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2023 HSR&D/QUERI National Conference Abstract

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1031 — What happens when Veterans become pregnant while using contraception?

Lead/Presenter: Deirdre Quinn
All Authors: O'Connor-Terry CM (Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh), Zhang, X (Center for Health Equity Research and Promotion, VA Pittsburgh) Mor, MK (Center for Health Equity Research and Promotion, VA Pittsburgh) Chang, JC (Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Pittsburgh) Callegari, LS (Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound) Borrero, S (Center for Health Equity Research and Promotion, VA Pittsburgh) Quinn, DA (Center for Health Equity Research and Promotion, VA Pittsburgh)

Objectives:
Consistent use of contraception is an effective way to prevent pregnancy; however, research suggests that many people still experience pregnancy while using a method of contraception. Understanding more about these pregnancies, including whether they are terminated or continued, is necessary to ensure that reproductive health policy and healthcare services meet the needs of pregnant people in this common but often overlooked scenario. The current study explores the outcomes of pregnancies that occur in the month of contraceptive use among a national sample of women Veterans.

Methods:
We used data from the Examining Contraceptive Use and Unmet Need (ECUUN) Study, a nationally-representative, telephone-based survey of women Veterans (n = 2302) aged 18-44 receiving primary care at VA; interviews were conducted between April 2014 and January 2016. For each pregnancy reported by study participants, we asked about the circumstances in which pregnancy occurred, including whether it occurred in the month of contraceptive use. For those that occurred in the month of contraceptive use, we examined associations with the outcome of the pregnancy (e.g., birth, miscarriage, abortion) using multinomial logistic regression while controlling for relevant demographic, clinical, and military factors (e.g., age, race/ethnicity, marital status, education, annual household income, parity, history of medical comorbidities, and geographic region) and clustering of pregnancies from the same woman.

Results:
Our study sample included n = 4436 pregnancies from n = 1689 women Veterans. Nearly 38% of pregnancies (n = 1672) occurred in the month of contraceptive use, and nearly 60% of Veterans who had ever been pregnant had experienced such a pregnancy. A majority of these pregnancies (81%) were described as unintended; 59.4%, 21.1%, and 16.1% resulted in live births, miscarriage, and abortion, respectively. In multinomial modeling, pregnancies that occurred in the month of contraceptive use were significantly more likely to end in abortion than pregnancies that did not occur in the month of contraceptive use (aOR:1.66, 95%CI: 1.33, 2.07).

Implications:
A substantial proportion of Veterans experienced a pregnancy in the same month as contraceptive use. These pregnancies were largely described as unintended. While most still ended in live birth, these pregnancies were more likely to end in abortion than other pregnancies, underscoring that access to contraception does not obviate the need for access to abortion. These findings highlight a need to better understand drivers of pregnancy continuation among Veterans (e.g., acceptability of unintended pregnancy, lack of access to abortion care).

Impacts:
In the wake of widespread restrictions to reproductive health services across much of the United States, ensuring Veterans’ access to comprehensive care, including abortion, is critical to supporting their reproductive autonomy and whole health.