Racial Disparities in Highly Effective Contraceptive Use Among U.S. Active Duty Servicewomen, Fiscal Years 2016-2019

Previous studies have found that unintended pregnancy rates are higher among racial minorities and active duty servicewomen (ADSW), correlating with lower rates of effective contraceptive use. The Military Health System (MHS) provides universal health care benefit coverage for all ADSW, including access to all highly effective contraceptive (HEC) methods. This study investigated the association between race and HEC use among ADSW. We conducted a cross-sectional study using fiscal year 2016-2019 data from the MHS Data Repository for all ADSW ages 18-45 years. Statistical analyses included descriptive statistics and logistic regression models, adjusted and unadjusted, determining the odds of HEC use, overall and by method. Of the 729,722 ADSW included in the study, 59.7% used at least one HEC during the study period. The highest proportions of users were aged 20-24 years, White, single, Junior Enlisted, and serving in the Army. Lower odds of HEC use were demonstrated in Black (odds ratio [OR] = 0.94, 95% confidence interval [CI] = 0.92-0.95), American Indian/Alaska Native (OR = 0.85, 95% CI = 0.82-0.89), Asian/Pacific Islander (OR = 0.81, 95% CI = 0.80-0.83), and Other (OR = 0.97, 95% CI = 0.94-0.99) ADSW compared with White ADSW. Universal coverage of this optional preventive service did not guarantee its use. The MHS can serve as a model for monitoring racial disparities in HEC use.