Abstract：
BACKGROUND: Postpartum use of long-acting reversible contraception has been found to be effective at increasing interpregnancy intervals, reducing unintended pregnancies, and optimizing health outcomes for mothers and babies. Among female active-duty military service members, reproductive planning may be particularly important, yet little is known about postpartum long-acting reversible contraceptive use among active-duty soldiers.
OBJECTIVE: This study aimed to (1) quantify postpartum uptake of long-acting reversible contraception among active-duty female US Army soldiers and (2) identify demographic and military-specific characteristics associated with use.
METHODS: This retrospective cohort study used longitudinal data of all digitally recorded health encounters for active-duty US Army soldiers from 2014 to 2017. The servicewomen included in our analysis were aged 18 to 44 years with at least one delivery and a minimum of 4 months of total observed time postdelivery within the study period. We defined postpartum long-acting reversible contraception use as initiation of use within the delivery month or in the 3 calendar months following delivery and identified likely immediate postpartum initiation via the proxy of placement recorded during the same month as delivery. We then evaluated predictors of postpartum long-acting reversible contraception use with multivariable logistic regression.
RESULTS: The inclusion criteria were met by 15,843 soldiers. Of those, 3162 (19.96%) initiated the use of long-acting reversible contraception in the month of or within the 3 months following delivery. Fewer than 5% of these women used immediate postpartum long-acting reversible contraception. Among women who initiated postpartum long-acting reversible contraceptive use, 1803 (57.0%) received an intrauterine device, 1328 (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 showed that self-reported White women had the highest use rates overall. When compared with these women, 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). There was also a trend of decreasing postpartum use with increasing age within each race group. Differences observed between age groups and race identities could partially be attributed to differential use of permanent contraception (sterilization), which was found to be significantly more prevalent among both women aged 30 years or older and among women who identified as Black.
CONCLUSIONS: Among active-duty US Army servicewomen, 1 in 5 used postpartum long-acting reversible contraception, and fewer than 5% of these women used an immediate postpartum method. Within this population with universal healthcare coverage, we observed relatively low rates of use and significant differences in the uptake of effective postpartum long-acting contraceptive methods across self-reported race categories.
OBJECTIVE: This study aimed to (1) quantify postpartum uptake of long-acting reversible contraception among active-duty female US Army soldiers and (2) identify demographic and military-specific characteristics associated with use.
METHODS: This retrospective cohort study used longitudinal data of all digitally recorded health encounters for active-duty US Army soldiers from 2014 to 2017. The servicewomen included in our analysis were aged 18 to 44 years with at least one delivery and a minimum of 4 months of total observed time postdelivery within the study period. We defined postpartum long-acting reversible contraception use as initiation of use within the delivery month or in the 3 calendar months following delivery and identified likely immediate postpartum initiation via the proxy of placement recorded during the same month as delivery. We then evaluated predictors of postpartum long-acting reversible contraception use with multivariable logistic regression.
RESULTS: The inclusion criteria were met by 15,843 soldiers. Of those, 3162 (19.96%) initiated the use of long-acting reversible contraception in the month of or within the 3 months following delivery. Fewer than 5% of these women used immediate postpartum long-acting reversible contraception. Among women who initiated postpartum long-acting reversible contraceptive use, 1803 (57.0%) received an intrauterine device, 1328 (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 showed that self-reported White women had the highest use rates overall. When compared with these women, 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). There was also a trend of decreasing postpartum use with increasing age within each race group. Differences observed between age groups and race identities could partially be attributed to differential use of permanent contraception (sterilization), which was found to be significantly more prevalent among both women aged 30 years or older and among women who identified as Black.
CONCLUSIONS: Among active-duty US Army servicewomen, 1 in 5 used postpartum long-acting reversible contraception, and fewer than 5% of these women used an immediate postpartum method. Within this population with universal healthcare coverage, we observed relatively low rates of use and significant differences in the uptake of effective postpartum long-acting contraceptive methods across self-reported race categories.
