Reproductive Health Care Available To Women On Active Duty And Veterans Should Be Reassessed

Noting that active-duty servicewomen have higher rates of unintended pregnancy than the general population and lower reported contraception use, one researcher at Women & Infants Hospital is suggesting the answer might be a review of the health care offered to females in the military and veterans.

Vinita Goyal, MD, MPH, published the study "Unintended pregnancy and contraception among active-duty servicewomen and veterans" in a recent issue of the American Journal of Obstetrics & Gynecology. As part of her research, conducted in cooperation with the Veteran's Administration (VA) Hospital in Providence, she studied the reproductive health care available to American military women domestically and abroad, rules in the military that may preclude women from seeking contraception, and the results of unintended pregnancy on the military and the lives of military women.

"Because of its potentially high burden for military women as well as the impact on military operations, prevention of unintended pregnancy is one reproductive health issue of particular importance," Dr. Goyal said. "For the women, who face barriers to early prenatal care and abortion services in the military, unwanted pregnancy restricts their career achievement potential and limits their earning capacity."

The numbers of women in the military has soared in the last few decades. Today, women make up 20% of new military recruits, 15% of active-duty military personnel, and 17% of reserve and National Guard forces. Almost all of these women are of child-bearing age. Studies included in Dr. Goyal's review indicate that reproductive health services available to military women can be improved upon.

"Health care providers within the community, as well as those in the Department of Defense (DOD) and VA, need to be aware of the reproductive health needs of this population," she said, adding that this includes contraception services domestically and abroad because many women in the military today have experienced an unintentional pregnancy. This, she explained, can be detrimental to all parties involved.

In a 2005 DOD survey, 16.29% of military women 20 years old or younger reported an unintended pregnancy in the previous year. In the general population that year, the total pregnancy rate of intended and unintended pregnancies was 7.1% for the same age women. Demographically, Dr. Goyal cited several reasons for the difference, noting that women in the military are predominantly:
Young
Unmarried
Of lower educational achievement
Of lower socioeconomic status
Racial minorities
In addition, she found that contraceptive use among sexually active military women was low.

"(Research shows that) 50 to 62% of servicewomen presenting with an unintended pregnancy were not using contraception when they conceived," Dr. Goyal reported. "Similar surveys of active-duty personnel of reproductive age demonstrate that although 70 to 85% were sexually active, nearly 40% used no contraception."

This could be the result of lack of access or other factors, including the fact that the military prohibits sexual intercourse outside of marriage and contraception can be viewed as incriminating evidence. She also pointed to the need for additional training of military health care providers.

"Health care providers and the servicewomen themselves need to be more educated about contraceptives. Deployed servicewomen have reported a lack of confidence in the contraceptive knowledge of military medical personnel stationed overseas," Dr. Goyal said.

In conclusion, Dr. Goyal suggested reproductive health education for military and VA health care providers as well as the servicewomen themselves, increasing awareness among civilian providers about reproductive health issues faced by military women, and making emergency contraception available to help reduce unplanned pregnancy. Use of hormonal contraception for menstrual suppression could also prove beneficial for women who face challenges managing their menstrual cycles while deployed.

"Understanding and addressing the needs of these women will give health care providers an opportunity to improve reproductive health care as well as pregnancy outcomes for this population," she said.