Staff Sgt. Kabriya Mason, a Pregnancy/Postpartum Physical Training Program exercise leader, assigned to the 52nd Brigade Engineer Battalion, 2nd Stryker Brigade Combat Team, 4th Infantry Division, leads a physical training session for pregnant and postpartum Soldiers at Fort Carson, CO, earlier this year. Soldier moms have 365 days after the birth of a child in the new Army Directive 2022-06 (Parenthood, Pregnancy, and Postpartum) before they take a record Army Combat Fitness Test and meet their height and weight standards. (U.S. Army photo by Sgt. Woodlyne Escarne)
BETHESDA, MD — Almost 45% percent of pregnancies in the United States are unintended, with an estimated 4.5% of reproductive age women having an unintended pregnancy each year. Recent research suggested that, among active-duty service women (ADSW) the percentage is even higher, with 54% of pregnancies being unintended—a figure that raises growing concerns about military readiness, particularly as women continue to make up an increasing percentage of the military.
To better understand the scope of unintended pregnancy in ADSW and its potential impact on military readiness—broadly defined as the military’s capacity to engage in combat and fulfill assigned missions and tasks—researchers at Henry M. Jackson Foundation for the Advancement of Military Medicine and Uniformed Services University turned to the Military Health System Data Repository, the centralized data repository that captures, archives and distributes Defense Health Agency corporate healthcare data worldwide.
Using fiscal year 2019 data from the repository, the researchers identified 230,596 active duty service women aged 18 to 44 in the Army, Air Force, Navy and Marine Corps and found that 12,564 (5.4%) gave birth in the same year. Using the expected prevalence of 54% of pregnancies resulting in these deliveries were unintended, the researchers estimated that 6,785 of all births among ADSW were unintended.1
Because postpartum women don’t have to meet height and weight standards or complete a physical fitness test for up to 365 days after a full-term delivery, the researchers calculated lost readiness days by multiplying the number of unintended pregnancies by 365 days. Their finding: Unintended pregnancies resulted in an estimated 2,476,364 maximum potential readiness days lost, the researchers reported.
“Medical readiness is a critical component of military readiness,” the researchers wrote in BMJ Military Health. “[Unintended pregnancies] among service members … affect individual medical readiness and ADSW’s ability to fully participate in their military career. This is due to the physical limitations, temporary duty restrictions, and limited deployment eligibility that result from pregnancy.”
“Women’s participation promotes long-term stability, both within and between states in fragile environments, particularly during democratic transitions,” the researchers wrote. “It is critical to sustaining lasting democratic institutions and civil society and is associated with lower propensity for conflict, both between and within states. Countries are more stable where there is gender equality and equity.”
The DoD has an implementation plan and is committed to Women, Peace & Security (WPS), a policy framework that acknowledges the critical roles women play in international peace and security efforts. That includes ensuring that women are prepared to have meaningful participation, the researchers wrote. “However, metrics that simply count the number of individuals or engagements do not describe the impact of an [unintended pregnancy on the Women Peace and Security Strategic Framework] objective to increase meaningful participation,” they wrote. “Decreasing the rates of [unintended pregnancies] among ADSW meets WPS objectives and increases the likelihood that security objectives are met.”
Stratifying the data by age, race, rank and branch of service, the researchers found the highest rates of unintended pregnancies were among women 18 to 24 years of age, white race in a junior enlisted rank and in the Army, suggesting interventions at reducing unintentional pregnancies among ADSW should target those demographic groups.
The researchers stated that ADSW should have no difficulties accessing reproductive healthcare, as the MHS provides universal access to care for all armed services members and their dependents. However, they said studies looking at reproductive healthcare access among ADSW have reported difficulty accessing reproductive health services due to inability to schedule an appointment, inability to take time off to attend appointments and fear of being judged. In fact, the use of contraceptives, known to decrease the risk of unintended pregnancies, is low among the demographic groups at highest risk.
“It is possible ADSW with [unintended pregnancies] who are less educated and young, may not understand that contraception is necessary and therefore do not access contraceptives,” the authors wrote. “For this reason, it is important that ADSW receive contraceptive counseling early in their military career.”
“Contraceptive education, such as mandatory group contraceptive counseling, is more effective if implemented early in the military career of ADSW, with best results if education is received during basic training and must ensure that ADSW understand the need for contraceptives in order to be most effective.”
The researchers concluded that “dealing with unintended pregnancies proactively, by encouraging comprehensive family planning and instituting additional reproductive health policies promoting, sex education and contraceptive options for servicemembers, would improve women’s ability to meaningfully participate to meet the DoD’s WPS objectives by ensuring that active-duty servicemembers can make informed decisions about their reproductive health while maintaining operational effectiveness.”
- Janvrin ML, Banaag A, Lawry LL, Scott R, Koehlmoos T. Estimates of unintended pregnancy among US active-duty service women and the impact on Women Peace and Security objectives as measured by potential readiness days lost. BMJ Mil Health. 2024 Jul 23:e002654. doi: 10.1136/military-2023-002654. Epub ahead of print. PMID: 39043431.
