A follow-up survey of United States servicewomen and their access to contraceptives during their deployment revealed both good and bad news. Some women reported greater access to contraception, while others experienced barriers to obtaining contraceptives in the weeks leading up to their deployment.1

“Many servicewomen reported difficulty to getting an appointment for contraceptives prior to being deployed,” says Jane Seymour, MPH, senior project manager with Ibis Reproductive Health in Cambridge, MA. “Other participants noted that the free and low cost of contraceptive coverage was a huge facilitator to their use of contraception.”

The proportion of women who found contraceptive access easy vs. those who experienced difficulties was nearly equal: 51% said it was somewhat or very easy, and 49% said it was somewhat or very difficult.

Investigators asked study participants open-ended questions to learn more about the barriers they experienced. The most common barriers included difficulty getting an appointment to discuss contraceptives with a healthcare provider, military system issues like transferring medical records, and privacy concerns. For example, one participant noted that her provider did not permit appointments for contraception, and she had to show up for a sick call instead, Seymour says.

“It was the way the military organized appointments that was challenging for this respondent,” she adds. “We believe that regardless of the proportion of people who were able to access contraception, if any individual who wishes to obtain contraception is unable to do so, it is an issue.”

Scheduling barriers included clinics that only offered contraceptive counseling and services on certain days of the week, which did not always fit particular servicewomen’s schedules, Seymour says. Another issue that some women raised was their inability to obtain a full supply of contraceptives prior to their deployment.

“Other women cited that as a facilitator — they were able to get a full supply of birth control pills, and that facilitated their use,” Seymour says. “Some people had access more than others. We were not able to parse whether it changed by branch or rank, but it was something we noted.”

This is something the military could change through policy, she notes. “I think a recommendation we would have is to ensure that all people going into a deployment setting are able to obtain a full contraceptive supply for their tour,” Seymour says.

Researchers asked women participating in the study whether they thought they had access to all contraceptive options. Some indicated they had difficulty obtaining their desired method, such intrauterine devices (IUDs) and other long-acting, reversible contraceptives.

“We’ve seen that in past studies around the military that in certain settings there might not be a provider who is able to place an IUD,” Seymour says. “There have been barriers to certain methods in the past.”

The No. 1 reason servicewomen chose to use contraception was to suppress menstruation, according to the 2019-2020 edition of Managing Contraception. “Menstrual suppression is more important than contraception for some servicewomen,” the authors wrote.2

Other barriers included limited access to the vaginal ring because of refrigeration requirements, and prohibitions on sex during deployment. One active-duty Army enlistee said she could not use her vaginal ring during deployment because of refrigeration problems. She did not want the long-acting shot because of concerns about weight gain. Her provider refused to prescribe her any other medication. “The nurse practitioner that I saw then wouldn’t prescribe me anything, because she didn’t see why I needed it,” the woman reported. “Finally, I said I was deploying with my husband, and she relented and gave me a birth control pill prescription.”1 This experience suggests access issues due to sexism or patriarchy, Seymour says.

One-fourth of the study population said they used an IUD, but some participants faced access barriers. According to an Air Force officer, deployed locations do not keep a large stock or variety of birth control pills, and they cannot insert IUDs. When the officer asked for a specific brand because of health concerns with other types of contraceptive medications, she felt as though her pharmacist treated her as a “problem child.”1

A recent military mandate calls for counseling prior to a contraceptive appointment, Seymour says. “We recommend, as this new contraceptive counseling mandate is rolled out, that there is a need for rigorous evaluation of the mandate to make sure it’s implemented and providers are giving comprehensive, noncoercive counseling about side effects. Counseling should help service members find the best fit for their needs.”

In some ways the study’s results are unsurprising, Seymour says. “We at Ibis remain concerned that service members continue to face unnecessary barriers to birth control before deployment,” she explains. “Many of the findings reflected what we found in previous studies and reflected common sense: When contraceptives are lower cost and easier to access, they’re more utilized.”

The barriers related to the military’s chain of command remain a concern. Military healthcare leaders should work to identify ways to improve contraceptive access for all service members, Seymour says.

“One neat piece about this analysis is it points to both barriers and facilitators to access,” she adds. “As we consider ways to improve contraceptive access for deployed service members, it points to difficulty getting appointments, and it points to facilitators, including lower cost and ease of appointments.”

REFERENCES

  1. Seymour JW, Fix L, Grossman D, Grindlay K. Contraceptive use and access among deployed US servicewomen: Findings from an online survey. BMJ Sex Reprod Health 2020. doi:10.1136/bmjsrh-2019-200569.
  2. Hatcher RA, Haddad L, Zieman M, et al. Managing Contraception 2019-2020. 15th ed. Bridging the Gap Foundation; 2019.