Seymour Jane W, Fix Laura, Grossman Daniel, Grindlay Kate
Ibis Reproductive Health, 2067 Massachusetts Avenue, Cambridge, MA.
Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA.
Mil Med. 2019 May 1;184(5-6):e417-e423. doi: 10.1093/milmed/usy340.
Despite evidence that the unintended pregnancy rate is higher among U.S. servicewomen than the general population and that servicewomen may face barriers to contraceptive use, there is little research about contraceptive access and use experiences of non-deployed active duty servicewomen. This qualitative study aimed to explore the experiences of accessing contraception while in the U.S. military among active duty servicewomen who had an abortion.
From January 2015 to July 2016, we conducted qualitative in-depth interviews with 21 servicewomen who had obtained an abortion within the prior two years while active duty. The interviews included questions about participants' experiences accessing and using contraception while in the military. Interviews were transcribed and analyzed thematically using inductive and deductive coding. Ethical approval was obtained from the Allendale Investigational Review Board.
Over half of the respondents had ever obtained contraception from the military and had positive feelings about the military's contraceptive services; however, the vast majority of participants described barriers to contraceptive access in the military. Many identified barriers that were related to the military health care system, including inadequate counseling, challenges getting a preferred contraceptive method, and the structure and functioning of the military health system, or were a result of the demands of military service. In addition to these factors that were directly related to being in the military, respondents identified barriers not directly related to service, including contraceptive adherence, product concerns, and side effects; although not directly related to their service, in some cases, these barriers were exacerbated by their career.
Active duty servicewomen who had an abortion experienced many barriers to accessing contraception while in the military. These findings highlight the need to improve contraceptive counseling and access in the U.S. military. Results support the need to implement mandatory yearly and pre-deployment contraceptive counseling as required by the 2016 National Defense Authorization Act, offer contraceptive counseling in multiple settings, ensure military providers receive training to avoid contraceptive coercion, expand military clinic and pharmacy hours, increase the number of female military health care providers and providers able to administer all forms of contraception, and expand the contraceptive methods included under the Basic Core Formulary. Limitations to this study include that participants were self-selected and were asked to recall experiences up to several years in the past. Future studies should evaluate representative samples to understand the proportion of servicewomen with unmet contraceptive need.
尽管有证据表明，美国女军人的意外怀孕率高于普通人群，且女军人在使用避孕措施时可能面临障碍，但对于未部署的现役女军人获取和使用避孕措施的经历，相关研究却很少。这项定性研究旨在探究美国现役女军人在军队中获取避孕措施的经历，这些女军人都有过堕胎经历。
2015年1月至2016年7月，我们对21名现役女军人进行了定性深入访谈，她们在过去两年内曾堕胎。访谈内容包括有关参与者在军队中获取和使用避孕措施的经历的问题。访谈内容被转录，并采用归纳和演绎编码进行主题分析。研究获得了艾伦代尔调查审查委员会的伦理批准。
超过一半的受访者曾从军队获取过避孕措施，并且对军队的避孕服务有积极的感受；然而，绝大多数参与者描述了在军队中获取避孕措施存在的障碍。许多人指出了与军事医疗系统相关的障碍，包括咨询不足、获取首选避孕方法面临挑战、军事医疗系统的结构和运作，或者是军事服役需求导致的结果。除了这些与服役直接相关的因素外，受访者还指出了与服役不直接相关的障碍，包括避孕依从性、产品问题和副作用；尽管这些障碍与她们的服役不直接相关，但在某些情况下，她们的职业加剧了这些障碍。
有过堕胎经历的现役女军人在军队中获取避孕措施时面临许多障碍。这些发现凸显了改善美国军队中避孕咨询和获取途径的必要性。研究结果支持按照2016年《国防授权法案》的要求实施强制性年度和部署前避孕咨询，在多个场所提供避孕咨询，确保军事医疗服务提供者接受培训以避免避孕强制行为，延长军事诊所和药房的营业时间，增加女性军事医疗服务提供者以及能够提供所有形式避孕措施的提供者的数量，并扩大基本核心处方集所涵盖的避孕方法。本研究的局限性包括参与者是自我选择的，且被要求回忆过去几年的经历。未来的研究应该评估具有代表性的样本，以了解有未满足避孕需求的女军人的比例。
