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Janvrin ML, Banaag A, Lawry LL, Scott R, Koehlmoos T. Estimates of unintended pregnancy among US active-duty service women and the impact on Women Peace and Security objectives as measured by potential readiness days lost. BMJ Mil Health 2024:e002654. [PMID: 39043431 DOI: 10.1136/military-2023-002654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/24/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION The prevalence of unintended pregnancy (UIP) in the United States is high among active-duty service women (ADSW). OBJECTIVE To estimate the number of UIPs and the impact these pregnancies have on the ability to meet Women, Peace and Security objectives as measured by maximum potential readiness days lost (mRDL). METHODS Using data from the Military Health System Data Repository, ADSW aged 18 to 44 years, were identified from fiscal year (FY) 2019 data. Deliveries were identified using Medicare Severity Diagnosis-Related Group codes. The estimated number of UIPs was calculated by multiplying both the number of ADSW and the number of deliveries by age-adjusted rates of UIP. Post partum women do not have to meet height and weight standards or complete a physical fitness test for up to 365 days after a full-term delivery. Lost readiness days were calculated by multiplying the number of UIPs by 365 days. Data were stratified by age, race, rank and branch of service. RESULTS A total of 230 596 ADSW were identified in FY2019. Using the number of ADSW, an estimated 12 683 ADSW experienced an unintended pregnancy, resulting in an estimated 4 629 215 mRDL. Using the number of deliveries, an estimated 6785 deliveries were a result of UIPs, resulting in an estimated 2 476 364 mRDL. The highest estimates of UIPs were among ADSW aged 18 to 24 years, of White race, in a Junior Enlisted rank and in the Army. CONCLUSION Estimates of UIPs among ADSW would result in considerable impact on their military career. Dealng with UIPs proactively, by encouraging comprehensive family planning and instituting additional reproductive health policies for service members by ensuring that service members can make informed decisions about their reproductive health while maintaining operational effectiveness, is important for meeting United States Department of Defense Women, Peace and Security objectives.
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Affiliation(s)
- Miranda Lynn Janvrin
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
- Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - A Banaag
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
- Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - L L Lawry
- Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - R Scott
- Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - T Koehlmoos
- Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Vargas SE, Thornton K, Norris C, Gist G, Clark MF, Ramirez L, Guillen M, Guthrie KM, Landoll RR. Sexual and reproductive health in military settings: A qualitative study. MILITARY PSYCHOLOGY 2024:1-10. [PMID: 38436987 DOI: 10.1080/08995605.2024.2324644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
Mission readiness is critical to the operational success of the United States (US) military and includes having a healthy and fit fighting force. Service members and their dependents have access to a wide range of sexual and reproductive health services with no out-of-pocket costs. Despite this access, negative outcomes such as sexually transmitted infections (STIs) and unintended pregnancy persist. Semi-structured, in-depth interviews were conducted with service members and stakeholders (e.g. medical providers). Interviews explored the individual, interpersonal, organizational, and institutional factors that inform sexual norms, behaviors, and healthcare experiences in the US military. Interview transcripts were coded manually; data were summarized for themes related to unique aspects of military culture and healthcare affecting sexual and reproductive health. Twenty-five (25) service members and 15 stakeholders completed interviews. Four themes emerged: 1) despite free access, both general and military-specific barriers to sexual and reproductive healthcare persist; 2) general and military-specific cultural norms apply to sexual behavior and care seeking; 3) sexual and reproductive health-related norms can be perceived as confusing and contradictory within the military; and 4) resources addressing sexual assault are ubiquitous in military settings, but resources addressing prevention of STIs and unintended pregnancy are limited. Both general and military-specific norms, behavior, and healthcare experiences need to be considered in clinical care, public health campaigns, and other efforts to promote sexual and reproductive health in military settings.
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Affiliation(s)
- Sara E Vargas
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kade Thornton
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, Maryland
| | - Colby Norris
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, Maryland
| | - Galen Gist
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, Maryland
| | - Madison F Clark
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Leslie Ramirez
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Melissa Guillen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Kate M Guthrie
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Ryan R Landoll
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, Maryland
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Kostas-Polston EA, Witkop CT, Degutis LC, Rosenbaum S, Wood SF. Assuring TRICARE Coverage of Preventive Health Services for Women Beneficiaries of the Military Health System. Mil Med 2023; 188:24-30. [PMID: 36882029 DOI: 10.1093/milmed/usac224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/21/2022] [Accepted: 07/07/2022] [Indexed: 03/09/2023] Open
Abstract
WHY DEFENSE HEALTH HORIZONS PERFORMED THIS STUDY The primary role of the Military Health System is to assure readiness by protecting the health of the force by providing expert care to wounded, ill, and injured service members. In addition to this mission, the Military Health System (both directly through its own personnel and indirectly, through TRICARE) provides health services to millions of military family members, retirees, and their dependents. Women's preventive health services are an important part of comprehensive health care to reduce rates of disease and premature death and were included in the 2010 Patient Protection and Affordable Care Act's (ACA) expanded coverage of women's preventive health services, based on the best available evidence and guidelines. These guidelines were updated by the Health Resources and Services Administrations and the American College of Obstetrics and Gynecology in 2016. However, TRICARE is not subject to the ACA, and therefore, TRICARE's provisions or the access of TRICARE's female beneficiaries to women's preventive health services was not directly changed by the ACA. This report compares women's reproductive health care coverage under TRICARE with coverage available to women enrolled in civilian health insurance plans subject to the 2010 ACA. WHAT DEFENSE HEALTH HORIZONS RECOMMENDS Three recommendations are proposed to ensure that women who are TRICARE beneficiaries have access to and receive preventive reproductive health services that are consistent with Health Resources and Services Administration recommendations as implemented in the ACA. Each recommendation has strengths and weaknesses that are described in detail in the body of this paper. WHAT DEFENSE HEALTH HORIZONS FOUND In covering contraceptive drugs and devices, TRICARE appears to reflect the scope of coverage found in ACA-compliant plans but, by not incorporating the term "all FDA-approved methods" of contraception, TRICARE leaves open the possibility that a narrower definition could be adopted at a future date. There are important differences in how TRICARE and ACA-compliant plans address reproductive counseling and health screening, including TRICARE's more restrictive counseling benefit and some limits to preventive screening. By not aligning with policies related to the provision of clinical preventive services established under the ACA, TRICARE allows health care providers in purchased care to diverge from evidence-based guidelines. Although the ACA respects medical judgment when providing women's preventive services, standards restrict the extent to which health care systems and providers can depart from evidence-based screening and prevention guidelines essential to optimizing quality, cost, and patient outcomes.
