Manski Ruth, Grindlay Kate, Burns Bridgit, Holt Kelsey, Grossman Daniel
Ibis Reproductive Health, 17 Dunster Street, Suite 201, Cambridge, MA 02138.
Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, SPH 3, Floor 7, Boston, MA 02115.
Mil Med. 2014 Jun;179(6):645-52. doi: 10.7205/MILMED-D-13-00302.
Servicewomen's reproductive health experiences during deployment are important given that the majority of women in the U.S. military are of reproductive age and that this population experiences a disproportionately high rate of unintended pregnancy. Few studies have explored women's reproductive health experiences and their perceived barriers and facilitators to health care access during deployment. From May 2011 to January 2012, we conducted 22 in-depth interviews with women in the U.S. military about their reproductive health experiences during deployment, including their access to health services. Participants identified a range of barriers to accessing medical care in deployment settings, including confidentiality concerns, lack of female providers, and health-seeking stigma, which were reported to disproportionately impact reproductive health access. Some participants experienced challenges obtaining contraceptive refills and specific contraceptive methods during deployment, and only a few participants received predeployment counseling on contraception, despite interest in both menstruation suppression and pregnancy prevention. These findings highlight several policy and practice changes that could be implemented to increase contraceptive access and reduce unintended pregnancy during deployment, including mandated screening for servicewomen's contraceptive needs before operational duty and at least annually, and increasing the number of female providers in deployed settings.
鉴于美国军队中的大多数女性处于育龄,且该群体意外怀孕率极高,部署期间女军人的生殖健康经历十分重要。很少有研究探讨女性在部署期间的生殖健康经历以及她们所感知到的获得医疗保健的障碍和促进因素。2011年5月至2012年1月,我们对美国军队中的女性进行了22次深入访谈,了解她们在部署期间的生殖健康经历,包括她们获得医疗服务的情况。参与者指出了在部署环境中获得医疗护理的一系列障碍,包括对隐私的担忧、缺乏女性医疗服务提供者以及寻求医疗的耻辱感,据报告这些因素对生殖健康服务的获取产生了不成比例的影响。一些参与者在部署期间难以获得避孕药具的补充和特定的避孕方法,尽管对抑制月经和预防怀孕都有兴趣,但只有少数参与者在部署前接受了避孕咨询。这些发现凸显了一些可以实施的政策和实践变革,以增加部署期间避孕药具的获取并减少意外怀孕,包括在执行任务前和至少每年对女军人的避孕需求进行强制筛查,以及增加部署环境中女性医疗服务提供者的数量。