Optimizing Women's Health in The U.S. Army Through Contraceptive Therapy and Standardized Soldier Readiness Programs

A Path Toward Integrated Care Across NATO and U.S. Forces

By COL Erin A. Keyser, MD, FACOG

Article published on: August 14th, 2025, in the August 2025 Issue of The Pulse of army Medicine

Read Time:< 8 mins

The evolving demographics of the U.S. Army reflect a growing presence of women across all ranks and roles, including combat arms. Women now make up nearly 20% of the U.S. Army. This shift highlights the need to reassess healthcare strategies to meet the specific needs of female service members. Among the most pressing concerns are menstruation and reproductive health. These issues, if unaddressed, can hinder both individual performance and unit readiness. As the female military population continues to expand, proactive measures to support their health are essential. Contraceptive therapies offer a promising solution, not only improving personal well-being but also enhancing operational effectiveness across the force.

Research has shown that there are additional health benefits of contraceptive use beyond pregnancy prevention. These health benefits include reducing menstrual bleeding, decreasing painful menstrual cycles, regulating menstrual cycles, and treating gynecological conditions such as dysmenorrhea, premenstrual syndrome, and endometriosis.

CONTRACEPTIVE BENEFITS AND HEALTH IMPLICATIONS

Contraceptive therapies offer a variety of health benefits beyond the prevention of pregnancy, making them essential tools for improving women’s health in the military. Some of the additional health benefits of contraceptives include:

• Reduction in Menstrual Events: Contraceptive methods can reduce significant menstrual bleeding by as much as 66%.
• Treatment of Menstrual Conditions: Contraceptives effectively treat conditions such as heavy menstrual bleeding, dysmenorrhea (painful periods), and irregular menstrual cycles.
• Prevention and Management of Gynecological Conditions: Contraceptive methods also offer protection against conditions like premenstrual syndrome, menstrual migraines, and endometriosis.

Ensuring an explanation with every exam… Cmdr. Teri Ryals, Naval Hospital Bremerton OB/GYN clinic department head and certified nurse midwife discusses the pap smear/pap test procedure. Naval Hospital Bremerton Jan, 01, 2024

• Cancer Prevention: There is evidence that contraceptive use can decrease the risk of endometrial, ovarian, and colorectal cancers.
• Improved Bone Health: Some forms of contraception improve bone mineral density, which is especially important for active-duty Soldiers who experience high physical demands.

The use of contraception also allows female Soldiers to manage their health in ways that align with operational needs. For example, contraceptives can be taken continuously to eliminate periods all together, which can be useful during deployments, where sanitary resources may be limited, and health facilities may be scarce.

The unique operational environment of the military and the nature of deployments make addressing these concerns critical. However, current military healthcare practices do not consistently provide female Soldiers with access to comprehensive gynecologic care. The absence of a standardized Women’s Health SRP that includes contraceptive therapy, education, and counseling before deployment contributes to gaps in care that affect both health outcomes and military readiness.

BARRIERS TO ACCESS AND UTILIZATION

Despite the significant health benefits, contraceptive usage remains low among female Soldiers, particularly during deployments. Studies have shown that:

• Only 63% of Soldiers receive some form of contraception during deployment, and 59% do not discuss contraceptive options with a military provider before deployment.
• Specific methods such as intrauterine devices (IUDs), implants, and sterilization are often unavailable or discouraged.
• 41% of women who require refills report difficulty obtaining them during deployment, resulting in inconsistent access to effective contraception. These barriers highlight the absence of a standardized Women’s Health SRP, which could ensure that all female Soldiers receive the education, counseling, and access to contraceptive methods they need to optimize their health and readiness.

IMPACT OF INADEQUATE CONTRACEPTIVE CARE ON MILITARY OPERATIONS

A. Unplanned Pregnancy

Unplanned pregnancies are a significant concern in the military, with rates higher among military women than in civilian populations. These pregnancies pose substantial barriers to deployment and operational readiness. For example, prescribing a full year of birth control pills rather than only a three-month supply could prevent approximately 583 unintended pregnancies annually in a population of 24,309 women. Pregnancy makes a women non-deployable for 21 months, impacting operational readiness for prolonged periods. Furthermore, unplanned pregnancies during deployment lead to significant financial costs for transportation out of theater and disruptions to military operations.

B. Lost Duty Days

Menstrual conditions also contribute to lost duty days, with up to 15% of female Soldiers experiencing missed days of work (absenteeism) due to painful menstrual cycles. Data from the Gulf War reveals that women generated 1,792 sick call visits, over 25% of which were due to conditions such as painful, heavy or irregular menstrual bleeding, that could have been managed or alleviated through contraception. Additionally, a study of 397 deployed women found that 35% experienced at least one gynecological problem during deployment, with irregular menstrual bleeding being the most common complaint.

C. Medical Evacuations

In 2019, a report from the Capabilities Development Integration Directorate’s Computational Science Division analyzed the Standardized Inpatient Data Record (SIDR) and found that 2,428 women were evacuated to Role 3 facilities in the CENTCOM Area of Responsibility (AOR) from 2001 to 2014 for gynecological conditions (painful, heavy or irregular menstrual bleeding) that could have been prevented or treated with contraception. These evacuations contribute to increased healthcare costs and disruptions in military operations.

CONCLUSION AND RECOMMENDATIONS

Given the clear benefits of contraception and the challenges posed by insufficient access, it is imperative to establish a standardized Women’s Health SRP for all female Soldiers. This program would ensure that all women receive comprehensive education, counseling, and access to contraceptive options such as birth control pills, patches, rings, intrauterine devices (IUDs) or implants before deployment, and that contraceptive care is continued during deployment. The following actions are recommended:

• Pre-Deployment SRP: Ensure that all female Soldiers undergo a Women’s Health SRP at least 90 days before deployment, which includes counseling on contraceptive options, education on how to take contraception to suppress menstrual cycles, and the provision of a full year’s supply of contraception. This appointment should be with a women’s health specialist, such as an obstetrician gynecologist, family practice physician, women’s health nurse practitioner or women’s health physician assistant. We recommend 90 days prior to deployment as it can take up to three months for contraceptive interventions to achieve desired outcomes of reduced menstrual bleeding.
• Expanded Access to Contraceptive Methods: Increase the availability of all contraceptive methods, ensuring that Soldiers have access to the method that best suits their needs. Full spectrum contraceptive options include the following:
  • Sterilization
  • Hormone IUDs
  • Copper IUD
  • Contraceptive implant (Nexplanon)
  • Injectable contraceptives (Depo-Provera)
  • Birth control rings (Annovera and Nuvaring)
  • Birth control patches (Ortho Evra)
  • Birth control pills
• Ongoing Education and Support: Provide continuous education about reproductive health, contraceptive choices, and the benefits of menstrual cycle control to ensure that female Soldiers can make informed decisions about their healthcare.

By implementing these recommendations, the Army can optimize the health and readiness of its female Soldiers. Addressing these issues not only improves women’s health but also enhances military readiness by reducing absenteeism and preventing avoidable medical evacuations. The benefits of pre-deployment access to contraception are now recognized and mandated by Department of Defense Instruction (DoDI); however, further efforts are needed to ensure all forms of contraception are available to soldiers regardless of where they are stationed. Further efforts need also ensure the availability of women’s health trained providers to educate and support female soldiers. Ensuring that female soldiers have consistent, pre-deployment access to contraception and gynecological care is not just a matter of health—it’s a matter of operational readiness, cost-effectiveness, and supporting the women who serve our country.