摘要：
背景：已发现产后使用长效可逆避孕（LARC）可有效增加妊娠间隔，减少意外怀孕，优化母亲和婴儿的健康结果。在女性现役军人中，生殖规划可能特别重要，然而，现役士兵对产后长效可逆避孕药的使用知之甚少。
目的：（1）量化美国陆军现役女兵对长效可逆避孕的产后摄取，(2)确定与利用相关的人口和军事特征。
方法：这项回顾性队列研究使用了2014-2017年所有数字记录的美国陆军现役士兵健康遭遇的纵向数据。我们分析中包括的服务女性年龄为18-44岁，至少有一次分娩，并且在研究期内分娩后观察到的总时间至少为四个月。我们将产后长效可逆避孕应用定义为在分娩月或分娩后三个日历月开始。并通过与分娩相同月份记录的安置代理确定可能立即开始产后。然后，我们使用多变量逻辑回归评估了产后长效可逆避孕利用的预测因素。
结果：15,843名士兵符合纳入标准。其中,3,162（19.96％）在一个月内接受了长效可逆避孕方法，或者在接下来的三个月内，delivery.这些妇女中只有不到5％立即使用产后长效可逆避孕。在接受产后长效可逆避孕方法的妇女中，1,803（57.0％）收到了宫内节育器，1,328例（42.0％）接受了依托孕烯植入，31例接受了两者（0.98％）。年轻的士兵，自我报告的白人种族，已婚或先前已婚的人更有可能在产后开始长效可逆避孕。种族分层分析表明，自我报告的白人女性总体利用率最高。和这些女人相比,自我报告的黑人和亚洲/太平洋岛民妇女产后利用率的调整后几率分别降低了18％和30％，分别(均p<0.001)。在每个种族组中，随着年龄的增加，产后利用率也有降低的趋势。在年龄组和种族身份之间观察到的差异可能部分归因于永久性避孕（绝育）的差异利用，这在30岁或30岁以上的女性中明显更普遍，以及识别黑人的女性。
结论：在现役军人中，五分之一的人使用产后长效可逆避孕，这些妇女中只有不到5％的人立即使用产后方法。在这个拥有全民医保的人群中，我们观察到,在自我报告的种族类别中,有效产后长效避孕方法的使用率相对较低,且在摄取方面存在显著差异.
目的：（1）量化美国陆军现役女兵对长效可逆避孕的产后摄取，(2)确定与利用相关的人口和军事特征。
方法：这项回顾性队列研究使用了2014-2017年所有数字记录的美国陆军现役士兵健康遭遇的纵向数据。我们分析中包括的服务女性年龄为18-44岁，至少有一次分娩，并且在研究期内分娩后观察到的总时间至少为四个月。我们将产后长效可逆避孕应用定义为在分娩月或分娩后三个日历月开始。并通过与分娩相同月份记录的安置代理确定可能立即开始产后。然后，我们使用多变量逻辑回归评估了产后长效可逆避孕利用的预测因素。
结果：15,843名士兵符合纳入标准。其中,3,162（19.96％）在一个月内接受了长效可逆避孕方法，或者在接下来的三个月内，delivery.这些妇女中只有不到5％立即使用产后长效可逆避孕。在接受产后长效可逆避孕方法的妇女中，1,803（57.0％）收到了宫内节育器，1,328例（42.0％）接受了依托孕烯植入，31例接受了两者（0.98％）。年轻的士兵，自我报告的白人种族，已婚或先前已婚的人更有可能在产后开始长效可逆避孕。种族分层分析表明，自我报告的白人女性总体利用率最高。和这些女人相比,自我报告的黑人和亚洲/太平洋岛民妇女产后利用率的调整后几率分别降低了18％和30％，分别(均p<0.001)。在每个种族组中，随着年龄的增加，产后利用率也有降低的趋势。在年龄组和种族身份之间观察到的差异可能部分归因于永久性避孕（绝育）的差异利用，这在30岁或30岁以上的女性中明显更普遍，以及识别黑人的女性。
结论：在现役军人中，五分之一的人使用产后长效可逆避孕，这些妇女中只有不到5％的人立即使用产后方法。在这个拥有全民医保的人群中，我们观察到,在自我报告的种族类别中,有效产后长效避孕方法的使用率相对较低,且在摄取方面存在显著差异.
