(SLC-011) Contraceptive Utilization, Adherence, and Pregnancy Outcomes Among Active Duty Service Women

Background: In May 2019, the Defense Health Agency-Procedural Instruction (DHA-PI) 6200.02 was introduced to permit extended contraceptive supply at military treatment facility (MTF) pharmacies. However, the impact of this policy on contraceptive adherence, pregnancy rates, and emergency contraception use among Active Duty Service Women (ADSW) has not been evaluated.

Objectives: This study describes contraceptive adherence, pregnancy rates, and emergency contraception use among ADSW who initiated contraception, with a focus on the potential impact of extended contraceptive coverage.

Methods: A retrospective cohort study was conducted among contraception-naïve ADSW (ages 18-55) who initiated contraception and had continuous TRICARE enrollment for at least three months before and 15 months after their initial prescription (index date) between January 1, 2016, and September 30, 2022. Contraceptive initiation was defined as the use of short-acting reversible contraception (SARC), long-acting reversible contraception (LARC), or permanent contraception. The primary outcomes included contraceptive adherence—defined as perfect adherence(≥90% coverage during the treatment period) and typical adherence (average percentage of coverage)—as well as emergency contraception use and pregnancy within 12 months of contraceptive initiation. Descriptive analyses were performed to summarize cohort characteristics and trends in contraceptive use, adherence, emergency contraception, and pregnancy.

Results: The study included 123,779 ADSW, of whom 64.06% initiated SARC, 33.42% used LARC, and 2.52% underwent permanent contraception. Overall, 50.95% achieved perfect adherence, with the highest adherence observed among permanent contraception users (94.64%). Typical adherence was observed in 72.36% of the cohort, again highest among those with permanent contraception. Within 12 months of contraceptive initiation, 4.6% used emergency contraception, and 9.5% experienced a pregnancy. SARC users had the highest rate of emergency contraception use (5.9%), while permanent contraception users had the highest pregnancy rate (13.6%).

Conclusions: This descriptive analysis highlights adherence patterns, emergency contraception use, and pregnancy rates among ADSW who initiated contraception. While 50% of ADSW achieved perfect adherence, 5% required emergency contraception, and 10% experienced pregnancy within 12 months of initiation. These findings provide insights into contraceptive utilization and adherence in this population, underscoring the need for further evaluation of extended contraceptive coverage policies to optimize reproductive health outcomes.