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.
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 and Data were obtained from VA administrative and clinical databases. Chi-squared tests and logistic regression were Sexual health clinic leeds contraceptive mandate to evaluate the association between MST, ascertained by routine clinical screening, and first documented receipt of hormonal or long-acting contraception.
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. 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.
Little is known about the contraceptive services provided to the growing population of women Veterans of reproductive age. No published research is available about contraceptive use among women Veterans who seek care outside the VA and limited available data suggests that few women receive contraception from the VA.
Women Veterans who experienced military sexual trauma MSTdefined as sexual assault or harassment while in military, 7 may face particular challenges in seeking reproductive healthcare and thus may be less likely to receive needed contraceptives. Based on available evidence, we hypothesized that women Veterans who report MST
Sexual health clinic leeds contraceptive mandate be less likely to receive contraceptive services from the VA compared with those who denied MST.
Eligible study participants had at least one visit to the VA between and These databases provide healthcare utilization data, pharmacy data, clinical Sexual health clinic leeds contraceptive mandate including MST, health encounters and coded procedure data Current Procedural Terminology [CPT] associated with all VA outpatient encounters. A clinical reminder, recorded as a health factor, in the patient's electronic medical record prompts the healthcare provider Sexual health clinic leeds contraceptive mandate screen for MST.
Response options to MST screening Sexual health clinic leeds contraceptive mandate all sites include yes, no or declined
Sexual health clinic leeds contraceptive mandate answer. Patients are coded as having a positive MST screen if they respond affirmatively to either screening item. The outcome of interest was receipt of a new hormonal or long-acting contraceptive method or documented tubal sterilization within the VA system.
For example, if Sexual health clinic leeds contraceptive mandate woman received a prescription for oral contraceptive pills but then later had an intrauterine device IUD inserted, both would be counted.
If the same woman later received another prescription for oral contraceptive pills, only the first prescription Sexual health clinic leeds contraceptive mandate be counted. To provide the most conservative estimate of the difference in contraceptive use among women who routinely refilled contraceptive prescriptions and those who were one-time users, only first-time contraceptive documentation was evaluated.
The DSS pharmacy files were used to identify first-time prescriptions for combined oral contraceptive pills, contraceptive patch, vaginal contraceptive ring, progestin-only pills, or the contraceptive injection. CPT codes were used to identify first time IUD insertion or contraceptive implant placement, first time contraceptive injection administration, and documented tubal sterilization. Only contraceptive services provided by a VA clinician or pharmacy were included in this analysis.
If women received contraceptive services outside the VA, but had these services paid for by the Department of Veterans Affairs i. Descriptive statistics including chi-squared tests were used to assess differences in characteristics between women Veterans who reported, denied, or had missing data for the MST screen.
Women who had documented receipt of any contraceptive method were categorized as such and compared to those who did not. Chi-squared tests were used to evaluate differences in characteristics among women Veterans who did and did not receive any contraceptive method. A logistic regression model was created to evaluate the effect of MST on receipt of any contraceptive method while adjusting for potential confounding variables including age, race, marital status, military branch, military component, education, women's health clinic visit, or number of visits.
None of the variables significantly changed the odds ratio, however based on prior research which has associated age, race and marital status with MST and contraceptive use, 92122 these three variables were included in our final model. Subgroup analyses of women Veterans who had a documented visit in Sexual health clinic leeds contraceptive mandate emergency department, a primary care clinic including the general internal medicine, primary care, Sexual health clinic leeds contraceptive mandate women's Sexual health clinic leeds contraceptive mandate clinicor for gynecologic care including the gynecology or women's surgery clinic or breast or cervical cancer screening within the VA during and were performed to evaluate responses to MST screening and receipt of any contraceptive method using chi-squared tests.
