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Research Questions

  1. Are requirements being met regarding ADSW's access to comprehensive family planning and counseling services on a full range of contraceptive methods?
  2. What reproductive health issues do DoD and Coast Guard ADSW face?

The Women's Reproductive Health Survey (WRHS) of active-duty service members represents the first time since the 1990s that the U.S. Department of Defense (DoD) has sponsored a department-wide survey of only service women. Maintaining the readiness of the U.S. armed forces requires attention to the health and health care needs of all who serve, including active-duty service women (ADSW). With respect to reproductive health, Congress passed two pieces of legislation in the 2016 and 2017 National Defense Authorization Acts that required DoD to provide ADSW access to comprehensive family planning and counseling services and to do so at predeployment and annual physical exams. The legislation also required DoD to conduct a survey of ADSW's experiences with family planning services and counseling and use and availability of preferred birth control methods.

RAND Corporation researchers developed the WRHS to address these two pieces of congressional legislation. The Coast Guard requested that RAND also field the survey among its ADSW. In this report, the authors detail the methodology, sample demographics, and results from the survey (conducted between early August and early November 2020) across a number of domains: health care utilization, birth control and contraceptive use, reproductive health during training and deployment, fertility and pregnancy, and infertility. Differences are examined by service branch, pay grade, age group, race/ethnicity, marital status, and sexual orientation. The results are intended to inform policy initiatives to help support the readiness, health, and well-being of ADSW.

Key Findings

  • Just over 60 percent of DoD ADSW (and just over half of Coast Guard ADSW) indicated that they received an appointment with a primary care physician within one week, and almost three-quarters of both DoD and Coast Guard ADSW indicated that they received an appointment with an OBGYN within 28 days, per TRICARE guidelines.
  • Of the 21 percent of DoD ADSW who had experienced a urinary tract or vaginal infection during a deployment in the two years prior to the survey, 64 percent indicated that it always or sometimes interfered with their performance or job duties. For ADSW in the Coast Guard, 12 reported an infection, and over three-quarters said that it always or sometimes interfered with their job.
  • Roughly 60 percent of both DoD and Coast Guard ADSW reported any current contraceptive use. Approximately three in ten were currently using a highly effective form of contraception.
  • Approximately one in five ADSW reported being unable to access their preferred form of birth control through the Military Health System (MHS) at some point since joining the military.
  • Among ADSW who deployed within the past 24 months, a minority reported receiving any contraceptive counseling from an MHS provider prior to deployment: 18 percent of DoD ADSW and 9 percent of Coast Guard ADSW.
  • Just over 16 percent of DoD ADSW and 13 percent of Coast Guard ADSW were pregnant in the one-year period covered by the survey. The unintended pregnancy rate was 5.9 percent.
  • Half of DoD ADSW (and 43 percent of ADSW in the Coast Guard) who had been pregnant in the year prior to the survey reported depression during or after the pregnancy.
  • Fifteen percent of DoD ADSW and 11 percent of Coast Guard ADSW were unable to conceive after 12 months of trying, a common definition of self-reported infertility. Twelve percent of DoD ADSW (and 8 percent of Coast Guard ADSW) reported an unmet need for fertility services since joining the military.

Recommendations

  • Explore options for expanding the prevalence and availability of care through women's health clinics.
  • Provide training for MHS providers regarding the full range of contraceptive methods.
  • Incorporate alerts into the electronic health record system to remind providers to address contraception, including for menstrual suppression, during routine physical exams.
  • Schedule predeployment health care appointments at least 90 days before deployment for ADSW and ensure that ADSW receive an adequate supply of their contraceptive to last the entire deployment.
  • Consider strategies for improved access to feminine hygiene supplies, facilities, and treatment for urinary or vaginal infections during training and deployment, particularly for ADSW in the Army and Marine Corps.
  • Improve ADSW's comfort in seeking contraception from the MHS and increase contraceptive counseling and access to highly effective contraception.
  • Devote resources to understanding and addressing rates of miscarriage among ADSW.
  • Develop a comprehensive strategy to address maternal depression.
  • Improve access to medical fertility assistance.

This research was sponsored by the Defense Health Agency and the U.S. Coast Guard and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).

This report is part of the RAND research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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