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 Although unintended pregnancies are more common in the military than
among U.S. women in general, military treatment facilities and
Tricare, the military health insurance program for active duty
service members, only offer abortions in cases of rape, incest or
life endangerment, researchers note in the journal Military
Medicine.
For current study, researchers interviewed 21 active duty
servicewomen, ranging in age from 19 to 34, about their experiences
accessing and using contraception after an abortion.
Military treatment facilities and Tricare cover a wide range of
contraceptives including daily pills, long-acting implanted devices
and emergency contraception pills. But the women described barriers
to contraception use related to the military medical system,
including inadequate contraceptive counseling, poor continuity of
care, long wait times, limited contraceptive method options and
feelings of judgment from military healthcare providers, said lead
study author Jane Seymour of Ibis Reproductive Health in Cambridge,
Massachusetts.
Even when they did get birth control, women still faced hurdles,
Seymour said by email.
"Because of their busy and/or inconsistent military work schedules,
it could be difficult to remember to use contraception, and side
effects of contraception, such as weight gain, were incompatible
with their service," Seymour said.
"While challenges with contraception access and use are not unique
to servicewomen, our current study identified barriers directly
related to military service that should be addressed in order to
improve access to contraception for U.S. servicewomen," Seymour
added.
As of 2011, the unintended pregnancy rate among U.S. servicewomen
was more than one-and-a-half times the rate in the general U.S.
population: 72 versus 45 unintended pregnancies for every 1,000
women, researchers note.
These high unintended pregnancy rates may be explained by gaps in
contraceptive access, failure to use birth control correctly or
consistently, or reliance on less effective methods among
servicewomen, the study team writes.
In a 2011 survey, for example, 41 percent of servicewomen who
experienced an unintended pregnancy in the prior year reported not
using birth control and another 19 percent said they had used the
withdrawal or rhythm methods at the time of their pregnancy.
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More than half of the women in the current study reported getting
contraception from the military at some point in time and had
positive feelings about the military's contraceptive services.
The majority - 14 of the 21 - said they had used contraception in
the three to six months prior to the pregnancy that resulted in
their most recent abortion.
Among women on contraception, four participants said their chosen
method of birth control failed; four said they hadn't used it
consistently; and four said they had stopped using birth control
altogether before they conceived.
In addition to unique barriers to accessing and using contraceptives
that might be attributed to military service, the women also cited a
lot of issues that could hold true for women from other walks of
life, including concerns about safety and side effects and
forgetting to take or refill pills.
"It is very difficult to speculate what obstacles individual women
may experience and which of these are specific to military women,"
said Dr. Catherine Witkop, a colonel in the U.S. Air Force and a
women's health researcher at the Uniformed Services University of
the Health Sciences in Bethesda, Maryland.
"Contraceptive services for military women are generally available
at most military treatment facilities and military women are not
limited by challenges with insurance or affordability, as is the
case for some women outside the military," Witkop, who wasn't
involved in the study, said by email.
It is possible that some deployed women might lack access to a full
range of options like hormonal implants because of limited supplies
or limited numbers of providers trained to insert long-acting
contraceptives, Witkop added. Servicewomen who have an abortion
should have the same options as other women in the military, she
said.
SOURCE: https://bit.ly/2SyTWyq Military Medicine, online December 7,
2018.
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