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Study Examines Unintended Pregnancy and Contraceptive Use among Women Veterans


BACKGROUND:
Little is known about contraceptive care or outcomes among the growing population of women Veterans who receive VA healthcare. The Examining Contraceptive Use and Unmet Need (ECUUN) study sought to determine rates of contraceptive use, unmet need for prescription contraception, and unintended pregnancy in a national sample of reproductive-aged women Veterans who receive VA healthcare. Using VA administrative data from FY2013 to FY2015, investigators identified women Veterans ages 18 to 44 with a least one VA primary care visit in the previous 12 months. From this national sample, 2,302 women Veterans completed a telephone-based survey. Survey questions focused on methods of contraception, pregnancy history, demographics, and health variables. For comparison, investigators calculated general U.S. population rates for contraceptive use, unmet contraceptive need, and unintended pregnancy using data from the 2011-2013 National Survey of Family Growth (NSFG). Rates of contraceptive use and unintended pregnancy were estimated among the entire study sample, in addition to unmet need for prescription contraception in the subset of women at risk for unintended pregnancy (sexually active with a man in the prior 3 months; no history of hysterectomy or infertility; and not pregnant or seeking pregnancy).

FINDINGS:

  • While rates of contraceptive use, unmet contraceptive need, and unintended pregnancy among women Veterans served by VA are similar to those in the U.S. population, these rates are sub-optimal in both populations. More than one-third of pregnancies in both populations are unintended, about 10% of women at risk of unintended pregnancy are not using any method of contraception, and nearly 30% are not using prescription contraception.
  • Overall, 62% of women Veterans reported currently using contraception compared to 68% of women in the U.S. population. Among the subset of women at risk for unintended pregnancy, 27% of Veterans were not using prescription contraception compared to 30% in the U.S. population.
  • More than half of women Veterans (56%) reported at least one medical illness; 69% reported at least one mental health illness, and 55% reported a history of military sexual trauma.

IMPLICATIONS:

  • This study provides the first published data on rates of contraceptive use, unmet contraceptive need, and unintended pregnancy in a national sample of women VA-users.
  • Given the high prevalence of medical and mental illness among women Veterans, which can elevate the risk of negative outcomes associated with unintended pregnancy, unintended pregnancy may be particularly problematic among this population.

LIMITATIONS:

  • Investigators do not know how cost considerations may have impacted contraceptive use.
  • Only women Veterans who used VA care were included.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 12-124), and Dr. Callegari is supported by an HSR&D Career Development Award (CDA 14-412). Drs. Borrero and Zhao are part of HSR&D's Center for Health Equity Research & Promotion, (CHERP), Pittsburgh, PA, and Dr. Callegari is part of HSR&D's Center of Innovations for Veteran-Centered and Value-Driven Care, Seattle, WA.


PubMed Logo Borrero S, Callegari L, Zhao X, et al. Unintended Pregnancy and Contraceptive Use among Women Veterans: The ECUUN Study. Journal of General Internal Medicine. August 2017;32(8):900-908.

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HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.