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Affiliation(s)
| | - Catherine T Witkop
- F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | | | - Sara Rosenbaum
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC 20037, USA
| | - Susan F Wood
- Department of Health Policy and Management, Jacobs Institute of Women's Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
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Guertin J, Lanuza K. Novel Shared Decision-Making Tool Improves Contraceptive Screening and Right Care during Pregnancy in a Military Hospital: A Quality Improvement Report. J Midwifery Womens Health 2023; 68:125-134. [PMID: 36117403 DOI: 10.1111/jmwh.13403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 06/07/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Unintended pregnancy rates in the military remain high compared with rates outside of the military in the United States (54%-60% vs 45%-50%, respectively). Contraceptive counseling in conjunction with shared decision-making is recommended to improve military unintended pregnancy rates. Best counseling practices and decision aids for contraceptive counseling are unknown in military and nonmilitary populations. Pregnancy may be an opportune time to complete contraceptive counseling because of regularly scheduled prenatal visits, and counseling during pregnancy is associated with higher postpartum contraception use. A quality initiative was implemented to improve contraceptive screening and counseling during pregnancy for servicewomen and nonservicewomen in a clinic setting. PROCESS The initiative included 4 patient-centered core interventions: a patient screening, a shared decision-making tool, a right care checklist, and a team engagement plan, across 4 rapid plan-do-study-act cycles. OUTCOMES Contraceptive screening rates and delivery of right care improved from 37% to 79% in the pregnant patients over 90 days; 81% of patients screened positive for contraception needs; 89% of patients made a same-day decision about their contraception plan after completing the tool; and 92% of patients had a contraception plan documented in the electronic health record by the health care provider prior to birth. DISCUSSION Results demonstrated that contraception screening rates and right care improved with initiative interventions for servicewomen and nonservicewomen. A novel shared decision-making tool presented 18 contraception methods, risks and benefits, and tiered effectiveness that aided the majority of patients in a same-day decision with high patient satisfaction. Provider counseling was also simplified without delay in clinic time. Contraceptive counseling completed with a shared decision-making tool may benefit military and civilian populations during pregnancy. Additional research is needed to examine the best time to conduct counseling during pregnancy and the long-term rates of contraceptive use or unplanned pregnancy following counseling events.
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Emergency Contraception: Access and Challenges at Times of Uncertainty. Am J Ther 2022; 29:e553-e567. [PMID: 35998109 DOI: 10.1097/mjt.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The UN Commission on Life-Saving Commodities for Women's and Children's Health identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation. AREAS OF UNCERTAINTY Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access. DATA SOURCES PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetrician and Gynecologists, the World Health Organization, The United Nations. THERAPEUTIC ADVANCES A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device. CONCLUSIONS EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts, threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.
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Wilson C, Phillips AK, Iobst SE, Myers ER, Trego L, Allard RJ, Landoll R. A Scoping Review of Unintended Pregnancy in Active Duty United States Military Women. Womens Health Issues 2021; 31 Suppl 1:S66-S80. [PMID: 34454705 DOI: 10.1016/j.whi.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/14/2020] [Accepted: 11/12/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The purpose of this scoping review was to apply the Social Ecological Model for Military Women's Health to literature on unintended pregnancy (UIP) to answer the question: In United States active duty military women (population) with the potential for UIP (context), what is known about risk factors, prevention, and pregnancy outcomes (concepts)? METHODS We conducted this review based on a PRISMA-ScR protocol registered a priori in Open Science Framework. Following a literature search of six databases and the grey literature, we used DistillerSR to manage data screening and data charting. The Social Ecological Model for Military Women's Health served as the theoretical framework to chart findings regarding UIP at the individual, microsystem, mesosystem, exosystem, and macrosystem levels. RESULTS A total of 74 research, review, and grey literature articles met the inclusion criteria. Risk factors included specific demographics, military service, and recent deployment. Prevention included contraceptive practices, access, and education that should take place early in servicewomen's careers and before deployment. Outcomes included early return from deployment, personal career challenges, and seeking alternative health services outside the military health system. CONCLUSIONS Research and policy initiatives should focus on decreasing risk factors in the military working environment, with particular attention to the deployed environment. These initiatives should include input from military leaders, health care providers, servicewomen, and servicemen with the goal of decreasing the incidence of unintended pregnancies. Pregnancy intentionality among military women should be considered as a concept to shape intervention research to reduce unintended pregnancies.
