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Vargas S, Landoll R, Guthrie KM, Quinlan J, Clark MF, Obuseh F, Ozemoya A. Enhancing Mission Wellness: Iterative Optimization and Stakeholder Engagement to Promote Sexual and Reproductive Health in the United States Military. Mil Med 2024; 189:306-313. [PMID: 39160859 DOI: 10.1093/milmed/usae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/17/2024] [Accepted: 03/03/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Sexual and reproductive health is critical for the readiness of the warfighter, as costs of sexually transmitted infections and unintended pregnancy result in added health care costs, lost mission time, and impact on morale. The Multiphase Optimization Strategy (MOST) is an engineering-inspired framework used to optimize biobehavioral interventions. The Military Active-Duty Reproductive and Sexual Health (MARSH) research team applied the MOST framework to develop "Mission Wellness"-an electronic health intervention to promote sexual and reproductive health within the U.S. Military. MATERIALS AND METHODS From 2017 to 2022, the MARSH team implemented the first and second phases of MOST to develop and optimize "Mission Wellness." All phases received institutional review board approval. The first phase consisted of expert and literature review, qualitative interviews, and beta testing to identify intervention components and the optimization objective and to inform study design. The second phase consisted of a factorial trial. RESULTS Figures 1-4 outline the research program approach, demographics of the sample, and format of the app. Service members who used the application found it to be acceptable and, overall, reported that it would be easier to talk to a sexual partner about risk behaviors and history at the post-intervention assessment compared to baseline. This iterative optimization approach using both local and strategic engagement enhanced program development and set the stage for dissemination and implementation efforts. CONCLUSIONS In line with the iterative nature of MOST, the lessons learned during the optimization trial led the MARSH team to return "Mission Wellness" to the preparation phase. The utilization of mixed (i.e., qualitative and quantitative) research methods and engagement with stakeholders at multiple levels of the military enterprise provided the information necessary to further optimize "Mission Wellness." This programmatic approach also provides a blueprint for the development of research design and testing in military health care balancing rigor and agility.
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Affiliation(s)
- Sara Vargas
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02906, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - Ryan Landoll
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD 20814, USA
| | - Kate M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02906, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - Jeffrey Quinlan
- Department of Family Medicine, University of Iowa Carver College of Medicine, University of Iowa Health Care, Iowa City, IA 52242, USA
| | - Madison F Clark
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Francis Obuseh
- Defense Centers for Public Health-Portsmouth, Portsmouth, VA 23708, USA
| | - Amelia Ozemoya
- Defense Centers for Public Health-Portsmouth, Portsmouth, VA 23708, USA
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Barnhart HM, Banaag A, Koehlmoos TP. Racial Disparities in Highly Effective Contraceptive Use Among U.S. Active Duty Servicewomen, Fiscal Years 2016-2019. J Womens Health (Larchmt) 2024; 33:1016-1024. [PMID: 38546176 DOI: 10.1089/jwh.2023.0735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Background: Previous studies have found that unintended pregnancy rates are higher among racial minorities and active duty servicewomen (ADSW), correlating with lower rates of effective contraceptive use. The Military Health System (MHS) provides universal health care benefit coverage for all ADSW, including access to all highly effective contraceptive (HEC) methods. This study investigated the association between race and HEC use among ADSW. Materials and Methods: We conducted a cross-sectional study using fiscal year 2016-2019 data from the MHS Data Repository for all ADSW ages 18-45 years. Statistical analyses included descriptive statistics and logistic regression models, adjusted and unadjusted, determining the odds of HEC use, overall and by method. Results: Of the 729,722 ADSW included in the study, 59.7% used at least one HEC during the study period. The highest proportions of users were aged 20-24 years, White, single, Junior Enlisted, and serving in the Army. Lower odds of HEC use were demonstrated in Black (odds ratio [OR] = 0.94, 95% confidence interval [CI] = 0.92-0.95), American Indian/Alaska Native (OR = 0.85, 95% CI = 0.82-0.89), Asian/Pacific Islander (OR = 0.81, 95% CI = 0.80-0.83), and Other (OR = 0.97, 95% CI = 0.94-0.99) ADSW compared with White ADSW. Conclusions: Universal coverage of this optional preventive service did not guarantee its use. The MHS can serve as a model for monitoring racial disparities in HEC use.