Twenty-eight percent of women Veterans had missing data for the MST screen. Compared to those who provided a response to the MST screen, those with missing data were older, more likely to be married, serve in the Air Force, have officer military rank,
Sexual health clinic leeds contraceptive mandate greater than high school education, have only one visit
Sexual health clinic leeds contraceptive mandate the VA, and were less likely to be seen in a women's health clinic.
Compared with those who denied MST, women Veterans who reported MST were more likely to be white, married, serve in the active duty component, and have visited a women's health clinic Table 1.
Sexual health clinic leeds contraceptive mandate who were 18—24 years old, unmarried, active duty, enlisted military rank, graduated from high school or earned a GED, and had 4—6 visits were more likely to have received a contraceptive method from a VA provider. Few women were provided with the contraceptive patch, Sexual health clinic leeds contraceptive mandate, or tubal sterilization Table 3.
In unadjusted analyses, compared to women who denied MST, those who reported MST were significantly more likely to receive a prescription for progestin-only pills odds ratio [OR] 1.
There was no significant difference in oral contraceptive pill OR 1. Women who provided a response to the MST screen were more likely than those who had missing data to receive any of the contraceptive methods aOR 7. Results of the subgroup analyses for women Veterans who had a documented emergency, primary care, or gynecology related visit are similar to the entire study population. In contrast our hypothesis that women reporting MST would be less likely to receive contraception, this study demonstrates that women Veterans who Sexual health clinic leeds contraceptive mandate MST were significantly more likely than women who denied MST to receive contraceptive services within the VA healthcare system.
Importantly, women who reported MST were more likely to receive highly effective methods of contraception such as the IUD. This higher rate of contraceptive receipt may be due to the fact that women who are more frequently seen in a VA women's health clinic are more likely to be screened for MST, feel comfortable enough with their clinician to MST, and have the opportunity to discuss a need for contraception.
Among women aged 15—44 in the U. The positive screen rate in our study is comparable to other data regarding the prevalence of MST. In this study, a greater proportion of women Veterans who reported MST were seen at a women's health clinic compared
Sexual health clinic leeds contraceptive mandate those who denied MST.
Furthermore, a visit to a women's health clinic was associated with greater documented receipt of any contraceptive method. These findings are important in informing ongoing VA planning and policy with respect to healthcare delivery to women Veterans, including those who have experienced MST.
For example, for women Veterans who have experienced MST and receive mental and behavioral health counseling or medications within patient-centered medical homes or patient-aligned care teams in the VA, provision of contraceptive services within those healthcare structures is extremely important to reduce unintended pregnancy and optimize health outcomes.
The primary limitation of this study is the large proportion of the study cohort who had missing data for the MST screen.
The data for this study were collected beginning in the early period of MST screening which may have resulted in a lot of missing data.
Despite the mandate for universal screening, some VA facilities used nonstandard screening questions, had clinical reminder implementation problems, or had incomplete Sexual health clinic leeds contraceptive mandate of MST data from the local facility to national data warehouses that led to missing MST data.
Additionally, we were unable to determine the extent to which provision of contraceptive services reflect underlying childbearing intentions. Our finding that older, married Veterans were less likely to receive contraception from a VA provider may reflect a desire for pregnancy in this population. Women Veterans who are not in relationships with men, had a hysterectomy or tubal sterilization not documented within VA records, or who are infertile are also not at risk for unintended pregnancy.
In a similar manner, women who obtain contraception outside the VA were not accounted for in our study. In this study, women with missing MST data had less contact with VA clinicians and may have sought contraceptive services outside the VA healthcare system. The findings from this study demonstrate that women Veterans who report MST are receiving contraceptive services and using women's health clinics in VA settings at higher rates than women Veterans have not reported experiencing MST.
However, a larger remaining proportion of women Veterans in both groups who could benefit contraception do not receive this service from the VA. Additionally, women Veterans who have experienced MST but do not report
Sexual health clinic leeds contraceptive mandate or who do not seek care at a VA, and specifically a VA women's health clinic, may be less likely to receive contraceptive services.