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Affiliation(s)
- Candy Wilson
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland.
| | | | | | - Evan R Myers
- Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Lori Trego
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado
| | - Rhonda J Allard
- Uniformed Services University of the Health Sciences, James A. Zimble Learning Resource Center, Bethesda, Maryland
| | - Ryan Landoll
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland
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Hossain-López S, Ruiz-Berdún D. Being a woman, being a soldier, being a mother: a qualitative analysis of perceptions of pregnancy on working lives of women in the Spanish Armed Forces. BMJ Mil Health 2021; 168:64-69. [PMID: 33688081 DOI: 10.1136/bmjmilitary-2020-001722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/30/2021] [Accepted: 02/09/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Thirty-two years after Spain first allowed women to join the armed forces, 12% of active troops are women, although there are no data on how many of them are mothers. There is a lack of research related to the impact of motherhood on their careers and the challenges they face as well. Previous quantitative research, within North Atlantic Treaty Organization (NATO) forces, has focused on the increased vulnerability and reduced performance of women returning to service after childbirth. However, no study to date has examined the narratives of these women. METHODS A qualitative, cross-sectional study was carried out by means of individual interviews which were subsequently analysed employing the interpretative approach of hermeneutic phenomenology. All the interviews were conducted by videoconference, being recorded for subsequent transcription and analysis with MAXQDA v.2018. RESULTS Servicewoman reported experiencing fear of informing their command chain of their pregnancy. Many women described feelings of constantly having to prove their worth, and thus perceived the physical restrictions associated with pregnancy and/or postpartum as a threat to their previous achievements. This sometimes led to behaviours that posed a risk to the health of mothers and babies, or eventually resulted in both acute and chronic conditions. CONCLUSIONS Some restrictions put in place to protect them during their pregnancies become a source of additional anxiety. Returning to active service, we found that women's desire to fulfil their duties can cause long-term damage to their physical and psychological health. The attitudes servicewomen perceive towards pregnant women and mothers seems to exert a strong influence on the risks they are willing to assume. Understanding and addressing the needs of servicewomen after childbirth, either now, as active members of the Armed Forces, or in the foreseeable future, as veterans, is crucial to both military and civilian healthcare providers.
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Affiliation(s)
- Sheima Hossain-López
- Surgery, Medical and Social Sciences, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá de Henares, Alcala de Henares, Madrid, Spain
| | - D Ruiz-Berdún
- Surgery, Medical and Social Sciences, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá de Henares, Alcala de Henares, Madrid, Spain
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Keyser EA, Westerfield K, Eagan S, Hall A, Yauger B, Powell-Dunford N. Making the Case for Menstrual Suppression for Military Women. Mil Med 2020; 185:e923-e925. [DOI: 10.1093/milmed/usaa036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Erin A Keyser
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78234
| | - Katie Westerfield
- 1st Security Forces Assistance Brigade, 8873 Watkins Rd, Fort Benning, GA 31905
| | - Sheena Eagan
- Department of Bioethics & and Interdisciplinary Studies, Brody School of Medicine at East Caroling University, 600 Moye Blvd. Greenville, NC 27834
| | - Ashley Hall
- Department of Obstetrics and Gynecology, Dwight D. Eisenhower Army Medical Center, 300 E. Hospital Rd, Fort Gordon, GA, 30905
| | - Belinda Yauger
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78234
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Heitmann RJ. Contraception and Unintended Pregnancy in the Military Healthcare System. Semin Reprod Med 2020; 37:211-214. [PMID: 32018305 DOI: 10.1055/s-0039-3400461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The number of women serving in the Armed Forces is growing and readiness has been decreed as the number 1 priority for the total Army. Provision of contraception and unintended pregnancy rates higher than the general population are two key factors in readiness of female soldiers. An in-depth review of women's healthcare in the military identified these two areas of women's health as greatly understudied. Long-acting reversible contraception provides effective and cost-efficient method for contraception and a proven way to decrease unintended pregnancy. Increased research and focus into these two areas of women's health is crucial to providing the best care for our female service members.
