Preventing Unintended Pregnancy and Meeting Contraception Needs in the U.S. Army

Effective contraception is essential for U.S. Army Women (USAW), most of whom are of reproductive age and at risk for unintended pregnancy. In this study, we use the Periodic Health Assessment (PHA) to identify contraception needs and electronic health records (EHR) to identify pregnancy events within the Military Health System (MHS).

This was retrospective cohort from August 31, 2021, to August 31, 2023 of PHAs, electronic health records, and pharmacy records obtained from the Armed Forces Surveillance division. The population was USAW who completed 2 PHAs during the study period (n = 23,015). Inclusion criteria were being female sex, 18-45 years, and need for contraception (n = 10,679). Need for contraception was defined as sexually active women with a uterus, who do not plan to conceive over the following 12 months. This was further divided into a "met" or "unmet" need. A met need was defined as use of sterilization, long and short-acting reversible contraceptives, or barrier methods. An unmet need was defined as those not desiring pregnancy and not using contraception. The prevalence of reproductive-aged USAW with need for contraception who are on (needs meet) or not on (needs unmet) contraception along with rate of pregnancy was obtained.

Overall prevalence of unmet need for contraception was 18.3%. Junior Officers were 2.24 times (95% CI, 1.89-2.64) more likely than junior enlisted to have contraception needs met after adjusting for other factors. Black/African U.S. U.S. Army Women had significantly lower odds (0.57; 95% CI, 0.50-0.65) of having their needs met compared to their non-Hispanic White counterparts. An unmet need was associated with increased risk of unintended pregnancy (adjusted OR = 2.46, 95% CI, 2.10-2.88).

Twenty percent of USAW with a need for contraception potentially had that need unmet over 12 months, which resulted in twice the rate unintended pregnancy compared to those with a met need. The military may consider using the PHA and other proactive strategies to address this issue.