Using Periodic Health Assessments to Assess Unmet Need for Contraception and Subsequent Risk of Unintended Pregnancy Among Active-Duty Service Women in the U.S. Army

Abstract

Introduction: The increasing representation of women in the military, and over 97% of Active-Duty Service Women (ADSW) of reproductive age, there is a need for effective contraception services for women. Despite universal healthcare coverage, including no-cost contraception, a significant proportion of ADSW experience unmet contraception needs, leading to higher rates of unintended pregnancies. This study examines the effectiveness of the Periodic Health Assessment (PHA) as a tool for identifying and addressing ADSW's contraception needs within the Military Health System (MHS). Methods: A retrospective cohort study was conducted among ADSW in the Regular Army from August 31, 2021, to August 31, 2023. Data from the Armed Forces Health Surveillance Division's Defense Medical Surveillance System database was analyzed, including PHAs, electronic health records, and pharmacy records. Inclusion criteria for the study were being female sex, serving in the RA, being over 18 years of age but under 46 years old at the time of initial PHA, and completing two or more PHAs during the study period. Contraception need was determined based on PHA survey responses, categorizing ADSW into groups either having met or unmet contraception needs, based on responses to PHA questions on pregnancy desire, sexual practices, and contraception. Results: Out of 23,015 ADSW included in the study, 46.4% expressed a need for contraception. Among those, 25.3% had an unmet need within the MHS. ADSW with an unmet need for contraception experienced a 2.46 times higher rate of unintended pregnancy compared to those with met need. The study also revealed racial, rank, and occupational disparities in contraception access. Less than half of the women who expressed a desire for contraception services on their PHA received counseling. The mean duration from PHA completion to contraception counseling was 114 days. Conclusions: This study describes a critical gap in contraception services provided for ADSW within the MHS, despite the availability of universal healthcare. The PHA has potential as a valuable tool for improving contraception access and suggests that optimizing its use could significantly reduce unintended pregnancy rates in the military population. Addressing the identified disparities and systemic barriers to contraception access may be essential for enhancing reproductive health services and supporting military readiness.