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Affiliation(s)
- Ryan J Heitmann
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington
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Smith AL, Cohen JA, Ontaneda D, Rensel M. Pregnancy and multiple sclerosis: Risk of unplanned pregnancy and drug exposure in utero. Mult Scler J Exp Transl Clin 2019; 5:2055217319891744. [PMID: 31853368 PMCID: PMC6909269 DOI: 10.1177/2055217319891744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/22/2019] [Accepted: 11/01/2019] [Indexed: 12/12/2022] Open
Abstract
Background Multiple sclerosis is a central nervous system demyelinating disease that affects women of reproductive potential. It is important to identify the frequency and risk factors of unplanned or disease-modifying therapy-exposed pregnancies to create interventions to reduce these. Methods This retrospective, single-center, observational chart review study aims to identify risk factors for unplanned pregnancy to identify a target population for family counseling. Results In total, 63 live births in 45 patients (20 unplanned and 43 planned) were analyzed. The percentage of unplanned pregnancy was 32%. The proportion of those receiving family planning counseling was lower in the patients with unplanned pregnancies (p < 0.001). The main risk factors for unplanned pregnancy were younger age (p = 0.004), disease-modifying therapy exposure (p < 0.001), and being unmarried (p < 0.001). Overall, 16 pregnancies had disease-modifying therapy exposure and in a subsequent study the risk for disease-modifying therapy exposure was unplanned status (p < 0.001). Birth outcomes were not different between groups. There were more enhancing lesions in the post-partum magnetic resonance imaging of women with planned pregnancy (p < 0.04). Conclusion Prevention of unplanned pregnancy could lead to less disease-modifying therapy exposed pregnancies. This study suggests a targeted intervention of family planning counseling in younger, unmarried multiple sclerosis patients could potentially lead to less unintended in utero disease-modifying therapy exposure.
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Affiliation(s)
- Andrew L Smith
- Mellen Center for MS Treatment and Research, Cleveland Clinic, United States of America
| | - Jeffrey A Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, United States of America
| | - Daniel Ontaneda
- Mellen Center for MS Treatment and Research, Cleveland Clinic, United States of America
| | - Mary Rensel
- Mellen Center for MS Treatment and Research, Cleveland Clinic, United States of America
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Deans EI, Batig AL, Cordes S, Scribner AN, Nielsen PE, Jamieson DJ, Lathrop E, Cwiak C. A Survey of Family Planning Training, Knowledge, and Practices Among Health Care Providers Within the Military Health System at Joint Base Lewis-McChord. Mil Med 2019; 184:e394-e399. [PMID: 30252078 DOI: 10.1093/milmed/usy255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Within the active duty U.S. military population, the age-adjusted unintended pregnancy rate is higher than the national average. Unplanned pregnancy within the military impacts individual and unit medical readiness. Contraceptive education and availability are means to reduce unintended pregnancy rates; health care providers are key facilitators in provision of contraception. Understanding provider knowledge and practices related to contraceptive provision may identify strengths and gaps in order to provide focal points for sustainment or improvement in family planning practices. The purpose of this study was to assess family planning knowledge, training, and practices among health care providers serving military and dependent beneficiaries within the military health care system at Fort Lewis, Washington. MATERIAL AND METHODS This was a cross-sectional survey of health care providers on Joint Base Lewis-McChord in Tacoma, Washington who deliver health care services to U.S. uniformed service members and their dependents in varied settings, including outpatient clinics and a tertiary care center. The survey included questions regarding prior contraceptive training, and current contraceptive knowledge and practices. Survey results were evaluated using descriptive and bivariate analyses. The study was approved by both Institutional Review Boards at Emory University and at Madigan Army Medical Center. RESULTS Overall, 79 eligible health care providers completed the survey. Eighty-six percent of women's health providers consistently ("always or most of the time") provided family planning services to female service members, compared with 38% of primary care providers. Women's health providers were more likely to counsel by method effectiveness and adapt their counseling to consider patients' reproductive life plans. There were no differences between provider type in considering service members' deployment status during contraceptive counseling. Overall, providers identified the correct effectiveness of long-acting contraceptive methods, but tended to overestimate the effectiveness of short-acting methods. CONCLUSIONS Family planning services available to service members may be improved through enhanced provider education, targeting efficacy-based counseling and identification of barriers to access and provision of long-acting reversible contraceptive methods.
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Affiliation(s)
- Elizabeth I Deans
- Department of Ob/Gyn, Duke University Medical Center, 200 Trent Drive, Durham, NC
| | - Alison L Batig
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Tacoma, WA
| | - Sarah Cordes
- Department of Gyn/Ob, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, SE - Faculty Office Bldg., Atlanta, GA
| | - Alicia N Scribner
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Tacoma, WA
| | - Peter E Nielsen
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Tacoma, WA
| | - Denise J Jamieson
- Department of Gyn/Ob, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, SE - Faculty Office Bldg., Atlanta, GA
| | - Eva Lathrop
- Department of Gyn/Ob, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, SE - Faculty Office Bldg., Atlanta, GA
| | - Carrie Cwiak
- Department of Gyn/Ob, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, SE - Faculty Office Bldg., Atlanta, GA
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Miller LJ, Ghadiali NY. Mental Health Across the Reproductive Cycle in Women Veterans. Mil Med 2019; 183:e140-e146. [PMID: 29415146 DOI: 10.1093/milmed/usx094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/08/2017] [Indexed: 11/12/2022] Open
Abstract
Introduction Premenstrual, perinatal, and/or perimenopausal psychiatric problems require specific screening, assessment, and treatment strategies. The scope of these reproductive-linked psychiatric symptoms among women veterans is unknown. Due to high rates of sexual trauma among women veterans, it is also important to ascertain relationships between sexual trauma experiences and reproductive cycle mood problems. This pilot study investigates the prevalence of self-reported premenstrual, perinatal, and perimenopausal emotional problems and whether these correlate with pre-military sexual abuse, military sexual harassment, and/or military sexual assault, among veterans receiving psychiatric evaluations within a Veterans Administration Women's Health Clinic. Materials and Methods Participants included all women veterans (N = 186) who received psychiatric evaluations within a Veterans Administration Women's Health Clinic over a 13-mo period. Evaluations included a clinical questionnaire, a psychiatric interview, and medical record review. De-identified data were extracted from a clinical data repository for this descriptive study. Results High proportions of study participants reported emotional problems premenstrually (43.3%), during pregnancy (35.1%), postpartum (30.4%), or during perimenopause (31.2%). Unintended pregnancy (73.3% of pregnancies) and pregnancy loss (56.6% of women who had been pregnant) were prominent perinatal stressors. Military sexual harassment was significantly associated with emotional problems during pregnancy and postpartum. Conclusion These pilot data suggest the need for further study of the reproductive mental health needs of women veterans and their relationship with sexual trauma. The findings underscore the need for Veterans Administration facilities and other providers of veterans' health care to be prepared to detect, diagnose, and treat premenstrual, perinatal, and perimenopausal mental health problems.
