Unplanned military pregnancies declining

The rate of unintended pregnancies throughout the US military declined significantly since 2005, according to a study published in Contraception.¹ Nevertheless, authors say, the burden that such pregnancies place on female servicemembers and the military health care system continues to demand aggressive upfront education and counseling.

Investigators compared data from 16,806 active-duty service members (including 4,993 women) who answered the 2018 Department of Defense Health-Related Behaviors Survey (HRBS) against findings of HRBS surveys from 2005, 2008, and 2011. In 2018, 5.6% of servicewomen reported experiencing unintended pregnancy; this figure represents a significant decline from 2005 (9.5%), and virtually no change since 2015.¹ The proportion of servicemen who reported causing unintended pregnancy in 2018 was 2.4%. The overall decrease in unintended military pregnancies observed between 2008 and 2018 mirrors an 18% decline among civilian women between 2008 and 2011.²

Compared with long-acting contraception methods, survey factors associated with unintended pregnancy among women included contraception nonuse (adjusted odds ratio/AOR 9.2), being between 17 and 24 years old (AOR 2.7) and being married (AOR 3.6) or cohabitating (AOR 5.5). Conversely, the use of permanent and long-acting contraception yielded the lowest unintended pregnancy rates for women.

Additionally, 2.8% of 986 servicewomen who had deployed in the year before the survey experienced unintended pregnancy during deployment. Only 48.3% of deployed women reported receiving pre-deployment contraceptive counseling. A similar proportion (42.3%) reported being able to initiate or refill their preferred method of birth control before deployment, although 2.4% of women and 14.7% of men reported being unable to get birth control pre-deployment. More importantly, most women and men did not even try to discuss or obtain contraception pre-deployment, a finding which authors said warrants further investigation.

Consistent with previous research^,3,4 young, enlisted, and less educated servicewomen in the survey faced the highest risk for unintended pregnancy. Such women are least likely to be educated about reproductive services and the limited options available in the event of unintended pregnancy during military service, authors said, and least likely to use highly effective contraception strategies. “For these reasons,” authors wrote, “the military health system should aggressively educate, promote, and provide contraceptive services throughout military service.” A Navy policy of offering enhanced contraceptive services during basic training since 2015 increased contraceptive use but did not reduce unintended pregnancies versus other service branches.⁵

Some of the declining prevalence of unintended pregnancy in the US military may stem from the increasing use of contraception, authors allowed. However, the increase in contraceptive use among servicewomen appears relatively small. A 2021 report shows that between 2016 and 2020, the use of long-acting reversible contraceptives among US servicewomen grew from 21.9% to 23.9%.⁶

Accordingly, the authors suggested that other factors likely play a role. Such factors could include methodological differences in data collection, differing sociodemographic or behavioral characteristics, differences in how servicewomen report unintended pregnancy or abortion, or a combination of these factors.

Key study weaknesses include a low response rate—9.6%. Additionally, the self-reported survey instrument may have allowed for subjective interpretation of whether a pregnancy was intended.

REFERENCES:

1. Hamrick JE, Ahmed AE, Witkop CT, Manetz KE, Mancuso JD. Unintended pregnancy among US military active duty servicemembers: HRBS estimates for 2018 and trends since 2005 [published online ahead of print, 2022 Oct 13]. Contraception. 2022;S0010-7824(22)00388-2. doi:10.1016/j.contraception.2022.09.132

2. Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008-2011. N Engl J Med. 2016;374(9):843-852. doi:10.1056/NEJMsa1506575

3. Grindlay K, Grossman D. Unintended pregnancy among active-duty women in the United States military, 2008. Obstet Gynecol. 2013;121(2 Pt 1):241-246. doi:10.1097/AOG.0b013e31827c616e

4. Grindlay K, Yanow S, Jelinska K, Gomperts R, Grossman D. Abortion restrictions in the US military: voices from women deployed overseas. Womens Health Issues. 2011;21(4):259-264. doi:10.1016/j.whi.2011.04.014

5. Roberts TA, Smalley JM, Baker LL, Weir LF, Adelman WP. Influence of military contraceptive policy changes on contraception use and childbirth rates among new recruits. Am J Obstet Gynecol. 2020;223(2):223.e1-223.e10. doi:10.1016/j.ajog.2020.01.060

6. Lotridge JA, Stahlman SL, Patel DM, Chauhan AV, Mcquistan AA, Wells N. Long-acting reversible contraceptive use, active component service women, US Armed Forces, 2016-2020. MSMR. 2021;28(7):2-10. Published 2021 Jul 1.PMID: 34542257

DISCLOSURES:

Study authors report no competing financial interests or personal relationships. The research did not receive any specific grant from public, commercial, or not-for-profit funding agencies.