Assessing Reproductive Health Among Active-Duty Service Women in the U.S. Marine Corps

Assessing Reproductive Health Among Active-Duty Service Women in the U.S. Marine Corps: Results from Respondents to the Women's Reproductive Health Survey

Health Care Utilization

• 60.7% said it was usually or always easy to get an appointment with an MHS provider
• 51.5% were able to get an appointment with a primary care physician within 7 days (the TRICARE guideline for a general health care visit is 7 days)
• 69.4% were able to get an appointment with an OBGYN within 28 days (the TRICARE guideline for a specialty care visit is 4 weeks)

Birth Control and Contraception Use

• 47.7% obtained birth control from the MHS in the past 12 months
• During the most recent periodic health assessment (PHA), an MHS provider
  • discussed benefits, side effects, and risks of different types of birth control with 27.4%
  • discussed using birth control methods to reduce or suppress menstruation with 25.4%
  • discussed protection against sexually transmitted infections, including condom use, with 37.4%
• 15.3% were ever unable to get their preferred birth control method from the MHS
• 38.2% were more comfortable getting birth control from providers outside the MHS
• 65.0% ever needed or wanted to regulate or suppress menstruation since joining the military

Fertility and Pregnancy

• 17.9% were pregnant in the past 12 months
• Among pregnancies in the past 12 months, 26.9% ended in miscarriage
• The unintended pregnancy rate in the past 12 months was 6.3%
• 47.9% used no contraception at the time of unintended pregnancy
• 64.7% of those who had a past-year pregnancy reported depression during or after pregnancy; of those, 38.5% sought care from a health care provider
• 45.8% of those who had a past-year pregnancy talked to an MHS provider about postpartum depression

Infertility

• 9.6% ever tried to conceive for 12 months or more and were not successful
• 10.0% were told by a doctor that they had fertility problems not related to age
• 7.7% saw an MHS provider and 4.4% saw a non-MHS provider to discuss ways to help get pregnant
• Advice, infertility testing, and drugs to improve ovulation were the three most common infertility treatments received both inside and outside the MHS
• Among ADSW who received infertility treatment through the MHS, 30.8% stopped the service or treatment before getting pregnant
  • Wait for services or treatment being too long was the most common reason for stopping treatment
• Since joining the military, 9.4% wanted help to get pregnant but did not receive it

Reproductive Health During Training, Predeployment, and Deployment

• Among those deployed in the past 24 months, 19.2% received any predeployment contraceptive counseling from an MHS provider
• 35.2% received their preferred method of birth control prior to deployment, if deployed in the past 24 months
• 26.4% had ongoing access to birth control or contraceptives through the MHS during the most recent deployment in the past 24 months
• 38.2% ever had a urinary tract infection (UTI) or vaginal infection during field exercises or extended training
  • Among those with a UTI or vaginal infection, 44.1% were sometimes or always able to get care
  • Among those with a UTI or vaginal infection, 66.5% indicated that such infections sometimes or always interfered with military job duties or performance
• 22.0% ever had a UTI or vaginal infection during deployment
  • Among those with a UTI or vaginal infection during deployment, 74.3% were sometimes or always able to get care
• 51.7% sometimes or often lacked access to personal hygiene products, and 54.9% sometimes or often lacked access to bathing facilities to address hygiene needs during training
• 40.1% sometimes or often lacked access to personal hygiene products, and 34.9% sometimes or often lacked access to bathing facilities to address hygiene needs during a deployment in the past 24 months

The Women's Reproductive Health Survey (WRHS) of active-duty service members represents the first U.S. Department of Defense–wide survey of only active-duty service women (ADSW) since 1998. The survey focused on several domains: health care utilization; use of birth control and receipt of contraceptive counseling; reproductive health during training, predeployment, and deployment; fertility and pregnancy; and infertility.

Methodology

The WRHS was a web-based confidential survey, fielded between August 2020 and November 2020. The representative sample consisted of randomly selected ADSW in the U.S. Air Force, Army, Marine Corps, and Navy, excluding trainees and those above flag rank, and a census of Coast Guard ADSW below flag rank.¹

The final analytic sample consisted of 23,950 ADSW who responded to the survey and completed at least 50% of questions on contraceptive access. The overall weighted response rate was 17.8%; the response rate in the Marine Corps was 14.9%.

A single imputation process with a sequential imputation model and predictive mean matching was used to account for missing data. Less than 4% of data were missing, mostly owing to survey drop-off.

All analyses use analytic weights, which are the product of design weights (that account for the sampling approach) and nonresponse weights (that account for differential propensity for response based on respondent characteristics). Use of the weights results in a representative sample on many important demographic and military characteristics (e.g., age, race/ethnicity, marital status, education level, number of dependents, service branch, pay grade, years of service, occupation code, recent deployment, and Armed Forces Qualification Test score).

¹ Note that the Space Force is not included in the survey as a separate branch and is treated as part of the Air Force in the analysis. At the time of the survey, the female Space Force population was too small to sample on its own.

Limitations

There are several limitations to this research. First, WRHS response rates are low, although higher than in many recent U.S. Department of Defense–wide surveys. Second, for some subgroups, sample sizes are small; in these instances, estimates are suppressed for confidentiality. Third, the survey language did not specify whether care provided within the Military Health System (MHS) refers only to direct care at military treatment facilities or also includes care elsewhere through TRICARE. Fourth, the survey was fielded during the COVID-19 pandemic, although the impact of the pandemic on the study, if any, is not known.

This infographic depicts work done in the RAND National Security Research Division and documented in The Women's Reproductive Health Survey (WRHS) of Active-Duty Service Members, by Sarah O. Meadows, Rebecca L. Collins, Megan S. Schuler, Robin L. Beckman, and Matthew Cefalu, RR-A1031-1, 2022 (available at www.rand.org/t/RRA1031-1). To view this infographic online, visit www.rand.org/t/IGA1031-4. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. RAND® is a registered trademark.

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