Factors associated with contraception use among active duty service members at a large military base

Abstract: INTRODUCTION: Active duty service members (ADSMs) experience higher rates of unintended pregnancy compared to the general population. While the military has introduced programs aimed at improving access to sexual and reproductive healthcare services (SRH), significant barriers to care remain. MATERIALS AND METHODS: A survey was completed by ADSMs with access to no-cost, walk-in SRH. Descriptive statistics, univariable analyses, and multivariable logistic regression analyses examined the association of ADSM characteristics with SRH outcomes. RESULTS: Of 1,077 participants (72% male, 61% <25 years), 49% reported intercourse that could result in pregnancy in the past 3 months, and 21% reported that they or their partners used emergency contraception in the past year. Overall, 51% of those who sought SRH reported barriers, such as feeling judged, lack of knowledge of available services, difficulty booking appointments, and/or work schedules. Female ADSMs (n = 133/228, 58%) were more likely than male ADSMs (n = 133/296, 45%) to report experiencing a barrier (Odds Ratio (OR) = 1.8, 95% Confidence Interval (CI), 1.3-2.6; P = .001).In univariable logistic regression analysis, ADSMs who experienced barriers getting SRH (OR=1.6, 95% CI, 1.1-2.5) or believed that receiving SRH care can negatively affect their careers (OR=3.7, 95% CI, 1.9-7.2) were more likely to use emergency contraception than those who did not. In multivariable logistic regression analysis of ADSMs with a history of sexual intercourse, adjusting for race, ethnicity, reported SRH barriers, use of a military clinic, and current contraceptive use, emergency contraception use by an ADSM or their partner in the past year was associated with being <25 years old (aOR = 2.8, 95% CI, 1.6-4.8) and believing that seeking SRH could negatively impact their career (aOR = 4.7, 95% CI, 1.5-14.7). CONCLUSIONS: Active duty service members commonly perceive judgment and systemic barriers when accessing SRH. Active duty service members may benefit from additional efforts to destigmatize SRH and facilitate access to patient-centered SRH.