Contraceptive provision in the VA healthcare system to women who report military sexual trauma.
BACKGROUND
Women Veterans who suffered military sexual trauma (MST) may be at high risk for unintended pregnancy and benefit from contraceptive services. The objective of this study is to compare documented provision of contraceptives to women Veterans using the Department of Veterans Affairs (VA) health system who report or deny MST.


METHODS
This retrospective cohort study included women Veterans aged 18-45 years who served in Operation Enduring or Iraqi Freedom and had at least one visit to a VA medical center between 2002 and 2010. Data were obtained from VA administrative and clinical databases. Chi-squared tests and logistic regression were conducted to evaluate the association between MST, ascertained by routine clinical screening, and first documented receipt of hormonal or long-acting contraception.


RESULTS
Of 68,466 women Veterans, 13% reported, 59% denied and 28% had missing data for the MST screen. Among the entire study cohort, 30% of women had documented receipt of a contraceptive method. Women reporting MST were significantly more likely than those denying MST to receive a method of contraception (adjusted odds ratio [aOR] 1.12, 95% confidence interval [CI] 1.07-1.18) including an intrauterine device (odds ratio [OR] 1.29, 95% CI 1.17-1.41) or contraceptive injection (OR 1.17, 95% CI 1.05-1.29). Women who were younger, unmarried, seen at a women's health clinic, or who had more than one visit were more likely to receive contraception.


CONCLUSIONS
A minority of women Veterans of reproductive age receive contraceptive services from the VA. Women Veterans who report MST, and particularly those who seek care at VA women's health clinics, are more likely to receive contraception.
1 Department of Obstetrics and Gynecology, Women and Infants' Hospital , Providence, Rhode Island.
Vinita
V
Goyal
Kristin
K
Mattocks
Eleanor
E
Bimla Schwarz
Sonya
S
Borrero
Melissa
M
Skanderson
Laurie
L
Zephyrin
Cynthia
C
Brandt
Sally
S
Haskell
D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000600:supply & distribution*; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D011247:Pregnancy; D011275:Pregnancy, Unwanted; D012189:Retrospective Studies; D012742:Sex Offenses / Q000523:psychology / Q000706:statistics & numerical data*; D017406:Sexual Harassment; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D058014:Veterans Health; D016387:Women's Health; D055815:Young Adult
D003271:Contraceptive Agents, Female