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Affiliation(s)
- Helen M Barnhart
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Amanda Banaag
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Tracey P Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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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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Ricker EA, Koltun KJ, de la Motte SJ. Hormonal contraception and medical readiness for female service members. Am J Obstet Gynecol 2024:S0002-9378(24)00630-6. [PMID: 38810770 DOI: 10.1016/j.ajog.2024.05.044] [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: 12/19/2023] [Revised: 03/29/2024] [Accepted: 05/19/2024] [Indexed: 05/31/2024]
Abstract
Many female military service members choose to use hormonal contraception to prevent pregnancy and/or to control or suppress menses. Hormonal contraception, which comes in many different forms based on dose, estrogen/progestin type, and route of administration (oral, vaginal, transdermal, implant, intrauterine device, injectable), may cause side effects, some of which can influence military medical readiness, or the health status necessary to perform assigned missions. This expert review summarizes the evidence around common military-relevant side effects of hormonal contraception that could impact readiness, including effects on weight and body composition, bone health, psychological health, and physical performance, and serves as a tool for uniformed and civilian clinicians counseling female service members about hormonal contraception. Current evidence suggests some hormonal contraception can lead to weight and fat gain, may modulate susceptibility to mood or mental health disorders, and could impact bone mineral density and stress fracture risk; more research is needed on physical performance effects. Clinicians must be familiar with readiness considerations of each type of hormonal contraception to provide comprehensive patient education and allow for optimal shared decision-making about hormonal contraception use among female Service members. Considering the relative lack of data on the effects of nonoral hormonal contraception routes on readiness outcomes and the growing interest in long-acting reversible contraceptives among female service members, future research should continue to investigate effects of all hormonal contraception methods available to service members.
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Affiliation(s)
- Emily A Ricker
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD.
| | - Kristen J Koltun
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA
| | - Sarah J de la Motte
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
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Ahmed S, Vereen RJ, Aden JK, Dillon CA, Shapiro JB. Maternal and Neonatal Outcomes of Adolescent Pregnancies in the Military Health System. Mil Med 2024; 189:e854-e863. [PMID: 37856694 DOI: 10.1093/milmed/usad397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/22/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE To determine if universal access to care for military beneficiaries improves timing of presentation to prenatal care (PNC) in adolescent and young adult (AYA) pregnancies, improving maternal and neonatal outcomes. STUDY DESIGN Retrospective descriptive cohort study, which assessed PNC initiation in eligible military beneficiaries: dependent daughters, active-duty women, and active-duty spouses aged 13 to 26 between January 2015 and December 2019, and subsequent adverse maternal and neonatal outcomes. RESULTS The cohort included 4,557 eligible pregnancies and 4,044 mothers aged 13 to 26. Late entry to PNC was not associated with gestational diabetes, prolonged rupture of membranes, pregnancy loss, elective abortion, substance use, or premature labor. Younger age was significantly associated with substance use, elective abortion, and sexually transmitted infection. There were 2,107 eligible newborns. There was no significant difference in gestational age at birth, incidence of prematurity, birthweight percentile, or occurrence of a neonatal intensive care unit admission based on maternal age. In comparison to published national outcomes, there was a significantly smaller occurrence of preterm (5.3% vs. 9.57-10.23%, 95% CI, 4.4-6.4%), small for gestational age (5.2% vs. 10-13%, 95% CI, 4.3-6.2%), and large for gestational age (4.8% vs. 9%, 95% CI, 4.0-5.8%) births, but a higher occurrence of neonatal intensive care unit admissions (16.9% vs. 7.8-14.4%, 95% CI, 15.4-18.6%) in infants born to military beneficiaries. CONCLUSIONS Our findings suggest that expanded universal access to health care may improve AYA pregnancy and delivery outcomes. Infants born to AYA military beneficiaries have improved neonatal outcomes compared to nationally published data. These results may correlate to improved maternal access within a free or low-cost healthcare system.
