Division of Adolescent Medicine, Children's Mercy, Kansas City, University of Missouri Kansas City School of Medicine, Kansas City MO.
Division of Adolescent Medicine, San Antonio Military Medical Center, San Antonio, TX.
Am J Obstet Gynecol. 2020 Aug;223(2):223.e1-223.e10. doi: 10.1016/j.ajog.2020.01.060. Epub 2020 Feb 8.
Unplanned pregnancy is a common problem among United States servicewomen. Variation among service branches in contraceptive education and access during initial training is associated with differences in contraceptive use and childbirth rates despite access to a uniform health benefit including no-cost reproductive healthcare and contraception. However, it is unclear whether changes in branch-specific contraceptive policies can influence reproductive outcomes among junior enlisted women in that service branch.
To assess the longitudinal effect of contraceptive policy changes on contraception use and childbirth rates among military recruits.
Secondary analysis was performed of insurance records from 70,852 servicewomen who started basic training between October 2013 and December 2016, assessing the longitudinal impact of a Navy policy change expanding contraceptive access during basic training implemented in January 2015, and a Marine Corps policy change restricting contraceptive access during basic training implemented in January 2016 on the following: contraception use (pills, patches, rings, injectable, implantable, and intrauterine) at 6 months, long-acting reversible contraception use at 6 months, and childbirth prior to 24 months after service entry. We used logistic and Cox regression models, adjusted for age group, to compare outcomes of women in the Navy and Marine Corps who started basic training before and after their service branch's policy change with outcomes among women in the Army and Air Force.
Compared to the longitudinal difference observed among women attending Army or Air Force basic training, changing policies to increase contraceptive access during Navy basic training in January 2015 increased contraception use from 33.1% of sailors to 39.2% of sailors before and after the policy change (interaction term odds ratio, 1.31; 95% confidence interval, 1.22-1.41) and long-acting reversible contraception use 11.0% to 22.7% (odds ratio, 1.78; 95% confidence interval, 1.50-2.08). However, this policy change was not associated with a decline in childbirth rates among sailors (7.5% versus 6.1%) relative to the change among women in the Army and Air Force over the same time period (interaction term hazard ratio, 0.90; 95% confidence interval, 0.79-1.03). The January 2016 Marine Corps policy change decreased contraception use (29.6% to 24.4%; odds ratio, 0.78; 95% confidence interval, 0.70-0.88), long-acting reversible contraception use 14.6% to 7.3% (odds ratio, 0.39; 95% confidence interval, 0.31-0.48), and increased childbirth rates (8.0% to 9.6%; hazard ratio, 1.26; 95% confidence interval, 1.03-1.55) among Marines compared to outcomes in the Army and Air Force over the same time period.
Basic training contraceptive policy influences contraception use among junior enlisted servicewomen. Implementing best practices across the military may increase contraception use and decrease childbirth rates among junior enlisted servicewomen.
在美国女兵中，意外怀孕是一个常见问题。尽管提供了包括免费生殖保健和避孕在内的统一健康福利，但各军种在初始培训期间的避孕教育和获取方面的差异与避孕措施的使用和生育率的差异有关。然而，目前尚不清楚分支特定避孕政策的变化是否会影响该服务分支中初级入伍女性的生殖结果。
评估避孕政策变化对军人新兵避孕措施使用和生育率的纵向影响。
对 2013 年 10 月至 2016 年 12 月期间开始基础训练的 70852 名女兵的保险记录进行二次分析，评估 2015 年 1 月海军扩大基础训练期间避孕措施获取的政策变化和 2016 年 1 月海军陆战队限制基础训练期间避孕措施获取的政策变化对以下方面的纵向影响：6 个月时的避孕措施使用（药丸、贴片、环、注射剂、植入物和宫内节育器）、6 个月时的长效可逆避孕措施使用以及服务开始后 24 个月内的分娩。我们使用逻辑和 Cox 回归模型，按年龄组进行调整，比较在海军和海军陆战队开始基础训练之前和之后的女性与陆军和空军的女性的结果。
与在陆军或空军基础训练中观察到的女性之间的纵向差异相比，2015 年 1 月将政策改为增加海军基础训练期间的避孕措施获取，使水手的避孕措施使用率从政策变更前的 33.1%增加到 39.2%（交互项优势比，1.31；95%置信区间，1.22-1.41），长效可逆避孕措施使用率从 11.0%增加到 22.7%（优势比，1.78；95%置信区间，1.50-2.08）。然而，与同期陆军和空军女性的变化相比，这一政策变化并没有导致水手的生育率下降（7.5%对 6.1%）（交互项风险比，0.90；95%置信区间，0.79-1.03）。2016 年 1 月海军陆战队的政策变化降低了避孕措施使用率（29.6%至 24.4%；优势比，0.78；95%置信区间，0.70-0.88），长效可逆避孕措施使用率 14.6%至 7.3%（优势比，0.39；95%置信区间，0.31-0.48），并增加了生育率（8.0%至 9.6%；风险比，1.26；95%置信区间，1.03-1.55）与同期陆军和空军的结果相比，海军陆战队的女性。
基础训练避孕政策会影响初级入伍女兵的避孕措施使用。在整个军队中实施最佳实践可能会增加初级入伍女兵的避孕措施使用并降低生育率。
