.1
To estimate unintended pregnancy rates among a representative sample of active-duty women ages 18-44 in the U.S. military, researchers from Cambridge, MA-based Ibis Reproductive Health, a non-profit research organization, analyzed cross-sectional data from the 2011 Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel. A total of 9,038 women provided data on unintended pregnancy. To perform the study, unintended pregnancy rates were calculated for all women and by available background characteristics, including military branch, marital status (married versus unmarried), pay grade (enlisted versus officer), and deployment in the previous 12 months. Multivariable logistic regression testing for associations etween unintended pregnancy and subgroups also was performed.
The analysis indicated an unintended pregnancy rate of 72 per 1,000 women. Married women (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.11-1.54) had higher odds of reporting unintended pregnancy compared to unmarried women, while enlisted women (OR 2.71, 95% CI 1.99-3.69) had higher odds of reporting unintended pregnancy compared to officers. Women in the Navy (OR 1.51, 95% CI 1.19-1.91) and Marine Corps (OR 2.38, 95% CI 1.92-2.95) had higher odds of reporting unintended pregnancy compared to women in the Air Force and women in the Army (OR 1.16 95% CI 0.89–1.50). Unintended pregnancy rates did not differ between women who were deployed in the previous 12 months and nondeployed women, the analysis reflects. A total of 10% of women who were deployed for 11-12 months in 2011 reported an unintended pregnancy in the previous year, suggesting that their pregnancies occurred during deployment.1
What prompted Ibis Reproductive Health to look into this particular line of research?
“Since 2009, Ibis has conducted research to better understand the reproductive health needs and experiences of servicewomen,” says Kate Grindlay, MSPH, lead author on the study and a senior project manager at Ibis Reproductive Health. “Our interest in this area grew out of a desire to explore the impacts of federal policy limiting access to abortion services for servicewomen and military dependents.” (The “Washington Watch” column of Contraceptive Technology Update has reported on this issue. See “Abortion coverage alters for servicewomen,” March 2013.)
Ibis Reproductive Health conducted the first study of U.S. military women’s experiences seeking abortion care during overseas deployment.2 About the same time, it conducted a systematic literature review on contraceptive use, unintended pregnancy, and abortion in the military, and it found limited data on all of these issues.3
“We felt this was an important and overlooked area, and wanted to help fill in these gaps,” says Grindlay.
Women play an integral role in the U.S. military, making up 15.7% of the active-duty and reserve forces and numbering more than 350,000.4 In addition to the challenges faced by all women with unintended pregnancies, servicewomen might find that an unintended pregnancy compromises their career trajectory by removal from training exercises during pregnancy and postpartum, or through reassignment to a new unit or position outside of a primary occupation during and after pregnancy.5 It might force them to leave a military tour early, which makes career advancement more difficult.5
Unintended pregnancy is an important issue for servicewomen and for the military. A lack of contraceptive use, barriers to contraceptive access, and the high rate of sexual assault in the military all contribute to the levels of unintended pregnancy in the military. Federal Defense Department statistics for a single year, 2010, identified more than 3,000 reported sexual assaults, including roughly 875 rapes; however, the extent of the problem is considerably larger, because an estimated 86% of assaults go unreported.6
While some military branches have begun to improve access to pre-deployment contraception, a more comprehensive approach is needed to make sure that servicewomen who want to prevent pregnancy are able to access the contraceptive method of their choice, agree the researchers at Ibis Reproductive Health.
In 2016, the U.S. military will lift restrictions on women in combat. How important is it that military women have access to all forms of contraception, particularly long-acting reversible contraception?
One interesting finding from Ibis Reproductive Health’s research is that the number one reason that deployed women choose to use contraception is for menstrual suppression, says Daniel Grossman, MD, director of advancing new standards in reproductive health and professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco, and senior advisor at Ibis Reproductive Health. Servicewomen also are interested in contraceptive methods that are discreet and long-acting, Grossman notes.
“No single method is right for every servicewoman, but the levonorgestrel intrauterine system could be ideal for many women who desire amenorrhea and very effective contraception,” he states. “The problem of unintended pregnancy among active-duty women should be addressable by improving counseling about and provision of the full range of contraceptive methods.”
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Grindlay K, Grossman D. Unintended pregnancy among active-duty women in the U.S. military, 2011. Contraception 2015; 90(3):346-347.
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Grindlay K, Yanow S, Jelinska K, et al. Abortion restrictions in the U.S. military: Voices from women deployed overseas. Womens Health Issues 2011; 21(4):259-264.
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Holt K, Grindlay K, Taskier M, et al. Unintended pregnancy and contraceptive use among women in the U.S. military: A systematic literature review. Mil Med 2011; 176(9):1056-1064.
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Office of the Deputy Under Secretary of Defense. Profile of the Military Community: Demographics 2010. Washington, DC: Department of Defense; 2010.
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Ibis Reproductive Health. Sexual and Reproductive Health of Women in the US Military. Accessed at http://bit.ly/1jo5fXT.
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Department of Defense. Department of Defense Annual Report on Sexual Assault in the Military: Fiscal Year 2010. Washington, DC; 2011. Accessed at http://bit.ly/1Nz9mxw.