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Affiliation(s)
- Saira Ahmed
- Department of Pediatrics, Division of Adolescent Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20089, USA
| | - Rasheda J Vereen
- Department of Pediatrics, Division of Neonatology, Carl R. Darnall Army Medical Center, Fort Cavazos, TX 76544, USA
| | - James K Aden
- Research Division, Graduate Medical Education, Brooke Army Medical Center, JBSA-Fort Sam Houston, TX 78234, USA
| | - Christopher A Dillon
- Department of Pediatrics, Division of Adolescent Medicine, Brooke Army Medical Center, JBSA-Fort Sam Houston, TX 78234, USA
| | - Jonathan B Shapiro
- Department of Pediatrics, Division of Neonatology, Brooke Army Medical Center, JBSA-Fort Sam Houston, TX 78234, USA
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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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Seymour JW, Fix L, Grossman D, Grindlay K. Contraceptive use and access among deployed US servicewomen: findings from an online survey. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:61-66. [PMID: 32341070 DOI: 10.1136/bmjsrh-2019-200569] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND/INTRODUCTION This study aimed to survey US servicewomen on their contraceptive access and use during deployment. METHODS Between June 2016 and July 2017, we conducted a cross-sectional online survey among a convenience sample of current and former members of the US Military, National Guard and Reserves who had a deployment ending in 2010 or later. Participants were asked open-ended and closed-ended questions about their demographics and contraceptive use and access before and during their last deployment. Descriptive statistics were run on closed-ended questions and responses to open-ended questions were inductively coded. RESULTS A total of 353 participants were included. Sixty-five per cent reported using contraception during all or part of their last deployment. Nearly half (49.3%) did not have or remember having a discussion with a military care provider about contraception prior to deployment. Both prior to and during deployment, the free or low cost of birth control and ability to get a full supply for deployment facilitated contraceptive use. Difficulty obtaining an appointment and the inability to get a full supply of birth control were barriers to contraception access both before and during deployment. Half (49.1%) of respondents who had to start or refill contraception during deployment said it was somewhat or very difficult to do so. CONCLUSIONS For at least some servicewomen, there are barriers to contraceptive access and use prior to and during overseas deployment. Programmes to increase contraceptive access should be expanded and monitoring systems should be implemented to ensure all servicemembers receive predeployment contraceptive counselling.
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Affiliation(s)
| | - Laura Fix
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, California, USA
| | - Kate Grindlay
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
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Vargas SE, Norris C, Landoll RR, Crone B, Clark MF, Quinlan JD, Guthrie KM. Interventions to Improve Sexual and Reproductive Health in US Active Duty Military Service Members: A Systematic Review. Am J Health Promot 2020; 34:538-548. [PMID: 32133870 DOI: 10.1177/0890117120908511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify and describe behavioral interventions to promote sexual and reproductive health among US active duty military service members. DATA SOURCES Systematic searches of PubMed, CINAHL, and PsychINFO (N = 1609 records). INCLUSION CRITERIA English-language articles published between 1991 and 2018 and retrieved using search terms related to military service, interventions, and sexual and reproductive health. EXCLUSION CRITERIA Articles excluded if not empirically based, not published in peer-reviewed journals, did not sample active duty US military personnel, and did not examine the effectiveness of specified preventive sexual or reproductive health intervention(s). DATA EXTRACTION Teams of paired authors extracted study rationale; aims; design; setting; description of the intervention; measures; sample demographics; clinical, behavioral, and psychosocial outcomes; and conclusions. DATA SYNTHESIS Given the heterogeneity of studies, narrative synthesis was performed. RESULTS Fifteen articles met inclusion criteria: 10 focused on sexually transmitted infection (STI) acquisition and/or unintended pregnancy and 5 on sexual assault. Studies that assessed clinical outcomes found that interventions were associated with lower rates of STIs and/or unintended pregnancy. Significant effects were found on knowledge-related outcomes, while mixed effects were found on attitudes, intentions, and behaviors. CONCLUSIONS Current evidence on the effectiveness of sexual and reproductive health interventions in the US military is limited in quality and scope. Promoting sexual and reproductive health in this population is critical to maintaining well-being among servicemembers, their families, and the communities surrounding military installations.