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Affiliation(s)
- Laura J Miller
- Professor of Psychiatry; Loyola University Stritch School of Medicine; Medical Director of Women's Mental Health; Edward Hines Jr. VA Hospital; 5000 S. 5th Ave., Bldg. 228, Rm. 1016; Hines IL 60141
| | - Nafisa Y Ghadiali
- Assistant Professor of Psychiatry; Loyola University Stritch School of Medicine; Women's Mental Health Psychiatrist; Edward Hines Jr. VA Hospital; 5000 S. 5th Ave., Bldg. 228, Rm. 1016; Hines IL 60141
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Akilimali P, Anglewicz P, Engale HN, Kurhenga GK, Hernandez J, Kayembe P, Bertrand J. Differences in family planning outcomes between military and general populations in Kinshasa, Democratic Republic of the Congo: a cross-sectional analysis. BMJ Open 2018; 8:e022295. [PMID: 30580261 PMCID: PMC6318504 DOI: 10.1136/bmjopen-2018-022295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine family planning outcomes among women living in military camps in Kinshasa, Democratic Republic of the Congo, and compare these outcomes with a representative sample of non-military women in Kinshasa. PARTICIPANTS Women of reproductive ages, 15-49 years. We compare two populations: women living in military camps and the general (non-military) population in Kinshasa. STUDY DESIGN For sampling, we used a two-stage cluster sampling design, where we first randomly selected enumeration areas (EA), and then randomly selected women within each EA (separately for each of the two populations). We administered a survey on contraceptive use and family planning to all participating women. We use bivariate and multivariate analysis to compare these populations for a range of family planning outcomes. RESULTS We find many statistically significant differences between women in military camps and general female population of Kinshasa. Although they do not have more children, women in military camps are less likely to be using contraception (all methods OR 0.24, 95% CI 0.11 to 0.53; modern methods OR 0.25, 95% CI 0.08 to 0.79; traditional methods OR 0.41, 95% CI 0.24 to 0.71) and less knowledgeable about many family planning methods (less likely to have heard of implants (OR 0.23, 95% CI 0.11 to 0.48), injectables (OR 0.19, 95% CI 0.08 to 0.44), condoms (OR 0.23, 95% CI 0.12 to 0.47), withdrawal (OR 0.05, 95% CI 0.02 to 0.17) and rhythm (OR 0.12, 95% CI 0.03 to 0.44) methods), while at the same time they are more likely to want to limit their births (OR 5.17, 95% CI 2.52 to 10.62), and less likely to have obtained their preferred family planning method (OR 0.14, 95% CI 0.03 to 0.64). CONCLUSIONS Women in military camps in Kinshasa appear to be an important and underserved population with regard to family planning. Our results suggest that women in military camps have limited access to modern family planning methods.
