According to a recent study published in the American Journal of Obstetrics & Gynecology, rates of postpartum long-acting reversible contraception (LARC) are low among active-duty US Army servicewomen.
Takeaways
- Rates of postpartum long-acting reversible contraception (LARC) are low among active-duty US Army servicewomen.
- Most active-duty US Army servicewomen are of reproductive age, making reproductive health trends vital to evaluate in this population.
- Servicewomen experience higher rates of unintended pregnancy compared to US civilians, highlighting the need for further research and support for reproductive healthcare for military women.
- A retrospective cohort study was conducted to identify postpartum LARC uptake among active-duty US Army soldiers from 2014 to 2017, revealing that less than 20% of participants used LARC in the month of delivery or within 3 months.
- Postpartum LARC use varied based on age and race, with younger women and White women more likely to receive it, while Black women had lower odds of postpartum LARC use. Efforts were recommended to improve access to early postpartum LARC among this population.
Sixteen percent of active-duty personnel and 19% of active-duty officers are women, with rates of women in the US military rising since the 1970s. Most of these women are of reproductive age, making reproductive health trends vital to evaluate in this population.
Servicewomen experience increased rates of unintended pregnancy compares to US civilians, but more research on reproductive healthcare for military women is necessary. To identify postpartum LARC uptake among active-duty US Army soldiers from 2014 to 2017, as well as associated demographic and military characteristics, investigators conducted a retrospective cohort study.
Data was collected from the Stanford Military Data Repository, a longitudinal data set containing medical encounter information for active-duty US Army soldiers. Participants included active-duty US Army soldiers aged 18 to 44 years from January 2014 to June 2017, with at least 3 months of available data following delivery.
LARC use was reported as the primary outcome of the analysis, including subdermal hormone implants and intrauterine devices (IUDs). Postpartum LARC use was defined by study authors as, “initiation in the month of delivery or in the 3 subsequent calendar months.”
Immediate postpartum LARC, defined as initiation in the same month as delivery, was also reported. Use of permanent contraception such as tubal ligation and hysterectomy was also evaluated.
Demographic factors included race and ethnicity, age, marital status, education status, and faith identification. Military pay grade at the time of first delivery was also obtained to determine socioeconomic status.
There were 15,843 participants included in the final analysis, aged a mean 26.9 years at the time of delivery. LARC in the month of delivery or within 3 months was reported in 19.96% of participants. Immediate postpartum LARC was reported in 4.5% of these patients and 0.89% of the total study population.
Of patients who received postpartum LARC, 57% received an IUD, 42% an implant, and 0.98% both. Seventy percent of LARCs were received within 3 months after delivery, with the second month following delivery having the highest concentration of LARC placements.
Postpartum LARC was more common in patients who were White, younger, within the second lowest pay grade category, and with a lower educational attainment. The odds of postpartum LARC placement when compared to women aged 18 to 22 years was 12% in women aged 23 to 25 years, 23% in women aged 26 to 29 years, and 48% in women aged 30 years or older.
Black women had 18% decreased odds of postpartum LARC compared to White women. However, differences were not observed based on Hispanic ethnicity.
These results indicated low rates of postpartum LARC use among active-duty US Army servicewomen of a reproductive age, with rates varying based on age and race. Investigators recommended efforts be made to ensure early postpartum LARC access among this population.
Reference
Eastin EF, Nelson A, Shaw JG, Shaw KA, Kurina LM. Postpartum long-acting reversible contraceptive use among active-duty, female US Army soldiers. American Journal of Obstetrics & Gynecology. 2023;229(4):432.E1-432.E12. doi:10.1016/j.ajog.2023.07.023
