Sonya Borrero1,2, Lisa S Callegari3,4, Xinhua Zhao5, Maria K Mor5,6, Florentina E Sileanu5, Galen Switzer5,7, Susan Zickmund8,9, Donna L Washington10,11, Laurie C Zephyrin12,13, E Bimla Schwarz14. 1. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151 C), Building #30, Pittsburgh, PA, 15240, USA. Sonya.Borrero@va.gov. 2. Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA. Sonya.Borrero@va.gov. 3. Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA. 4. Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA, USA. 5. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151 C), Building #30, Pittsburgh, PA, 15240, USA. 6. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. 7. Departments of Medicine, Psychiatry and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA. 8. VA HSR&D Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA. 9. Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA. 10. VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. 11. Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. 12. Women's Health Services, Department of Veterans Affairs, Washington, D.C., USA. 13. Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA. 14. Division of General Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.
Abstract
BACKGROUND: Little is known about contraceptive care for the growing population of women veterans who receive care in the Veterans Administration (VA) healthcare system. OBJECTIVE: To determine rates of contraceptive use, unmet need for prescription contraception, and unintended pregnancy among reproductive-aged women veterans. DESIGN AND PARTICIPANTS: We conducted a cross-sectional, telephone-based survey with a national sample of 2302 women veterans aged 18-44 years who had received primary care in the VA within the prior 12 months. MAIN MEASURES: Descriptive statistics were used to estimate rates of contraceptive use and unintended pregnancy in the total sample. We also estimated the unmet need for prescription contraception in the subset of women at risk for unintended pregnancy. For comparison, we calculated age-adjusted US population estimates using data from the 2011-2013 National Survey of Family Growth (NSFG). KEY RESULTS: Overall, 62% of women veterans reported current use of contraception, compared to 68% of women in the age-adjusted US population. Among the subset of women at risk for unintended pregnancy, 27% of women veterans were not using prescription contraception, compared to 30% in the US population. Among women veterans, the annual unintended pregnancy rate was 26 per 1000 women; 37% of pregnancies were unintended. In the age-adjusted US population, the annual rate of unintended pregnancy was 34 per 1000 women; 35% of pregnancies were unintended. CONCLUSIONS: While rates of contraceptive use, unmet contraceptive need, and unintended pregnancy among women veterans served by the VA are similar to those in the US population, these rates are suboptimal in both populations, with over a quarter of women who are at risk for unintended pregnancy not using prescription contraception, and unintended pregnancies accounting for over a third of all pregnancies. Efforts to improve contraceptive service delivery and to reduce unintended pregnancy are needed for both veteran and civilian populations.
BACKGROUND: Little is known about contraceptive care for the growing population of women veterans who receive care in the Veterans Administration (VA) healthcare system. OBJECTIVE: To determine rates of contraceptive use, unmet need for prescription contraception, and unintended pregnancy among reproductive-aged women veterans. DESIGN AND PARTICIPANTS: We conducted a cross-sectional, telephone-based survey with a national sample of 2302 women veterans aged 18-44 years who had received primary care in the VA within the prior 12 months. MAIN MEASURES: Descriptive statistics were used to estimate rates of contraceptive use and unintended pregnancy in the total sample. We also estimated the unmet need for prescription contraception in the subset of women at risk for unintended pregnancy. For comparison, we calculated age-adjusted US population estimates using data from the 2011-2013 National Survey of Family Growth (NSFG). KEY RESULTS: Overall, 62% of women veterans reported current use of contraception, compared to 68% of women in the age-adjusted US population. Among the subset of women at risk for unintended pregnancy, 27% of women veterans were not using prescription contraception, compared to 30% in the US population. Among women veterans, the annual unintended pregnancy rate was 26 per 1000 women; 37% of pregnancies were unintended. In the age-adjusted US population, the annual rate of unintended pregnancy was 34 per 1000 women; 35% of pregnancies were unintended. CONCLUSIONS: While rates of contraceptive use, unmet contraceptive need, and unintended pregnancy among women veterans served by the VA are similar to those in the US population, these rates are suboptimal in both populations, with over a quarter of women who are at risk for unintended pregnancy not using prescription contraception, and unintended pregnancies accounting for over a third of all pregnancies. Efforts to improve contraceptive service delivery and to reduce unintended pregnancy are needed for both veteran and civilian populations.
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