Late Breaking News
Access to Contraceptives
- Categorized in: 2013 Compendium of Federal Medicine, Department of Defense (DoD), News, Women's Health
While most forms of contraception are covered by TRICARE, the majority of respondents reported that they were not counseled on pregnancy prevention or menstrual suppression prior to deployment.
“It is critical that women in the military have information about and access to the full range of contraceptive methods so they can select and use the method that will work best for them,” Grindlay said.
Military women also need specific counseling on the best options during deployment, as some preferred contraceptive methods are unsuitable in theater. The vaginal ring requires refrigeration, and the pill must be taken at the same time each day, both difficult conditions to meet when deployed. Other forms, such as the patch, may be affected by transportation delays.
In deployed settings, there also can be challenges with user-dependent methods, including the pill and condoms, and difficulty obtaining refills so other options may work better.
“Healthcare providers and women in the military should be educated on the availability and use of long-acting reversible contraceptives such as intrauterine devices and the contraceptive implant,” Grindlay urged.
In addition, some methods also suppress menstruation, she noted.
If long-acting contraceptives are not prescribed, women should receive sufficient supplies to last their full tour to avoid problems with refills and increase the likelihood of method continuation, she suggested.
-Photo by Staff Sgt. Kenneth Pawlak
Many servicewomen do not ask healthcare providers about contraception, particularly prior to deployment because they do not anticipate needing it, Grindlay said.
Consequently, a discussion of contraception should be a topic of discussion during a woman’s annual health examination and pre-deployment check-ups.
“Another factor deterring some women from seeking contraception was confusion about prohibition of sexual activity,” wrote the authors.
“Current regulations make sexual relationships a chargeable offence in a number of circumstances,” explained Grindlay, who added that “confusion or concern about these policies may put women at increased risk of unintended pregnancy, since some are led to believe they won’t need contraception and because they may be fearful of asking for contraception.”
Role of Sexual Assault
The high rate of sexual assault also contributes to the unintended pregnancy rate, according to Grindlay. “As many as 45% of servicewomen experience military sexual violence,” she said. DoD estimates that 86% of military rapes or attempted rapes go unreported.
To reduce the incidence of rape and resulting pregnancies, the services should follow the recommendations of the Institute of Medicine’s recent report, Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families, noted Grindlay.
The recommendations include strengthening policies to eliminate military sexual violence and reinforcing existing policies on military sexual violence by adding specific mandatory evaluation criteria concerning sexual assault into formal performance-appraisal and promotion systems issues for military leaders.
The latest Department of Defense Annual Report on Sexual Assault shows that some progress has been made in this area. In 2011, 3,192 reports of sexual assault resulted in disciplinary action against 791 subjects. Of those, 62% had courts-martial charges against them, up 10 percentage points from 2010, and more than twice the 30% rate initiated in 2007.
1 Grindlay K, Grossman D. Unintended pregnancy among active-duty women in the United States military, 2008. Obstet Gynecol. 2013 Feb;121(2 Pt 1):241-6. doi: http://10.1097/ AOG.0b013e31827c616e. PubMed PMID: 23344272.
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