Contraception, unintended pregnancy, and abortion among women in the US military: A systematic review

Women comprise a growing proportion of the US military's active duty forces. Servicewomen's ability to plan pregnancies is of concern to the military and an important public health issue, and contraception access and use are crucial, particularly given the high prevalence of sexual assault in the military and benefits of menstrual suppression during deployment. We systematically searched three databases for publications on contraception, unintended pregnancy, and abortion in the military in order to summarize what is known, highlight gaps in current knowledge, and provide recommendations for future research. We identified 46 studies, none on abortion. Limited data suggest servicewomen's pregnancy, unintended pregnancy, and unintended birth rates are similar to or slightly higher than women in the general US population, with higher rates in part explained by the disproportionate number of young women in the military. While contraceptive prevalence appears to be slightly higher among servicewomen compared to the general US population, studies suggest decreased contraceptive use during deployment and low use of long-acting reversible contraception. Reported use of hormonal methods for menstrual suppression is lower than reported interest. There are limited data on these topics; more large, representative studies, and longitudinal data from all military branches are needed, along with qualitative research to explore findings more deeply. Emergency contraception and abortion are particularly under-researched. Understanding military women's experiences accessing and using contraception and abortion services, and having good data on unintended pregnancy rates across all military branches, are crucial to efforts to prevent unintended pregnancy in the military.