Exploring Contraceptive Care and Access Experiences of Veterans

Practical access to contraceptive care and the ability to choose care that meets one's needs and preferences are important for an individual's health and well-being in the United States. Although a significant amount of research has been done to examine access to contraceptive care, particularly among civilian women, there is significantly less understanding about the contraceptive needs, preferences, and experiences of veteran men and women.

Issue

Arnold Ventures Contraceptive Choice and Access program is focused on closing gaps in access and choice for all people. Veterans are an often overlooked population in the provision of contraceptive services, and prior research about birth control choice and access among veterans has generally been limited to women's experiences within the Veterans Health Administration (VHA). In this study, we seek to provide unique data-driven insights into the experiences of men and women veterans within and outside VHA that have not been adequately explored.

Approach

Our study aimed to gather a representative sample of U.S. veterans aged 18 to 49 to investigate contraceptive access and choices. We integrated a quantitative survey approach with qualitative interviews to enrich the understanding of our survey findings. Our survey development process included a review of prior validated surveys that are relevant to contraceptive access. We employed weighted analyses to ensure representative data and allow robust comparisons across different groups of veterans. In addition to the survey, we conducted 53 semi-structured interviews to delve deeper into the experiences of veterans regarding contraceptive use and access. The interviews were analyzed using a deductive approach to identify the key themes and factors that influence contraceptive decisions.

Key Findings

Our study resulted in the following key findings:

• Only about one in four veterans reported that they believe hormonal birth control is safe.
• In response to survey questions about contraceptive knowledge, veterans answered fewer than one-half of the questions correctly or indicated that they did not know the answers. Veterans' contraceptive knowledge tended to be stronger about more-general topics, such as that condoms prevent sexually transmitted infections, than about specific methods, such as the timing for vaginal rings.
• Only 10 percent of veterans discussed birth control with their providers in the past year; most of these discussions occurred outside VHA.
• Veterans reported that they trust providers to supply contraceptive information but often must raise the topic themselves.
• More than one in two veterans and their partners reported that it is very important for them not to become pregnant in the next month, and slightly more than one in five veterans are using contraceptives.
• The most used contraceptive methods reported by veterans are condoms and pills, followed by withdrawal and intrauterine devices.
• Most veterans perceived their contraceptive needs as similar to those of civilians, although a subset of veterans mentioned unique factors, such as military-related exposures (e.g., post-traumatic stress disorder, harmful substances, sensitive information), that influence their reproductive decisions.
• Veterans reported few explicit barriers to contraceptive care, although male veterans often reported that contraception is viewed as a female topic and that they are hesitant to raise it with providers.
• Supplemental analyses showed that, when compared with a civilian sample, male and female veterans had higher self-reported sterilization rates; male veterans reported lower condom use.

Recommendations

Our recommendations are as follows:

• VHA or other veteran-serving organizations should establish more-comprehensive education programs that are targeted to veterans of reproductive age and that are not gender-specific. These programs could include different learning opportunities to address common misconceptions and provide accurate information about the benefits and risks of various birth control methods.
• VHA and veteran-serving organizations should enhance communication strategies about the availability of resources and family planning and contraception benefits. By developing clear communications to convey offerings—which could include pamphlets, brochures, or other digital content on websites—VHA and other veteran-serving organizations could ensure that veterans are aware of the services that are available to them after they transition from the military.
• Veterans generally viewed providers as their most trusted source of information about contraception, yet most were not discussing contraception with their providers. VHA could consider expanding comprehensive contraceptive counseling training for providers beyond women's health primary care providers. For non-VHA providers, efforts to improve education and awareness about proactively counseling patients on their options, particularly for male patients, should be explored by medical associations for the provider specialties that would tend to reach these populations (e.g., urology, family medicine, internal medicine).