Counseling and other factors associated with contraceptive use among active duty US military servicewomen

Objectives: Contraceptive prescriptions among U.S. service women rose to 68.7% between 2008 and 2013, which was higher than that seen nationally among women between 2017 and 2019 (65.3%). The objective of this study was to provide estimates of contraceptive use and its determinants among active duty service women, with a particular focus on the associations with contraceptive counseling. Methods: This was a cross-sectional study using the 2018 Department of Defense Health Related Behaviors Survey of active duty service members. Data from 5353 active duty service women were analyzed. Weighted logistic regression models were used to identify factors associated with contraceptive use. We used a previous survey from 2015 to examine trends in contraceptive use. Results: The overall prevalence of contraceptive use was 60.6%, and only 40% had discussed contraception with a health care provider in the past year. Contraception counseling was associated with decreased contraceptive nonuse (adjusted odds ratio = 0.63). Being older, Black or Hispanic race or ethnicity, in the Army, enlisted, identifying as lesbian, gay, or bisexual, and having one or more same sex partners were associated with higher odds of contraceptive nonuse. Conclusions: Despite universal eligibility for free health care, contraceptive counseling and use among US military service women remain suboptimal, and significant disparities in contraceptive use exist by rank, race, ethnicity, and sexual orientation. Improving implementation and enforcement of existing military directives to provide routine contraceptive counseling and services during health care visits, such as through informatics tools, could lower unintended pregnancies, reduce inequities, and increase readiness.