The following is a summary of “Postpartum long-acting reversible contraceptive use among active-duty, female US Army soldiers,” published in the October 2023 issue of Obstetrics and Gynecology by Eastin, et al.

Effective postpartum contraceptive practices contribute to increased interpregnancy intervals, reduced unintended pregnancies, and improved health outcomes for mothers and babies. While it is crucial for female active-duty military service members, little was known about postpartum long-acting reversible contraceptive (LARC) use among active-duty soldiers. For a study, researchers sought to quantify the postpartum uptake of long-acting reversible contraception among active-duty female US Army soldiers and identify demographic and military-specific characteristics associated with its use.

Conducted as a retrospective cohort study, longitudinal data of all digitally recorded health encounters for active-duty US Army soldiers from 2014 to 2017 were utilized. Servicewomen included in the analysis were aged 18 to 44 years, having experienced at least one delivery, and a minimum of 4 months of total observed time postdelivery within the study period. Postpartum LARC use was defined as initiation within the delivery month or the 3 months following delivery, with likely immediate postpartum initiation identified through placement recorded during the same month as delivery. Predictors of postpartum LARC use were evaluated using multivariable logistic regression.

The study included 15,843 soldiers meeting the inclusion criteria, among whom 3,162 (19.96%) initiated long-acting reversible contraception in the month or within the 3 months following delivery. Immediate postpartum LARC use was observed in fewer than 5% of these women. Among those who initiated postpartum LARC use, 1,803 (57.0%) received an intrauterine device, 1,328 (42.0%) received an etonogestrel implant, and 31 received both (0.98%). Soldiers of younger age, self-reported White race, and those who were married or previously married were more likely to initiate long-acting reversible contraception in the postpartum period. Race-stratified analyses indicated that self-reported White women had the highest overall use rates.

In comparison, the adjusted odds of postpartum use among self-reported Black and Asian or Pacific Islander women were 18% and 30% lower, respectively (both P < .001). A trend of decreasing postpartum use with increasing age was observed within each race group. Differences observed between age groups and race identities could be partially attributed to the varied use of permanent contraception (sterilization), which is significantly more prevalent among women aged 30 years or older and those identifying as Black.

In the cohort of active-duty US Army servicewomen, approximately 1 in 5 utilized postpartum long-acting reversible contraception, with less than 5% opting for immediate postpartum methods. Despite universal healthcare coverage within this population, the study revealed comparatively low rates of usage and notable variations in the adoption of effective postpartum long-acting contraceptive methods among self-reported race categories.

Source: ajog.org/article/S0002-9378(23)00471-4/fulltext