Identifying Patterns and Needs for Contraceptive Care Among Men and Women Veterans

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Practical access to contraceptive care and the ability to choose care that meets one’s needs and preferences is important for an individual’s health and well-being. Although a significant amount of research has been done to examine access to contraceptive care in the United States, particularly among civilian women, there is significantly less understanding about the contraceptive needs, preferences, and experiences of men and women veterans.

Veterans who are eligible for U.S. Veterans Health Administration (VHA) services can access all U.S. Food and Drug Administration–approved contraceptive methods (hormonal and nonhormonal, barrier devices, long-acting reversible contraceptives, sterilization), although some veterans may still incur co-payments for some services, such as for intrauterine device (IUD) insertion, unless exempt. Women veterans often have access to trained women’s health primary care providers (WH-PCPs), although varying levels of services are available on-site depending on the location. In the early 2020s, VHA supported innovative programs intended to improve access to contraception, such as pharmacist-led prescribing, 12-month refills for hormonal contraceptives (the Contraception on Demand program launched in 2021), and an initiative to improve vasectomy access and counseling (the Male Contraceptive Initiative launched in 2023). External veteran-serving organizations (such as the Service Women’s Action Network or Bob Woodruff Foundation) provide a variety of resources to support access to reproductive care for veterans. Regardless of care location, challenges to access and choice can arise from state policy differences, stigma (especially for men), the quality of provider engagement and counseling, and the availability of birth control methods.

RAND researchers conducted a mixed-methods study to identify gaps in contraceptive access and choice among veterans, potential variations in access and choice by such factors as sex and age range, and specific barriers veterans face to accessing their preferred contraceptive methods. The study was sponsored by Arnold Ventures as part of the philanthropy’s portfolio on contraceptive choice and access. Veterans aged 18 to 49 received about a 15-minute web-based survey through two national probability panels (Ipsos’ KnowledgePanel and NORC’s AmeriSpeak) in early 2025. RAND researchers drew items from existing surveys, such as the National Survey for Family Growth (NSFG), to design their survey. The researchers applied weights to the final combined panel sample to ensure representativeness by age, sex, race/ethnicity, region, and other demographics. The team also completed more than 50 in-depth interviews with a sample of survey respondents to explore respondents’ experiences with contraception and potential barriers to access.

This brief details the research team’s findings about veterans’ knowledge of contraception, engagement with providers about contraception, and use patterns of contraception and associated recommendations to improve contraceptive access and choice among veterans of reproductive age.

Perceptions of Birth Control and Knowledge Levels

Veterans’ general perceptions of birth control were very mixed (see Figure 1). For example, just under one-half (about 48 percent) of veterans thought that birth control is good for one’s health and well-being, and a similar but slightly smaller proportion (about 44 percent) thought that birth control affected people’s bodies in negative ways. Almost four in ten veterans thought that birth control had dangerous side effects.

From a set of 19 multiple-choice questions on veterans’ knowledge levels about contraception and specific methods, the median score of correct responses was 42 percent; females scored higher than males (58 percent compared with 37 percent), and there were significant differences in more than one-half of the item responses. Veterans had higher levels of knowledge about the ability of condoms to prevent sexually transmitted infections, the ability for semen to be released before ejaculation, and IUDs being less easily noticed by partners. Veterans’ knowledge scores were the lowest about knowing the specific length of time vaginal rings should be kept in place, that emergency contraceptive pills cannot end a pregnancy in its earliest stages, and that women do not need a pelvic exam to receive birth control pills. Finally, veterans were asked about their perceptions of side effect frequency for certain birth control methods. About six in ten had perceptions that were aligned with the side effect frequency reported in the literature. Those with inaccurate perceptions tended to overstate the side effect risks for certain contraceptive methods.

Engagement with Providers and Contraceptive Counseling

Only 10 percent of veterans reported having a discussion with their providers about birth control in the past year; this was more common among women, with around one in four women having these discussions compared with approximately one in 50 men. Most of these discussions did not take place in VHA health care settings. Despite the lack of conversations about contraception, veterans reported general trust in their providers and high confidence about having productive conversations with their providers about contraception. In interviews, veterans noted that they often initiated discussions about birth control. However, male veterans shared their perceptions that contraception is seen as a female-centric topic that is rarely raised with them by their providers.

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Contraceptive Use and Preferences

About one in five veterans used contraception in the past year to prevent pregnancy. The most commonly used methods were condoms, pills, withdrawal, and IUDs. Sterilization rates among veterans were high: 28 percent of men and 38 percent of women reported being sterilized. A little more than one in four men and women reported that they would use a different contraceptive method if it were accessible to them.

