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Improving contraceptive choice for military servicewomen: better provision serves both women and deployment planning
  1. Jonathan G Shaw1,2,
  2. Kate A Shaw2
  1. 1 Division of Primary Care & Population Health, Stanford University School of Medicine, Stanford, California, USA
  2. 2 Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Jonathan G Shaw, Division of Primary Care & Population Health, Stanford University, Stanford, CA 94305, USA; jgshaw{at}stanford.edu

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When it comes to contraception, we know that reducing barriers related to cost is accompanied by increased uptake of women’s preferred methods and, in particular, increased uptake of the most effective modern forms of reversible contraception, namely long-acting reversible contraception (LARC).1 LARC methods, such as intrauterine devices and subdermal hormonal implants, have the advantage of being user-independent in achieving extraordinary effectiveness. Yet, the most commonly used modern form of hormonal birth control remains the contraceptive pill, which is highly user-dependent with adherence directly impacting effectiveness.

For any contemporary health system, the importance of supporting access to the full spectrum of common contraceptive methods, including LARC, can be argued both from a reproductive autonomy and a public health perspective. But for women in the military, actively serving in defence of a nation and potentially in combat zones, the imperative and value is likely magnified. In this journal issue, a situation far from this ideal is presented and explored in the work by Rottenstreich et al. entitled ‘Adherence to no-cost oral contraceptives among active-duty servicewomen’.2 This study describes oral contraceptive use in the Israeli military, a young population in a particular situation where this method alone was offered by their healthcare system at no-cost.

This ‘Hobson’s choice’, where contraceptive ‘options’ means a single, ’take it or leave it' method, unsurprisingly does not meet servicewomen’s needs. Using prescription fulfilment data, the authors convincingly …

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