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Long-Acting Reversible Contraceptive Placement Among Active-Duty U.S. Army Servicewomen

Erickson, Anne K. BA; Nelson, D. Alan PA-C, PhD; Shaw, Jonathan G. MD, MS; Loftus, Pooja D. MS; Kurina, Lianne M. PhD; Shaw, Kate A. MD, MS

doi: 10.1097/AOG.0000000000001971
Contents: Original Research
Cochrane Reviews
Clinical ObGyn

OBJECTIVE: To quantify uptake of long-acting reversible contraceptives (LARC)—intrauterine devices (IUDs) and hormonal implants—among U.S. Army active-duty female soldiers and identify characteristics associated with uptake.

METHODS: This retrospective cohort study used the Stanford Military Data Repository, which includes all digitally recorded health encounters for active-duty U.S. Army soldiers from 2011 to 2014. We analyzed data from women aged 18–44 years to assess rates of LARC initiation using medical billing codes. We then evaluated predictors of LARC initiation using multivariable regression.

RESULTS: Among 114,661 servicewomen, 14.5% received a LARC method; among those, 60% received an IUD. Intrauterine device insertions decreased over the study period (38.7–35.9 insertions per 1,000 women per year, β=0.14, 95% confidence interval [CI] –0.23 to –0.05, P<.05), whereas LARC uptake increased, driven by an increase in implant insertions (20.3–35.4/1,000 women per year, β=0.41, CI 0.33–0.48, P<.001). Younger age was a positive predictor of LARC uptake: 32.4% of IUD users and 62.6% of implant users were in the youngest age category (18–22 years) compared with 9.6% and 2.0% in the oldest (36–44 years). The likelihood of uptake among the youngest women (compared with oldest) was most marked for implants (adjusted relative risk 7.12, CI 5.92–8.55; P<.001). A total of 26.2% of IUD users had one child compared with 13.2% among non-LARC users (adjusted relative risk 1.94, CI 1.85–2.04, P<.001). The majority (52.2%) of those initiating IUDs were married, which was predictive of uptake over never-married women (adjusted relative risk 1.52, CI 1.44–1.59, P<.001).

CONCLUSION: Among servicewomen, we observed low but rising rates of LARC insertion, driven by increasing implant use. Unmarried and childless soldiers were less likely to initiate LARC. These findings are consistent with potential underutilization and a need for education about LARC safety and reversibility in a population facing unique consequences for unintended pregnancies.

Among U.S. soldiers, long-acting reversible contraception use remains low but is slowly rising as a result of increased uptake of implants.

Departments of Medicine and Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.

Corresponding author: Kate A. Shaw, MD, MS, Department of Obstetrics and Gynecology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94304; email: kateshaw@stanford.edu.

This study was funded by a Stanford MedScholars Student Research Grant.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented in part at the North American Forum on Family Planning, November 5–7, 2016, Denver, Colorado.

All data used in this study were provided under a cooperative agreement with the U.S. Army Medical Command.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.