Study links unplanned pregnancies among service women to reduced military readiness

BMJ GroupJul 25 2024

Unplanned pregnancies among active service women may be curbing overall US military readiness for action and compromising its Women Peace and Security objectives, suggests research published online in the journal BMJ Military Health.

That's because they potentially result in the loss of an estimated 2.5 million to more than 4.5 million active duty days, depending on the denominator used, the findings indicate, with the highest rates among 18-24 year olds, those of White race, those deployed in junior ranks and those serving in the Army.

The researchers set out to assess the impact of unplanned pregnancy on military readiness and the ability to meet the Women Peace and Security objectives. These affirm the importance of women in the prevention and resolution of conflicts and in peacekeeping, as well as their equal participation and full involvement in all peace and security efforts.

The United States has a significantly higher rate of unplanned pregnancies than other high-income countries, with an estimated 4.5% of all women of reproductive age falling pregnant unintentionally every year, note the researchers.

The number of women serving in the military is growing, representing nearly 17% of service personnel, they explain, adding that since January 2023, new parents in the military are now entitled to 12 weeks of parental leave.

And new mothers don't have to meet height and weight standards and complete a physical fitness test for up to a year after a full-term delivery. Until they do so, service women aren't considered medically ready for duty.

In a bid to further inform reproductive health policies, the researchers estimated the number of unplanned pregnancies during the 2019 fiscal year and the number of unplanned deliveries, using two previously published studies on expected prevalence to calculate the number of readiness for military service days lost.

Defense Enrollment Eligibility Reporting System records and administrative claims data from the Military Health System Data Repository identified 230,596 active duty service women aged 18 to 44 in the Army, Air Force, Navy and Marine Corps during 2019, 12,564 (5.4%) of whom gave birth in the same year.

Using the expected prevalence of unplanned pregnancy among active service women of 5.5%, the researchers estimated that 12,683 fell pregnant unintentionally during the 2019 fiscal year. 

And using the expected prevalence of 54% of these deliveries being unplanned, they estimated that 6785 of all births were unintended.

They estimated the potential number of readiness for military service days lost by multiplying the number of unplanned pregnancies by the maximum number of 365 allowable days' leave to meet the height and weight standards and the completion of a physical fitness test.

Based on their estimates of 12,683 active service women experiencing an unplanned pregnancy, an estimated 4,629,215 readiness for military service days were lost in the 2019 fiscal year. 

Based on their estimates of 6785 unplanned births, they estimated that 2,476,364 readiness for military service days were lost. 

The highest estimated numbers of unplanned pregnancies were among 18 to 24 year olds, those of White race, those enlisted in a junior rank, and those serving in the Army, the analysis indicated.

The Military Health System provides universal access to healthcare for all members of the armed services and their dependants, say the researchers. But previously published studies suggest that service women find it difficult to schedule an appointment, or don't take time off to attend one for fear of being judged. And the use of contraceptives is low among those at highest risk of an unplanned pregnancy.

"The impacts of [unintended pregnancy] are far-reaching," the researchers explain. "Children born after [one] are at greater risk of cognitive delays and behavioral problems, which might affect the ability of [service women] to get back into their previous jobs or remain engaged in their positions. 

"Maternal depression rates and higher parenting stress are also prevalent partly due to an increased economic burden and childcare challenges, which would be pronounced among young, Junior Enlisted parents." And women are 30% more likely to leave the military after an unplanned pregnancy, they add.

The study findings are based on previously published prevalence data from two studies, both of which relied on self-report, acknowledged the researchers. And the numbers are estimates rather than actual figures.

The analysis also assumed that every active duty service woman who became pregnant in the 2019 fiscal year didn't meet height and weight standards and complete a physical fitness test for the entire 365 days. It also assumes that there were no pregnancy terminations during this time period, they add.

"Despite these limitations, we believe the estimates calculated in this study help to describe the potential impact that [unintended pregnancy] might have on military readiness, and highlight the need for increased access to comprehensive family planning and reproductive healthcare for service members," they conclude.