Army soldiers have more babies in their first two years of enlistment and miss more work as a result than do women in the other military branches, a finding researchers say is linked to different service policies on birth control education and access at basic training.
Between 2013 and 2016, the birth rate among soldiers in the first two years of military service ranged between 10.1% and 11.4%, while the combined rate for women in the other branches hovered at around 6.4%.
The higher rate among soldiers resulted in an additional .04 deliveries, 3.7 more days of postpartum leave and 28.2 more pregnancy-related non-deployable days per service woman trained than for sailors, airmen and Marines, said Dr. Tim Roberts, a retired Navy commander who now works at Children's Mercy Kansas City.
Babies themselves may be a joy, but when they aren’t planned, they can upend a service member’s life and affect readiness, Roberts said. Citing studies of service members who left deployments early in Operations Desert Shield and Desert Storm due to unintended pregnancies, Roberts called it “a problem that has a definite impact on the combat readiness of the troops.”
At Army boot camp, female recruits receive education on all types of birth control and have access to contraception at sick call. They also can receive the most effective types of birth control, known as long-acting reversible contraception such as intrauterine devices or implants, on referral.
In contrast, the Navy aggressively promotes long-acting reversible contraception, or LARC, and other effective forms of birth control at basic training. It requires recruits to meet individually with medical providers and provides access to contraception at sick call or in walk-in contraception-only clinics that provide same-day access to LARC.
According to Roberts, the Navy's approach, known as "LARC Forward" and implemented in 2015, has reduced the service's childbirth rates and related missed days by .012 deliveries, .9 days of postpartum leave and nearly 8 days of childbirth-related non-deployable days per service woman trained.
"The Navy has had some good leadership within the medical corps, and they really leaned forward into the problem of addressing women's health," Roberts said. "If someone in the military wants to get pregnant, by all means, have a kid. But if you don't want one, [Navy leadership said], 'Let us help you.' They became very proactive."
Roberts and several civilian and military colleagues, including Dr. William Adelman at Children's Mercy, Air Force adolescent medicine specialist Dr. Joshua Smalley and Air Force Maj. Larissa Weir, conducted the study to determine how different policies affected pregnancy, childbirth and work attendance, all of which affect military readiness.
They culled military insurance records to identify all female active-duty recruits between October 2013 and October 2017 and determine whether those recruits used birth control at six months of service and if they entered the hospital to have a baby within their first two years.
The data showed that in 2017, at six months, the Navy had the highest proportion of members who used highly effective methods of birth control, at 40%. The Air Force and Marines were at 26% and 23%, respectively, and the Army, 17%.
The percent of junior enlisted women who had a baby in 2017 was 5.1% for the Air Force, 6.1% in the Navy, 9.7% in the Marine Corps and 10.1% in the Army.
Notably, the childbirth rate for the Marine Corps was at 8% in 2015. It rose after the service decreased classroom time for non-military lessons in 2016. Instead of mandatory education on contraception at boot camp, female Marine recruits now have access to optional contraception education once a week, outside of working hours.
They can get contraception at sick call and have access to LARC in the last two weeks of basic training.
Roberts said the Marine Corps is a prime example of why education on contraception should be conducted at boot camp.
"They're saving time in basic training, but they are losing the time when they are non-deployable or on postpartum leave," he said.
According to the research, the Air Force stands out as having the lowest childbirth rates, even though the Navy has the highest use of contraception. At Air Force basic training, recruits receive group education at a clinic that emphasizes the most effective methods of birth control. They can receive contraception at sick call and one morning during the week at a specialty clinic. Since 2017, they also have had access to LARC in the last five weeks of basic training.
"The women in the Air Force have the lowest delivery rates than the women in the other services, and I'm not sure why," Roberts said. "There may be something different the Air Force is doing about contraceptive use when they get out of basic training. There may be something different about the women who join the Air Force versus the Army, Navy, Marines. If there's something they are doing, we would like to know."
Roberts described unintended pregnancies in the military as a "common problem." With the Defense Department providing no-cost contraception and reproductive health care services to all its members, he added, women should be able to have children only when they want them.
"It’s surprising to me that we have such wide variability in policies. We all have the same goal -- creating service members. But there's a variability as to what they allow people to do at basic training," Roberts said.
While he is not sure implementing the Navy's LARC Forward program at all basic training centers would result in similar outcomes, he believes it would help.
He'd like to see LARC Forward implemented at one of the Army’s three basic training facilities to see what effect, if any, it has on outcomes. He has began speaking with U.S. Army Training and Doctrine Command about conducting research into the issue, which would be funded by the Uniformed Services University of the Health Sciences.
"If you make it easy for recruits to start contraception and communicate with them to use the most effective methods, they don't get pregnant," Roberts said. "You can't just throw this to the next duty station, say ‘Start this later,’ because they don't."