Long-acting contraceptive placement among us army servicewomen

Abstract

Objectives: We aimed to quantify the uptake of long-acting reversible contraceptive (LARC) methods — that is, intrauterine devices (IUD) and hormonal implants — among active-duty female soldiers in the US Army; and describe characteristics associated with LARC method uptake. Methods: We analyzed the Stanford Military Data Repository, which includes all digitally recorded health encounters for active-duty US Army soldiers from 2011 to 2014. We calculated percentages of soldiers receiving LARC methods and used multivariable logistic regression to test for associations between LARC method placement and diverse demographic and military characteristics. Results: Among 114,615 servicewomen aged 18–44 (median observation period 38 months, IQR, 30–47), 14.2% received a LARC method (8.5% IUDs, 6.4% implants). While annual IUD insertions were stable, implant insertions steadily increased between 2011 and 2014 (from 1468 to 2468/year). Implant uptake was more common among younger women: 44% of placements occurred among women younger than 23, compared with 22% of IUDs. Having had a child increased the likelihood of implant placement and more than doubled IUD placement (OR, 1.28; 95% CI, 1.18–1.38; OR, 2.20; 95% CI, 2.08–2.34, respectively). Married women were more likely to receive an IUD (OR, 1.60; 95% CI, 1.52–1.70), but marital status was not associated with implant placement. Conclusions: Uptake of contraceptive implants is increasing among women soldiers, while IUD uptake remains stable. Unmarried soldiers are less likely to receive IUDs and soldiers without children are less likely to receive either LARC method, suggesting a continued need for education about method safety and reversibility with the goal of preventing unintended pregnancies among women in the army.