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Military women may face barriers to contraception

(Reuters Health) – Female soldiers on active duty may struggle to get contraception, a small U.S. study suggests.

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.

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: Military Medicine, online December 7, 2018.

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