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Affiliation(s)
- Pierre Akilimali
- Kinshasa School of Public Health, Universite de Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Philip Anglewicz
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Henri Nzuka Engale
- Medical Division, Congolese Armed Forces, Kinshasa, The Democratic Republic of the Congo
| | | | - Julie Hernandez
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Patrick Kayembe
- Kinshasa School of Public Health, Universite de Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Jane Bertrand
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
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van den Berk Clark C, Chang J, Servey J, Quinlan JD. Women’s Health and the Military. Prim Care 2018; 45:677-686. [DOI: 10.1016/j.pop.2018.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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de Kanter CB, Roberts TA, Raiciulescu S, Ali SM, Arnold JJ, Witkop C, Klein DA. Military Family Physicians’ Practices and Perceptions About Reproductive Health Services for Deploying Women. Mil Med 2018; 184:e424-e430. [DOI: 10.1093/milmed/usy244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Caitlyn B de Kanter
- Department of Family Medicine, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA
| | - Timothy A Roberts
- Department of Adolescent Medicine, Children’s Mercy Hospital, 3101 Broadway Blvd, 10th Floor, Kansas City, MO
| | - Sorana Raiciulescu
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD
| | - Syed M Ali
- Department of Family Medicine, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA
| | - James J Arnold
- Department of Family Medicine, Eglin Air Force Base, 307 Boatner Rd, Eglin AFB, FL
- Department of Family Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD
| | - Catherine Witkop
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD
| | - David A Klein
- Department of Family Medicine, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA
- Department of Family Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD
- Department of Pediatrics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD
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Muirhead L, Hall P, Jones-Taylor C, Clifford GD, Felton-Williams T, Williams K. Critical questions: Advancing the health of female Veterans. J Am Assoc Nurse Pract 2017; 29:571-580. [PMID: 28731291 DOI: 10.1002/2327-6924.12490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 06/04/2017] [Indexed: 11/09/2022]
Abstract
PURPOSE Women are the fastest growing Veteran population in the United States and many receive all or part of their health care outside of the Department of Veterans Affairs (VA). The purpose of this article is to review the healthcare issues of women Veterans and discuss implications for care. DATA SOURCES Review of selected literature, VA resources and guidelines, and expert opinion. CONCLUSIONS Few providers are aware of the impact military service has on the health of women and fail to ask the all-important question, "Have you served in the military?" Recognizing women's military service can reveal important information that can answer perplexing clinical questions, aid in designing comprehensive plans of care, and enable women to receive the assistance needed to address complex physical and psychosocial issues to improve the quality of their lives. IMPLICATIONS FOR PRACTICE There are gender disparities related to physical health conditions, mental health issues, environmental exposures, and socioeconomic factors that contribute to female Veterans' vulnerabilities. Many of the health conditions, if recognized in a timely manner, can be ameliorated and shift the health trajectory of this population. Clinicians play a critical role in identifying health risk and helping female Veterans start the sometimes arduous journey toward wellness. Discovering and acknowledging women's military history is critical in ensuring quality care and appropriate decision making.
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Affiliation(s)
- Lisa Muirhead
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Priscilla Hall
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Cedrella Jones-Taylor
- Primary Care, Atlanta VA Medical Center, Emory University School of Medicine, Decatur, Georgia
| | - Gari D Clifford
- Department of Biomedical Informatics, Georgia Institute of Technology, Emory University, Atlanta, Georgia.,Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, Georgia
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Witkop CT, Webber BJ, Chu KM, Clark LL. Contraceptive prescriptions for US servicewomen, 2008-2013. Contraception 2017; 96:47-53. [PMID: 28578145 DOI: 10.1016/j.contraception.2017.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/17/2017] [Accepted: 05/17/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the proportion and characteristics of US servicewomen who were prescribed contraception between 2008 and 2013 and to estimate the prevalence of contraceptive utilization among women who deployed during the surveillance period. STUDY DESIGN This is a descriptive study of all servicewomen of child-bearing potential serving in the active component of the US armed forces at any time between 2008 and 2013. We estimated contraceptive utilization status using pharmacy, procedural and diagnostic codes as recorded in the Defense Medical Surveillance System and Pharmacy Data Transaction Service. Estimates of contraceptive utilization were compared by demographic and military variables, including deployment status. Poisson regression with robust error variance was used to estimate adjusted prevalence ratios and 95% confidence intervals. RESULTS Among eligible servicewomen (N=375,847), 68.7% received at least one form of contraception during the surveillance period. Contraceptive methods included short acting only (55.6%), long-acting (11.9%), permanent (1.0%) and barrier methods (0.2%). An additional 8.2% received counseling services only without an associated procedure or prescription. After adjusting by several demographic variables, receipt of contraception was highest among women aged 25-29 years and lowest among those aged 17-19 and 45-49 years. Receipt of any contraception was similar across racial/ethnic groups, although Hispanic and black, non-Hispanic women were more likely to receive long-acting reversible contraception. Of those who deployed (N=131,597), 53.6% received contraception before or during their deployment, with 7.9% using long-acting contraception. CONCLUSION US servicewomen utilize contraception at high levels, with few demographic disparities. Gaps still exist, especially among the youngest women and around the time of deployment. IMPLICATIONS US servicewomen are prescribed contraception at high levels, but utilization is lower in the youngest servicewomen and around the time of deployment. Such data provide opportunities for development and evaluation of interventions designed to improve access to contraceptive services for all servicewomen and to reduce the rate of unintended pregnancy.
