Intended and Unintended Pregnancies: Social Determinants and Pregnancy Mental Health from a Decade of Military Research

INTRODUCTION: Unintended pregnancy is linked to maternal depression, substance use, late prenatal care, low birthweight, and preterm birth. Our objective was to examine the incidence of unintended pregnancies in the military, the effects on maternal mental health and the effects of Social Determinants of Health (SDOH).

MATERIALS AND METHODS: This was an institutional research board-approved secondary analysis of two independent military datasets of pregnant individuals participating in two prospective clinical trials of a pregnancy mentorship program, collected 2012-2017 (n = 246) and 2018-2022 (n = 1,523), and compared to assess relationships of SDOH and maternal mental health measures for those with and without intended pregnancies.

RESULTS: The rate of unintended pregnancy reported by participants was higher, 42.8% in 2012-2017 compared to 34.4% in 2018-2022. The rates of unintended pregnancy in both periods were lower than the national average and was lower in the second study period compared to the first. There were significantly higher scores for both anxiety and depression for those with unintended pregnancies, regardless of the sample. Over the same periods, the perception of support (as measured by the social support index) was higher in 2012-2017 compared to 2018-2022. Although the measures do not significantly differ by age, military branch, or rank, there was a significant relationship between the level of education and a lower rate of unintended pregnancy.

CONCLUSION: Exploration of Military Health System pregnancy data is important as it provides one of the best pictures of family and force readiness. The recent issue of unintended pregnancy and the increasing incidence of depression and anxiety, with lowered perceived support have long-term implications for the overall health and well-being of the U.S. military force, which demands continued investigation.