Partners played a large role in influencing veterans’ choice of birth control methods, and veterans often came to a joint decision with their partners on which methods would work best and meet their preferences. Male veterans recognized that there are more-limited options for men and stressed the importance of their female partner’s role in decisionmaking about contraceptives. Veterans’ choices of contraception often were tied to their stage of life, with more-permanent contraceptive methods chosen by veterans who no longer wanted to have children.

Notable Variations

There were several notable demographic variations in the nationally representative sample of veterans.

VA enrollment status

There were no differences in contraceptive use or counseling between VA-enrolled and non–VA-enrolled veterans. However, many veterans—especially men—shared in interviews that they were unaware of VA contraceptive benefits and unsure about male-specific options.

Sex

More female veterans had discussions about birth control with their providers than male veterans.

There were no significant differences in the rate of veterans’ use of most contraceptive methods when self-use and partner-use data were combined.

Age

Younger veterans aged 18 to 34 were more likely to discuss birth control methods and condoms with their providers than those aged 35 to 49.

Younger veterans used condoms more frequently, and older veterans were more likely to be sterilized.

Civilians

In a comparison of the findings in this study with recent estimates from the NSFG (i.e., a civilian sample), veterans of both sexes had higher sterilization rates and male veterans had lower condom use.

Barriers

Most veterans perceived their post-service contraceptive needs as similar to those of civilians, although some veterans cited certain experiences in the military (e.g., toxic agents, posttraumatic stress disorder, access to sensitive information) as influencing their reproductive choices. Many veterans pointed out gaps in contraceptive information, a lack of proactive discussions with providers, and a general perception that family planning is a “woman’s issue.” Veterans considering sterilization procedures shared their challenges with getting referrals or scheduling appointments, and others shared that counseling about the procedures was inadequate (e.g., a lack of full information about sterilization permanence or failure rates and providers only offering narrow options despite patient interest in alternatives).

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Recommendations

The findings presented in this brief suggest significant education needs for both veterans and providers. Veteran-serving organizations, including VHA, should consider increasing their investment in efforts to address misconceptions and improve veterans’ understanding about family planning needs and methods of birth control.

• Comprehensive and non–gender-specific education: VHA and other veteran-serving organizations should establish comprehensive education programs that are targeted to veterans of reproductive age to provide accurate information about the risks and benefits of various birth control methods. Targeting both men and women veterans can help acknowledge the role of a sexual partner in decisionmaking.
• Enhance communications about available benefits and resources: VHA should consider expanding the availability of clear and visible information about benefits and resources on its website and apps. Posters or other promotional materials, such as pamphlets or quick response (QR) codes, could be made available and more visible in general care areas as opposed to primarily in women’s health clinics to reach more veterans of reproductive age. Finally, in transition programs for separating service members, VHA could consider improving communications or education about the health benefits that veterans may be eligible for after they transition to civilian life.
• Expand provider training in contraceptive counseling: Although WH-PCPs at VHA receive specialized training on contraceptive counseling, not all providers do. VHA should consider expanding training for primary care and specialty providers, such as urologists, to initiate and counsel male and female veterans of reproductive age. Because many veterans receive health care outside VHA, professional medical associations should consider promoting similar trainings to better equip providers to meet their patients’ family planning and birth control needs and preferences.

Considerations for Future Researchers

This study appears to be the first to comprehensively examine contraceptive access and choice among male and female U.S. veterans of reproductive age. Historically, fertility control has predominantly focused on women and often neglected men’s roles and responsibilities in family planning. Men’s perspectives and experiences play a significant role in contraceptive decisionmaking within partnerships. Involving men in these studies can help identify ways to not only improve their own decisionmaking about male-specific contraceptive methods but also identify how they can be more-educated sources of support for female partners. Men’s involvement in these studies would also improve men’s access to and inform their choices about birth control methods more broadly.

Relatedly, the measurement of certain contraceptive constructs, such as contraceptive self-use, tends to be male- or female-focused. The survey discussed in this brief employed neutral wording where possible and a full list of male and female contraceptive methods with questions of use. In addition, some key characteristics to understanding veterans’ experiences involve understanding their locations of care and whether that care is through established referral networks, such as VA community care. However, veterans may not always recognize these terms when reporting about their care. In the analysis stage, RAND researchers learned that there were misinterpretation issues related to these survey items, which suggest a need for more cognitive testing to better measure these constructs and improve survey items.

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Topics

• Family Planning
• Health Care Access
• Health Care Quality
• Health Interventions
• Health Literacy
• Sexual Behavior
• Veterans Health Care