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Affiliation(s)
- Catherine T Witkop
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
| | - Bryant J Webber
- 559th Medical Group, Joint Base San Antonio-Lackland, TX 78234
| | - Kasi M Chu
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Leslie L Clark
- Armed Forces Health Surveillance Branch, Silver Spring, MD 20904
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Cha S, Chapman DA, Wan W, Burton CW, Masho SW. Discordant pregnancy intentions in couples and rapid repeat pregnancy. Am J Obstet Gynecol 2016; 214:494.e1-494.e12. [PMID: 26519783 DOI: 10.1016/j.ajog.2015.10.149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/14/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Rapid repeat pregnancy (RRP) is a major problem in the United States. Few studies have explored the influence of partner agreement on pregnancy intention and RRP. OBJECTIVE We sought to examine the association between couple pregnancy intentions and RRP among women in the United States. STUDY DESIGN Data came from the 2006 through 2010 National Survey of Family Growth. Multiparous women who cohabited with 1 husband/partner before conception of second pregnancy were included (N = 3463). The outcome, RRP, was categorized as experiencing a second pregnancy within 24 months of the first pregnancy resolution, or ≥24 months from the first pregnancy resolution. Maternal and paternal pregnancy intentions were categorized into 4 dyads: both intended (M+P+); maternal intended and paternal unintended (M+P-); maternal unintended and paternal intended (M-P+); and both unintended (M-P-). Multiple logistic regression was conducted to determine the association between couple pregnancy intentions and RRP. RESULTS Nearly half (49.4%) of women had RRP. Approximately 15% of respondents reported discordant couple pregnancy intentions and 22%, maternal and paternal unintendedness. Compared to couples who both intended their pregnancy (M+P+), the odds of RRP was higher when fathers intended pregnancy but not mothers (adjusted odds ratio, 2.51; 95% confidence interval, 1.45-4.35) and lower if fathers did not intend pregnancy but mothers did (adjusted odds ratio, 0.77; 95% confidence interval, 0.70-0.85). No difference was observed between concordant couple pregnancy intentions (M-P- vs M+P+). CONCLUSION Findings highlight the important role of paternal intention in reproductive decisions. Study results suggest that RRP is strongly influenced by paternal rather than maternal pregnancy intentions. Clinicians and public health workers should involve partners in family planning discussions and counseling on optimal birth spacing.
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Kazerooni R, Blake A, Thai J. Predictors of Pregnancy in Female Veterans Receiving a Hormonal Contraceptive Pill, Patch, or Ring. Ann Pharmacother 2015; 49:1284-90. [PMID: 26416948 DOI: 10.1177/1060028015607825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pregnancy rates in veterans are an understudied phenomenon. OBJECTIVE The objective of this study was to identify predictors of pregnancy within 1 year of starting hormonal contraception among female veterans. METHODS This was a retrospective, cohort study of female veterans from Veterans Affairs facilities within Southern California and Nevada, who newly started hormonal contraception (pill, patch, or ring only) between October 2008 and September 2012. Pregnancy was defined as any event corresponding to a pregnant state using ICD-9 codes. Patients were followed for 1 year post-initiation. Multivariate logistic regression analysis was performed. RESULTS The final analysis included a total of 2166 patients. Approximately 5.9% (n = 127) of patients became pregnant during follow-up. Increased odds of pregnancy were associated with the following: mental health disease (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.15-2.58), lowest socioeconomic quintile (OR 1.50, 95% CI 1.05-2.09), and Christian faith (OR 1.69, 95% CI 1.31-2.41). Age groups 25 to 34 years (OR 0.55, 95% CI 0.38-0.92] and 35 to 44 years (OR 0.32, 95% CI 0.06-0.64) were both associated with decreased odds of pregnancy versus age group 18 to 24 years. CONCLUSION This study successfully identified several predictors of pregnancy in female veterans starting a pill, patch, or ring form of hormonal contraception. Female veterans in the lowest socioeconomic quintile, aged 18 to 24 years, diagnosed with a mental health disorder, and of Christian faith were found to be at significantly higher odds of a pregnancy. Identification of these at-risk populations may help clinicians and policy makers choose strategies to identify which patients could benefit the most from more effective long-acting reversible contraception therapy.
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Affiliation(s)
- Rashid Kazerooni
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA, USA
| | - Ashley Blake
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA, USA
| | - Julia Thai
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA, USA
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Reproductive Life Planning in Primary Care: A Qualitative Study of Women Veterans' Perceptions. Womens Health Issues 2015; 25:548-54. [PMID: 26123640 DOI: 10.1016/j.whi.2015.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Women veterans using Veterans Administration (VA) health care have high rates of medical and mental health comorbidities, placing them at increased risk of poor outcomes from unplanned pregnancy. Reproductive life planning is a strategy recommended by the U.S. Centers of Disease Control and Prevention that could promote healthy pregnancies and reduce unplanned pregnancy in the VA. However, no data exist on women veterans' perceptions of reproductive life planning discussions. METHODS We trained six VA primary care physicians at two VA Women's Health Clinics to conduct reproductive life planning discussions with veterans aged 18 to 44 during primary care visits. After the visit, we performed semistructured telephone interviews with consenting veterans to explore perceptions of 1) reproductive life planning content and 2) provider-patient communication in reproductive life planning discussions. Interviews were audiorecorded, transcribed, and analyzed using content analysis. RESULTS We interviewed 27 veterans with a mean age of 31 years (range, 22-42). Women veterans perceived generally reproductive life planning discussions as important opportunities to discuss reproductive goals with providers and to obtain new and relevant information about contraception, planning healthy pregnancies, and available VA reproductive health services. Perceptions of reproductive life planning content were influenced by women's pregnancy intentions. Perceptions related to provider-patient communication included preferences for provider-initiated discussions and nonjudgmental counseling that incorporates patients' values and preferences. CONCLUSIONS Women veterans perceived reproductive life planning as valuable and important to their health. Reproductive life planning has the potential to enhance patient-centered delivery of reproductive health services in VA primary care.