Cynthia Brandt Sexual health clinic leeds contraceptive mandate Sally Haskell. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Children Health and Human Development of the National Institutes of Health.
No competing financial interests exist. The views expressed in this article are those of the authors and not necessarily reflect the position or policy of the Department of Veterans Affairs.
National Center for Biotechnology InformationU. Journal of Women's Health. J Womens Health Larchmt. Find articles by Vinita Goyal. Find articles by Kristin Mattocks.
Find articles by Eleanor Bimla Schwarz. Find articles by Sonya Sexual health clinic leeds contraceptive mandate. Find articles by Melissa Skanderson. Find articles by Laurie Zephyrin. Find articles by Cynthia Brandt. Find articles by Sally Haskell. Author information Copyright and License information Disclaimer. CopyrightMary Ann Liebert, Inc. This article has cited by other articles in PMC.
Statistical analyses Descriptive statistics including chi-squared Sexual health clinic leeds contraceptive mandate were used to assess differences in characteristics between women Veterans who reported, denied, or had missing data for the MST screen. Open in a separate window. CI, confidence interval; OR, odds ratio.
Discussion In contrast to our hypothesis that women reporting MST would be less likely to receive contraception, this study demonstrates that women Veterans who reported MST were significantly more likely than women who denied MST to receive contraceptive services within the VA healthcare system.
Conclusions The findings from this study demonstrate that women Veterans who report MST are receiving contraceptive services and using women's health clinics in VA settings at higher rates Sexual health clinic leeds contraceptive mandate women Veterans who have not reported experiencing MST.
Disclosure Statement No competing Sexual health clinic leeds contraceptive mandate interests exist. Department of Veterans Affairs. Sexual health clinic leeds contraceptive mandate population projections Sexual health clinic leeds contraceptive mandate VetPop. Projected female veteran population 17 years and older: Health effects of military service on women veterans. Department of Veteran's Affairs, Evolving comprehensive VA women's health care: Patient characteristics, needs, and preferences.
Womens Health Issues ; S—S [ PubMed ]. Findings from the National Survey of Women Veterans. Contraceptive care in the VA health care system. The burden of illness in the first year home: Do male and female VA users differ in health conditions and healthcare utilization.
The Veterans Health Administration and military sexual trauma. Am J Public Health ;
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On Saturday the 20th of August we are offering a Lassie worker supported Clinic. Visit the 'News' section '20th of August: Youth worker supported clinic'. That clinic runs a mix of drop in sessions and booked appointments. If you are coming to the drop in clinic you will need to be registered in clinic 30 minutes before the close of the session so that we give birth to enough time to complete your consultation.
Please be aware that although we offer a doff in service, slots are narrow so if the clinic is oversubscribed too many patients waiting to be seen , next you may be asked to come back at another time again or day. There may again be times when the relinquish in clinics may need to close earlier than the advertised times due to high tons of patients attending before the end of the clinic conference.
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- Books (about sex): "Everything You Always Wanted to Know About Sex* "
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Contraceptive Provision in the VA...
Natl Health Stat Report ; Telephone Compared with those who denied MST, women Veterans who reported MST were more likely to be white, married, serve in the active duty component, and have visited a women's health clinic Table 1. Posttraumatic sequelae associated with military sexual trauma in female veterans enrolled in VA outpatient mental health clinics.
Suris A, Lind L.
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Is ginger hair on a guy just outright unattractive?From the 1st April , Local Authorities were mandated to commission Hospitals NHS Trust and Contraception and Sexual Health services at Leeds. Community clinics in community settings in areas of higher need. FPA acts as the secretariat to the APPG on Sexual and Reproductive Health in the UK, The Advisory Group on Contraception (AGC) provided administrative . It is therefore clear that the mandate needs to be clarified in order to give .. Contraception primarily delivered in community clinics. • STI testing and treatment..