2022-09-24-兰德-兰德-现役军人女性生殖健康调查（WRHS）（英）_349页_2mb

The Women’s Reproductive Health Survey (WRHS) of Active-Duty Service Members

Core Content

The Women’s Reproductive Health Survey (WRHS) was conducted by the RAND Corporation in 2020 to assess the reproductive health and care experiences of active-duty service women (ADSW) across the U.S. Department of Defense (DoD) and the U.S. Coast Guard. The survey was commissioned by the Defense Health Agency and the Coast Guard to comply with the 2016 and 2017 National Defense Authorization Acts (NDAA), which mandated access to comprehensive family planning and contraceptive counseling services for ADSW during various health care visits.

The WRHS included a stratified random sample of ADSW from the Air Force, Army, Marine Corps, and Navy, as well as a census of Coast Guard ADSW. The final analytic sample comprised 23,950 ADSW, with an overall weighted response rate of 17.8 percent.

Main Points

1. Survey Objectives

• To evaluate the access and use of family planning and contraceptive services.
• To assess the availability of preferred contraceptive methods.
• To understand the impact of reproductive health on military readiness and assignments.
• To ensure that women receive the same level of medical care as their male counterparts.

2. Methodology

• Sampling: Stratified random sampling by service branch and pay grade, with a census of the Coast Guard.
• Response Rates: Calculated using weighted response rates, accounting for nonresponse and sampling probabilities.
• Weights: Adjusted for survey design and nonresponse to ensure the sample represented the broader population of ADSW.
• Imputation: Missing data were handled using a sequential imputation model with predictive mean matching.

3. Demographic and Military Characteristics

• ADSW are predominantly enlisted and hold junior ranks.
• Approximately 55% have a high school degree or less, while 45% have some college experience or higher.
• About 44% identify as non-Hispanic white, 25% as non-Hispanic black, and 19.6% as Hispanic.
• Nearly half (48.4%) are married, and about a third (33.4%) are responsible for a coresident child under 18.
• 17% identify as gay, lesbian, or bisexual.

4. Key Findings

Health Care Utilization

• Appointment Accessibility: Over half (58.3%) of DoD ADSW reported that it was usually or always easy to get an appointment with an MHS provider. The Coast Guard had a slightly lower rate (54.6%).
• Specialist and OBGYN Appointments: 29.2% of DoD ADSW said it was never easy to get a specialist appointment, compared to 12.3% for a generic appointment. For OBGYN appointments, 27.9% said it was never easy.
• Wait Times: About one-third of ADSW (31.9%) waited between a week and a month for their most recent health care visit. Roughly 10.5% of DoD ADSW and 6.1% of Coast Guard ADSW experienced wait times of less than 24 hours, while 9.0% and 13.3% respectively waited more than a month.
• TRICARE Guidelines: 61% of DoD ADSW could get a primary care appointment within a week, and 50.5% of Coast Guard ADSW had the same experience.
• Well-Woman Visits: 72.6% of DoD ADSW and 72.7% of Coast Guard ADSW could get an OBGYN appointment within 28 days. 70.2% and 69.7% respectively could get a specialist appointment within 28 days.
• Women’s Health Clinics (WHCs): 35.4% of DoD ADSW had access to a WHC, while 31.5% were unsure. Only 4% of Coast Guard ADSW had access to a WHC, and 17.9% were unaware of its existence.
• WHC Usage: 56.7% of DoD ADSW who had access to a WHC used it in the past year. Among Coast Guard ADSW, 66.8% of those with access used it.
• OBGYN Access: Among ADSW who used a WHC, 54.8% reported that it was usually or always easy to get an OBGYN appointment, compared to 44.0% for the overall sample.

5. Limitations

• The response rate, while higher than many previous DoD surveys, is still considered low.
• Small sample sizes for certain subgroups may result in less precise estimates and larger confidence intervals.
• Ambiguity in survey items related to the Military Health System (MHS) could lead to varied interpretations.
• The survey was conducted during the COVID-19 pandemic, which may have affected both access to care and survey participation.

Conclusion

The WRHS provides valuable insights into the reproductive health care experiences of ADSW. It highlights the importance of ensuring equitable access to family planning and contraceptive services, as well as the need for continued support and improvements in the availability and accessibility of these services. The findings underscore the role of reproductive health in maintaining military readiness and the significance of understanding and addressing the unique challenges faced by ADSW in accessing care.