Facilitators and barriers to contraceptive use among US servicewomen who had an abortion

Introduction: Despite evidence that the unintended pregnancy rate is higher among U.S. servicewomen than the general population and that servicewomen may face barriers to contraceptive use, there is little research about contraceptive access and use experiences of non-deployed active duty servicewomen. This qualitative study aimed to explore the experiences of accessing contraception while in the U.S. military among active duty servicewomen who had an abortion.

Materials and Methods: From January 2015 to July 2016, we conducted qualitative in-depth interviews with 21 servicewomen who had obtained an abortion within the prior two years while active duty. The interviews included questions about participants’ experiences accessing and using contraception while in the military. Interviews were transcribed and analyzed thematically using inductive and deductive coding. Ethical approval was obtained from the Allendale Investigational Review Board.

Results: Over half of the respondents had ever obtained contraception from the military and had positive feelings about the military’s contraceptive services; however, the vast majority of participants described barriers to contraceptive access in the military. Many identified barriers that were related to the military health care system, including inadequate counseling, challenges getting a preferred contraceptive method, and the structure and functioning of the military health system, or were a result of the demands of military service. In addition to these factors that were directly related to being in the military, respondents identified barriers not directly related to service, including contraceptive adherence, product concerns, and side effects; although not directly related to their service, in some cases, these barriers were exacerbated by their career.

Conclusions: Active duty servicewomen who had an abortion experienced many barriers to accessing contraception while in the military. These findings highlight the need to improve contraceptive counseling and access in the U.S. military. Results support the need to implement mandatory yearly and pre-deployment contraceptive counseling as required by the 2016 National Defense Authorization Act, offer contraceptive counseling in multiple settings, ensure military providers receive training to avoid contraceptive coercion, expand military clinic and pharmacy hours, increase the number of female military health care providers and providers able to administer all forms of contraception, and expand the contraceptive methods included under the Basic Core Formulary. Limitations to this study include that participants were self-selected and were asked to recall experiences up to several years in the past. Future studies should evaluate representative samples to understand the proportion of servicewomen with unmet contraceptive need.