Association Between Same-day Intrauterine Device Placement and Contraceptive Outcomes in the Military Health System

Access to reliable contraception, such as intrauterine devices (IUDs), is critical for the health and operational readiness of female active duty service members. Although same-day contraceptive services (SDCS) are the recommended standard of care to reduce logistical barriers, large-scale empirical data on their association with contraceptive continuation within the Military Health System remains limited. This study evaluated the association between the documented patient-level receipt of SDCS and IUD-related outcomes, while also assessing the influence of area-level socioeconomic proxies.

A retrospective cohort study utilized administrative data for active duty females who received an IUD between January 2011 and March 2025. To minimize selection bias and estimate the Average Treatment Effect in the Treated, researchers implemented 1:1 nearest-neighbor propensity score matching. The primary exposure was the documented receipt of SDCS. Mutually exclusive primary outcomes-IUD removal, reinsertion, mechanical failure, and pregnancy without documented removal-were analyzed using Fine-Gray competing risks models over a 36-month follow-up period.

The final matched cohort comprised 14,446 service members (7,223 per group). SDCS receipt was associated with a 10% lower relative hazard of IUD removal (subdistribution hazard ratio [SHR] 0.90; 95% confidence interval 0.85-0.96), corresponding to a reduction in absolute event counts over 36 months (1,952 vs. 2,191 removals). SDCS was not associated with meaningful differences in the hazard of IUD reinsertion, mechanical failure, or pregnancy. Area-level socioeconomic proxies demonstrated complex relationships; low-income duty locations were associated with higher hazards of removal (SHR 1.08) and mechanical failure (SHR 1.58), but a lower hazard of pregnancy.

The documented receipt of same-day IUD services is associated with improved contraceptive continuation among active duty service members, suggesting that reducing logistical barriers to access supports contraceptive longevity. However, universal healthcare access does not completely eliminate area-level socioeconomic disparities in specific contraceptive outcomes.