{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:53:38Z","timestamp":1777683218054,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T00:00:00Z","timestamp":1747785600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Health Serv Res Policy"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Contraceptive prescriptions among U.S. service women rose to 68.7% between 2008 and 2013, which was higher than that seen nationally among women between 2017 and 2019 (65.3%). The objective of this study was to provide estimates of contraceptive use and its determinants among active duty service women, with a particular focus on the associations with contraceptive counseling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a cross-sectional study using the 2018 Department of Defense Health Related Behaviors Survey of active duty service members. Data from 5353 active duty service women were analyzed. Weighted logistic regression models were used to identify factors associated with contraceptive use. We used a previous survey from 2015 to examine trends in contraceptive use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall prevalence of contraceptive use was 60.6%, and only 40% had discussed contraception with a health care provider in the past year. Contraception counseling was associated with decreased contraceptive nonuse (adjusted odds ratio = 0.63). Being older, Black or Hispanic race or ethnicity, in the Army, enlisted, identifying as lesbian, gay, or bisexual, and having one or more same sex partners were associated with higher odds of contraceptive nonuse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite universal eligibility for free health care, contraceptive counseling and use among US military service women remain suboptimal, and significant disparities in contraceptive use exist by rank, race, ethnicity, and sexual orientation. Improving implementation and enforcement of existing military directives to provide routine contraceptive counseling and services during health care visits, such as through informatics tools, could lower unintended pregnancies, reduce inequities, and increase readiness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13558196251344866","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T18:17:57Z","timestamp":1747851477000},"page":"258-269","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Counseling and other factors associated with contraceptive use among active duty US military servicewomen"],"prefix":"10.1177","volume":"30","author":[{"given":"Kyle E","family":"Manetz","sequence":"first","affiliation":[{"name":"School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anwar E","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine &amp; Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine T","family":"Witkop","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine &amp; Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA"},{"name":"Department of Gynecologic Surgery &amp; Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaqueline E","family":"Hamrick","sequence":"additional","affiliation":[{"name":"School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0717-8202","authenticated-orcid":false,"given":"James D","family":"Mancuso","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine &amp; Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1506575"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2022.09.132"},{"key":"e_1_3_5_4_2","unstructured":"Defense Health Agency. Defense health agency procedural instruction number 6200.02: comprehensive contraceptive counseling and access to the full range of methods of contraception. https:\/\/www.health.mil\/Reference-Center\/DHA-Publications\/2019\/05\/13\/DHA-PI-6200-02 (accessed 16 July 2024)."},{"key":"e_1_3_5_5_2","first-page":"47","article-title":"Contraceptive prescriptions for US servicewomen, 2008-2013","volume":"96","author":"Witkop CT","year":"2017","unstructured":"Witkop CT, Webber BJ, Chu KM, et al. Contraceptive prescriptions for US servicewomen, 2008-2013. Contraception 2017; 96: 47\u201353.","journal-title":"Contraception"},{"key":"e_1_3_5_6_2","unstructured":"Daniels K Abma JC. Current contraceptive status among women aged 15-49: United States 2017-2019. NCHS Data Brief Hyattsville MD: National Center for Health Statistics. 2020; (388): 1\u20138. https:\/\/www.cdc.gov\/nchs\/data\/databriefs\/db388-H.pdf."