A survey of knowledge, attitudes, and practices of family planning services of army primary care providers at Joint Base Lewis McChord
Contraception
Awarded 2014
Complex Family Planning Fellowship Research
Elizabeth Deans, MD
Emory University
$64,081

Objective: Unplanned pregnancy remains a nationwide problem. Within the active duty military population, the age-adjusted unintended pregnancy rate is higher than the national average.  Unplanned pregnancy provides additional challenges for female service members.  When the pregnancy is unplanned, the female service member is unexpectedly removed from the team, and unit readiness is compromised.  Additionally, access to elective abortion is limited and especially problematic during deployment.
Active duty service women have Tricare insurance, which provides comprehensive contraceptive coverage.  However, studies demonstrate few women receive contraceptive counseling prior to deployment. Access to contraception during deployment abroad can also be problematic.  Some women are not aware of options available, others are concerned about maintaining privacy while seeking out contraception, and not all of the military facilities consistently maintain contraceptive supplies.
In the military setting, there are no comprehensive studies evaluating healthcare provider knowledge, attitudes, skills, and practices regarding family planning services.
Methods: This is a cross-sectional study of primary care providers of active duty soldiers who provide care both within brigade clinics (on-base) and Madigan Army Medical Center hospital clinics at Fort Lewis, the Army base of Joint Base Lewis-McChord in Tacoma, Washington. The survey includes multiple choice questions regarding contraceptive knowledge, training, and practices.  SAS (Cary, NC) was used for the statistical analysis.
Results: Recruitment occurred during the Army’s yearly staff relocation, which contributed to a low response rate of 17%. Most respondents were young, physicians, had completed their training within 5 years, and provided care within the hospital-based clinics. All providers counsel on comprehensive methods, identify long-active reversible contraceptive (LARC) methods as top methods for contraceptive efficacy, but recommend the vaginal ring and combined oral contraceptive pills (COCs) for patient satisfaction. In the past year, women’s health providers were more likely than other primary care providers to offer depo provera (DMPA), intrauterine devices (IUDs) in nulliparous women, and offer ‘Quick Start’ use of DMPA and COCs. Emergency contraception (EC) was not popular among all providers. Overall, providers identified correct typical use failure rates and safety profiles of several contraceptives. Women’s health providers were more likely to correctly identify that COCs were not safe for patients with migraines with aura and IUDs were safe for adolescents.
Conclusions: Strategies for streamlining family planning into routine care for all service members are needed and may reduce barriers to effective contraception. Increasing LARC counseling may address the underlying perception that patients prefer shorter, less effective methods.  Determining why EC is not popular among providers is a gap for future investigation. 

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