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Affiliation(s)
- Sara E Vargas
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Colby Norris
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Ryan R Landoll
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA
| | - Baylee Crone
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA
| | - Madison F Clark
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jeffrey D Quinlan
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA
| | - Kate M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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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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10
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Shaw JG, Shaw KA. Improving contraceptive choice for military servicewomen: better provision serves both women and deployment planning. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:86-87. [PMID: 31000570 DOI: 10.1136/bmjsrh-2018-200238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/04/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Jonathan G Shaw
- Division of Primary Care & Population Health, Stanford University School of Medicine, Stanford, California, USA
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Kate A Shaw
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California, USA
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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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Seymour JW, Fix L, Grossman D, Grindlay K. Facilitators and Barriers to Contraceptive Use Among U.S. Servicewomen Who Had an Abortion. Mil Med 2018; 184:e417-e423. [DOI: 10.1093/milmed/usy340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/17/2018] [Accepted: 11/01/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jane W Seymour
- Ibis Reproductive Health, 2067 Massachusetts Avenue, Cambridge, MA
| | - Laura Fix
- Ibis Reproductive Health, 2067 Massachusetts Avenue, Cambridge, MA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA
| | - Kate Grindlay
- Ibis Reproductive Health, 2067 Massachusetts Avenue, Cambridge, MA
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13
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Shaw JG, Nelson DA, Shaw KA, Woolaway-Bickel K, Phibbs CS, Kurina LM. Deployment and Preterm Birth Among US Army Soldiers. Am J Epidemiol 2018; 187:687-695. [PMID: 29370332 DOI: 10.1093/aje/kwy003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 01/03/2018] [Indexed: 01/26/2023] Open
Abstract
With increasing integration of women into combat roles in the US military, it is critical to determine whether deployment, which entails unique stressors and exposures, is associated with adverse reproductive outcomes. Few studies have examined whether deployment increases the risk of preterm birth; no studies (to our knowledge) have examined a recent cohort of servicewomen. We therefore used linked medical and administrative data from the Stanford Military Data Repository for all US Army soldiers with deliveries between 2011 and 2014 to estimate the associations of prior deployment, recency of deployment, and posttraumatic stress disorder with spontaneous preterm birth (SPB), adjusting for sociodemographic, military-service, and health-related factors. Of 12,877 deliveries, 6.1% were SPBs. The prevalence was doubled (11.7%) among soldiers who delivered within 6 months of their return from deployment. Multivariable discrete-time logistic regression models indicated that delivering within 6 months of return from deployment was strongly associated with SPB (adjusted odds ratio = 2.1, 95% confidence interval: 1.5, 2.9). Neither multiple past deployments nor posttraumatic stress disorder was significantly associated with SPB. Within this cohort, timing of pregnancy in relation to deployment was identified as a novel risk factor for SPB. Increased focus on servicewomen's pregnancy timing and predeployment access to reproductive counseling and effective contraception is warranted.
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Affiliation(s)
- Jonathan G Shaw
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - D Alan Nelson
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Kate A Shaw
- Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, California
| | | | - Ciaran S Phibbs
- VA Palo Alto Health Care System, US Department of Veterans Affairs, Palo Alto, California
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Lianne M Kurina
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
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