},{"key":"e_1_3_5_7_2","first-page":"10","article-title":"Contraception among active component service women, U.S. armed forces, 2012-2016","volume":"24","author":"Stahlman S","year":"2017","unstructured":"Stahlman S, Witkop CT, Clark LL, et al. Contraception among active component service women, U.S. armed forces, 2012-2016. MSMR 2017; 24: 10\u201321.","journal-title":"MSMR"},{"key":"e_1_3_5_8_2","first-page":"2","article-title":"Long-acting reversible contraceptive use, active component service women, U.S. armed forces, 2016-2020","volume":"28","author":"Lotridge JA","year":"2021","unstructured":"Lotridge JA, Stahlman SL, Patel DM, et al. Long-acting reversible contraceptive use, active component service women, U.S. armed forces, 2016-2020. MSMR 2021; 28: 2\u201310.","journal-title":"MSMR"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usy340"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2019-200569"},{"key":"e_1_3_5_11_2","doi-asserted-by":"crossref","unstructured":"Meadows SO Engel CC Collins RL et al. 2018 Department of defense health related behaviors survey (HRBS). https:\/\/www.rand.org\/pubs\/research_reports\/RR4222.html (2021 accessed 28 August 2022).","DOI":"10.7249\/RR1695"},{"key":"e_1_3_5_12_2","unstructured":"Meadows SO Engel CC Collins RL et al. 2015 health-related behavior (HRB) survey - active duty service members. https:\/\/www.health.mil\/Military-Health-Topics\/Access-Cost-Quality-and-Safety\/Health-Care-Program-Evaluation\/Survey-of-Health-Related-Behaviors\/2015-Health-Related-Behavior-Survey-Active-Duty (2018 accessed 16 March 2021)."},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2017.10.003"},{"key":"e_1_3_5_14_2","first-page":"12","article-title":"Surveillance snapshot: mid-year populations by sex, age, and race and ethnicity of active component service members of the U.S. Armed Forces, 2018-2022","volume":"30","author":"McQuistan AA","year":"2023","unstructured":"McQuistan AA, Dreyer E, Mabila SL. Surveillance snapshot: mid-year populations by sex, age, and race and ethnicity of active component service members of the U.S. Armed Forces, 2018-2022. MSMR 2023; 30: 12.","journal-title":"MSMR"},{"key":"e_1_3_5_15_2","unstructured":"2018 Demographics report: profile of the military community. https:\/\/download.militaryonesource.mil\/12038\/MOS\/Reports\/2018-demographics-report.pdf (2018 accessed 16 March 2025)."},{"key":"e_1_3_5_16_2","unstructured":"Dobbs vs. Jackson womens health organization. 59 US. https:\/\/www.supremecourt.gov\/opinions\/21pdf\/19-1392_6j37.pdf (2022 accessed 2 July 2022)."},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2019-200377"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/13625187.2018.1465546"},{"key":"e_1_3_5_19_2","first-page":"8","article-title":"Update: contraception among active component service women, U.S. Armed forces, 2017-2021","volume":"29","author":"Armed Forces Health Surveillance Division","year":"2022","unstructured":"Armed Forces Health Surveillance Division. Update: contraception among active component service women, U.S. Armed forces, 2017-2021. MSMR 2022; 29: 8\u201313.","journal-title":"MSMR"},{"key":"e_1_3_5_20_2","volume-title":"OPA report no. 2019-0272018 workplace and gender relations of active duty members: overview report","author":"Breslin RA","year":"2019","unstructured":"Breslin RA, Davis L, Hylton K, et al. OPA report no. 2019-0272018 workplace and gender relations of active duty members: overview report. Analytics OoP (ed) Alexandria, Va: US Department of Defense, 2019."},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.11.018"},{"key":"e_1_3_5_22_2","first-page":"38","article-title":"Advancing health equity in the US military","volume":"16","author":"Mancuso JD","year":"2023","unstructured":"Mancuso JD, Young J, Rusiecki J, et al. Advancing health equity in the US military. Journal of Health Disparities Research and Practice 2023; 16: 38\u201350.","journal-title":"Journal of Health Disparities Research and Practice"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2023.109950"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.01.037"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.02.036"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41372-022-01598-w"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/military-2023-002654"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-720X.2010.00497.x"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2019.10.006"},{"key":"e_1_3_5_30_2","unstructured":"Office of the Under Secretary of Defense for Personnel and Readiness. DOD instruction 6200.06: periodic health assessment (PHA) program. https:\/\/www.esd.whs.mil\/Portals\/54\/Documents\/DD\/issuances\/dodi\/620006p.pdf"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usab194"}],"container-title":["Journal of Health Services Research &amp; Policy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13558196251344866","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13558196251344866","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13558196251344866","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:45:22Z","timestamp":1777452322000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13558196251344866"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,21]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1177\/13558196251344866"],"URL":"https:\/\/doi.org\/10.1177\/13558196251344866","relation":{},"ISSN":["1355-8196","1758-1060"],"issn-type":[{"value":"1355-8196","type":"print"},{"value":"1758-1060","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,21]]}}}