Interventions to Improve Sexual and Reproductive Health in US Active Duty Military Service Members: A Systematic Review

Abstract

Objective: To identify and describe behavioral interventions to promote sexual and reproductive health among US active duty military service members. Data Sources: Systematic searches of PubMed, CINAHL, and PsychINFO (N = 1609 records). Inclusion Criteria: English-language articles published between 1991 and 2018 and retrieved using search terms related to military service, interventions, and sexual and reproductive health. Exclusion Criteria: Articles excluded if not empirically based, not published in peer-reviewed journals, did not sample active duty US military personnel, and did not examine the effectiveness of specified preventive sexual or reproductive health intervention(s). Data Extraction: Teams of paired authors extracted study rationale; aims; design; setting; description of the intervention; measures; sample demographics; clinical, behavioral, and psychosocial outcomes; and conclusions. Data Synthesis: Given the heterogeneity of studies, narrative synthesis was performed. Results: Fifteen articles met inclusion criteria: 10 focused on sexually transmitted infection (STI) acquisition and/or unintended pregnancy and 5 on sexual assault. Studies that assessed clinical outcomes found that interventions were associated with lower rates of STIs and/or unintended pregnancy. Significant effects were found on knowledge-related outcomes, while mixed effects were found on attitudes, intentions, and behaviors. Conclusions: Current evidence on the effectiveness of sexual and reproductive health interventions in the US military is limited in quality and scope. Promoting sexual and reproductive health in this population is critical to maintaining well-being among servicemembers, their families, and the communities surrounding military installations.