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Callegari LS, Zhao X, Nelson KM, Borrero S. Contraceptive adherence among women Veterans with mental illness and substance use disorder. Contraception 2015; 91:386-92. [PMID: 25636807 DOI: 10.1016/j.contraception.2015.01.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/15/2015] [Accepted: 01/17/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Emerging data suggest that mental illness and substance use disorder (SUD) are important risk factors for inconsistent contraceptive use. We investigated whether mental illness without or with SUD is associated with contraceptive adherence and continuation of hormonal methods among women Veterans. STUDY DESIGN We conducted a retrospective analysis of national Veteran's Administration data among women aged 18-45 with a hormonal contraceptive prescription (pill/patch/ring/injectable) during the first week of fiscal year 2013. We tested associations between mental illness diagnoses (depression, posttraumatic stress disorder, anxiety, bipolar disorder, schizophrenia, adjustment disorder) without or with SUD diagnoses (drug/alcohol abuse) and 12-month contraceptive adherence (number and length of gaps ≥7 days between refills and months of contraceptive coverage) using multivariable regression models. RESULTS Among 9780 Veterans, 43.6% had mental illness alone, 9.4% comorbid mental illness and SUD, and 47.0% neither diagnosis. In adjusted analyses, compared to women with neither diagnosis, women with mental illness alone had a similar rate of gaps but increased odds of having gaps longer than 30 days [odds ratio (OR): 1.35, 95% confidence interval (CI): 1.10-1.52] and fewer months of contraceptive coverage (β_coefficient: -0.39, 95% CI: -0.56 to -0.23). Women with mental illness and SUD experienced more gaps (incidence rate ratio: 1.12, 95% CI: 1.03-1.21), increased odds of gaps longer than 30 days (OR: 1.46, 95% CI: 1.10-1.79), fewer months of contraceptive coverage (β_coefficient: -0.90, 95% CI: -1.20 to -0.62) and reduced odds of continuous 12-month coverage (adjusted OR: 0.76, 95% CI: 0.63-0.93). CONCLUSIONS Mental illness, particularly with comorbid SUD, is associated with reduced contraceptive adherence and continuation among women Veterans. Women with these risk factors could potentially benefit from use of long-acting reversible methods. IMPLICATIONS Women Veterans have a high burden of mental illness and SUD, which we found are associated with inconsistent contraceptive use. Efforts to improve adherence to hormonal contraceptives and to increase availability of long-acting reversible methods in this vulnerable population are warranted.
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Affiliation(s)
- Lisa S Callegari
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA 98108; Department of Obstetrics & Gynecology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195.
| | - Xinhua Zhao
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Building 30, Pittsburgh PA 15240
| | - Karin M Nelson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA 98108; Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195
| | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Building 30, Pittsburgh PA 15240; Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Pittsburgh, PA 15217
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Heitmann RJ, Mumford SL, Hill MJ, Armstrong AY. Estimated economic impact of the levonorgestrel intrauterine system on unintended pregnancy in active duty women. Mil Med 2014; 179:1127-32. [PMID: 25269131 PMCID: PMC6258204 DOI: 10.7205/milmed-d-14-00055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Unintended pregnancy is reportedly higher in active duty women; therefore, we sought to estimate the potential impact of the levonorgestrel-containing intrauterine system (LNG-IUS) could have on unintended pregnancy in active duty women. A decision tree model with sensitivity analysis was used to estimate the number of unintentional pregnancies in active duty women which could be prevented. A secondary cost analysis was performed to analyze the direct cost savings to the U.S. Government. The total number of Armed Services members is estimated to be over 1.3 million, with an estimated 208,146 being women. Assuming an age-standardized unintended pregnancy rate of 78 per 1,000 women, 16,235 unintended pregnancies occur each year. Using a combined LNG-IUS failure and expulsion rate of 2.2%, a decrease of 794, 1588, and 3970 unintended pregnancies was estimated to occur with 5%, 10% and 25% usage, respectively. Annual cost savings from LNG-IUS use range from $3,387,107 to $47,352,295 with 5% to 25% intrauterine device usage. One-way sensitivity analysis demonstrated LNG-IUS to be cost-effective when the cost associated with pregnancy and delivery exceeded $11,000. Use of LNG-IUS could result in significant reductions in unintended pregnancy among active duty women, resulting in substantial cost savings to the government health care system.
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Affiliation(s)
- Ryan J Heitmann
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 CRC, Room 1E-3140, 10 Center Drive, Bethesda, MD 20892-1109
| | - Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Boulevard, Rockville, MD 20852
| | - Micah J Hill
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 CRC, Room 1E-3140, 10 Center Drive, Bethesda, MD 20892-1109
| | - Alicia Y Armstrong
- Contraceptive Discovery and Development Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 CRC, Room 1E-3140, 10 Center Drive, Bethesda, MD 20892-1109
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25
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Nielsen PE, Towers GD, O'Boyle AL. Unintended pregnancy among active-duty servicewomen and veterans. Am J Obstet Gynecol 2013. [PMID: 23200716 DOI: 10.1016/j.ajog.2012.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Intimate Partner Violence: Perspectives on Universal Screening for Women in VHA Primary Care. Womens Health Issues 2013; 23:e73-6. [DOI: 10.1016/j.whi.2012.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 12/11/2012] [Indexed: 11/22/2022]
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