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Long-Acting Contraceptives are a Popular Choice with Service Members

Image of Bremerton nurse midwife demonstrates vaginal ring placement. Naval Hospital Bremerton has offered a Walk-In Contraceptive Clinic since March, 2021. Lt. Cmdr. Cheryl Q Castro, Obstetrics and Gynecology Department head and certified nurse midwife, demonstrates a vaginal ring. Castro, along with Family Medicine and OB/GYN physicians, nurse practitioners and nurse midwives provide screening and information on available forms of contraceptives for determining safe forms of contraception for all eligible patients. (Photo Credit: Douglas Stutz, Public Affairs Officer, NHB/Navy Medicine Readiness and Training Command (NMRTC), Bremerton

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Women's Health

At the OB-GYN clinic at Naval Hospital Jacksonville, Navy Lt. Cmdr. Christine Higgins has an array of options for contraception to offer female service members.

There are oral birth control pills, injections (once every three months) and long-term implants, among others. The most popular method, Higgins said, is the intrauterine device, or IUD. Once inserted by a health care professional, some IUDs last for up to 12 years.

"There's a real buy-in" for this type of contraception because of its durability, said Higgins, the clinic's department head.

Because the IUD is so long-acting, it is especially good for sailors and Marines deploying on ships or to austere environments. "A lot of women like this option for privacy's sake when aboard a ship," Higgins said.

Many female service members and their beneficiaries want control of their bodies' menstrual cycles for a variety of reasons, including military readiness. At medical centers, hospitals, and clinics around the world, the Military Health System provides education, counseling, and access to birth control.

Military women seek out contraception for a variety of reasons: to avoid unwanted pregnancies, and to decrease or suppress menstrual flow while serving in austere environments or for other reasons.

The military offers a variety of methods or products so women can choose the best birth control for their unique needs.

Some popular products are long-lasting but completely reversible once removed.

The long-acting reversible contraceptives (LARCs) such as IUDs and implants are used more widely by women in the Navy and Marine Corps, according to military health data in a 2021 report.

In 2020, LARCs were most common among service women in pilot/air crews followed by those in repair/engineering occupations, the report states. LARC use also was high among health care personnel.

The IUD can be particularly well suited for women who are approaching menopause, and who have high blood pressure, migraines, or blood clotting disorders, Higgins said. The latter group may not be able to use estrogen-containing contraception because of their medical conditions.

Other Options

The MHS offers many options for female service members and beneficiaries who are seeking contraception.

MHS-wide, single or combined estrogen or progesterone oral birth control pills are authorized in a 12-month supply, as well as Depo-Provera injections every 3 months.

Vaginal rings are another option for long-term birth control. Higgins said the newest one lasts for 13 cycles and doesn't have to be refrigerated or changed every month like earlier versions.

An implant is another form of long-acting birth control. It is a flexible, implantable rod that is placed in the inner upper arm and slowly releases progesterone for more than three years to prevent pregnancy.

Condoms are widely available at clinics and are free for the taking to protect women from unwanted pregnancies and sexually transmitted infections, Higgins explained.

The Plan B pill, the emergency contraceptive used after unprotected sex, is also available at military pharmacies without a health care provider's referral and also over-the counter at commercial pharmacies. For MHS beneficiaries, there is no co-pay for Plan B at a commercial pharmacy and the product is free at installation pharmacies, Higgins said.

At Naval Hospital Bremerton in Washington state, Navy Cmdr. (Dr.) Jacqueline Lamme explained how the implant accounts for just under 30% of all contraceptive visits at the walk-in clinic.

"While this visit does require a quick clinical procedure to place it and remove it, it does not require a pelvic exam, which many of our patients appreciate," Lamme said.

The hormonal IUD 'has the added benefit of making many patients' menses much lighter and sometimes stopping them altogether," she said.

"This is a great benefit, especially for our active duty patients, so they do not have to worry about periods and menstrual hygiene products while on deployment," Lamme said. About 21% of Bremerton patients opt for the IUD, she added.

Walk-in Clinics

The Navy developed the concept of the walk-in contraceptive clinic to improve the readiness of female sailors.

The clinics allow active duty service members to walk into a contraception clinic without an appointment or referral and have a same-day appointment for contraception only. This is good for deployed sailors when they are ashore for a few days on their way elsewhere, Higgins said. All other women's health services within the GYN clinic require a referral.

The first walk-in clinic was started in San Diego in 2016, and there are now more than two dozen across the fleet.

"Delaying access to contraception by requiring appointments can result in unplanned pregnancies, which have a direct impact on the readiness of the fleet," said Navy Lt. Cmdr. Lindsay Gillette, a family nurse practitioner assigned to the Navy Hospital Bremerton.

"This readiness concern prompted the creation of the clinic model. It is important to offer this service to all beneficiaries as part of a holistic women's health initiative," she said.

The Navy and Marine Corps offer a website on women's health and readiness issues, including a section on contraception.

The Navy's concept of walk-in clinics has prompted the Army and Air Force to offer similar options. For instance, there are now walk-in hours for contraceptives at Brooke Army Medical Center, San Antonio, Texas.

Decide + Be Ready app

New in 2021, the Decide + Be Ready mobile app helps female service members work with their health care providers to decide what kind of birth control would best suit them depending on their active duty status, health, and others factors such as practicality.

With the app, women answer a series of questions that allow them to start comparing contraceptive options that best suit their individual needs. The app helps patients identify their own preferences and which, if any, contraception they are interested in using.

"Women, we work and will put our health on the back burner," Higgins said. "The platform helps because it offers the same language, and the same technology that normalizes health care issues for women and improves readiness."

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