Longitudinal Effect of United States Military Policy on Contraception Use and Childbirth Among Junior Enlisted [10OP

Abstract

INTRODUCTION: Contraceptive use and unintentional pregnancy rates among junior enlisted vary between United States service-branches, despite equal access to no-cost contraception. Therefore, branch-specific policy may influence contraceptive use. METHODS: Secondary analysis of insurance records from 92,072 servicewomen, who attended basic training between 2013 and 2017, assessing the longitudinal effect of changes in branch-specific contraceptive policy on rates of: longer-acting (depot-medroxyprogesterone, implant, and intrauterine) contraception use at six months on active duty; and childbirth during the first 24-months of active duty. Multivariable Logistic (contraception use) and Cox (time to childbirth) Regression models were used to compare outcomes before and after the intervention, between the service making the intervention and the other three branches, and the interaction between these variables. IRB approved. RESULTS: Group contraceptive education emphasizing implantable and intrauterine methods followed by individual contraceptive consultation with a provider for all female, Navy basic trainees increased longer-acting method use (11.8% to 24.3%, Interaction Term OR: 2.14 (95% CI: 1.92-2.39), P<.001) and decreased childbirth rates (7.5% to 6.3%, HR: 0.86 (0.76-0.88), P=.015). Restricting time away from training for implant or intrauterine method insertion during Marine Corps basic training and providing education emphasizing use of depot-medroxyprogesterone for menstrual control decreased overall longer-acting method use (16.2% to 10.0%, OR: 0.43 (0.38-0.49), P<.001) and increased childbirth rates (8.0% to 9.7%, HR: 1.24 (1.02-1.51), P=.027). Allowing contraceptive implant placement during basic training increased use of longer-acting contraception among Air Force recruits 4.4% to 6.9%, OR: 1.31 (1.14-1.51), P<.001). CONCLUSION: Branch-specific changes in military contraceptive policy significantly impact contraceptive use and childbirth rates among junior enlisted.