Question

Critique the research methodology of one of the attached research papers:

“Contraception access and use among US servicewomen during deployment”

Student: LTCDR Duncan Mackenzie, RNZN

ID Number: 02240785
Paper Details: 149.790: Research Methods in Defence and Security Studies
Teacher's Name: Dr Wil Hoverd
Due Date: 21 December 2015
Word Count: 1104 (main body, not including questions/headings)
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02240785

1. Provide a brief summary of the research goal and findings

Based on previous research which found that approximately 12% of active duty (AD) US
servicewomen have an unintended pregnancy each year,1 the goal of this research was to
“address the question of women's access to and use of contraception during deployment.” 2

The research found that some women in the US military face challenges relating to
accessing or using contraception during deployments.3 Importantly, a lack of counselling
on contraception and menstrual suppression before deploying, difficulties in attaining the
preferred contraception whilst deployed, and policies prohibiting or discouraging sexual
activity on deployment, each contribute to a lack of uptake of contraception by some
women.4

The research offered recommendations to increase contraceptive access for

servicewomen, including increased counselling for pregnancy prevention, relaxation of
laws to reflect the reality of sexual relationships between deployed service-members and
incorporation of long-acting contraceptives as options for servicewomen.5

2. Outline and Describe the Research method used in the paper

1
?
Laura Duberstein Lindberg, ‘Unintended Pregnancy among Women in the US Military.’, Contraception 84, no.
3 (2011): 249–51, doi:10.1016/j.contraception.2011.01.017. p250

2
?
Kate Grindlay and Daniel Grossman, ‘Contraception Access and Use among U.S. Servicewomen during
Deployment.’, Contraception 87, no. 2 (2013): 162–69, doi:10.1016/j.contraception.2012.09.019. p162

3
?
Ibid. p167

4
?
Ibid. p167

5
?
Ibid. p167
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The research pertaining to this paper was collected as a part of a larger study on military
women’s sexual health.6 A convenience sample of 281 women7 were recruited online
(99%) and through flyers in health clinics (1%), each completing an online survey.8

The paper identifies a use of mixed-methods (qualitative and quantitative) research. 9

Quantitative data was collected for demographics, with age, education level, race/ethnicity,
military branch and rank and military status (AD, reserve, or no longer serving) compared
with the over-all AD population. Other responses, such as “ease of access to birth control
for deployment”10 appear to have been measured using ordinal scales (e.g. Likert-type), in
order to group and rank observations.11 Qualitative data was collected through “open
response questions…analysed inductively using grounded theory methods”12 No specific
information regarding how the open response questions were framed was provided in the
paper.

3. What are the strengths of the method?

Mixed-methods research should result in complementary strengths and non-overlapping
weaknesses of the quantitative and qualitative questions.13 By including open response
questions, the survey was able to tap into the participant’s perspective, thus providing

6
?
Ibid. p163

7
?
Eligibility for the study required an ability to be able to speak English and an overseas deployment any time
from 2001and later

8
?
Ibid. p163

9
?
Ibid. p163

10
?
Ibid. p165

11
?
Shah Ebrahim and Ann Bowling, Handbook of Health Research Methods : Investigation, Measurement and
Analysis (Maidenhead: McGraw-Hill Education, 2005). P408

12
?
Grindlay and Grossman, ‘Contraception Access and Use among U.S. Servicewomen during Deployment.’
p163

13
?
R Burke Johnson and Anthony J Onwuegbuzie, ‘Mixed Methods Research: A Research Paradigm Whose Time
Has Come’, Educational Researcher 33, no. 7 (2004): 14–26, doi:10.3102/0013189X033007014. P18
 4Duncan Mackenzie
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qualitative context to quantitative data. The collection of quantitative data enabled the
researcher to identify the limitations of the study, such as biases induced through
participant self-selection and recollection, and the non-representative nature of the
sample.14 All of the data was collected anonymously which helps to ensure the safety of
the survey participants.

4. What are the weaknesses of the method?

There are several weaknesses in the research methodology. The paper does not explain
why the selected research methods were preferred over others. The only explanation
provided for the qualitative research was that it was undertaken using ‘grounded theory’ 15 -
throughout the paper the qualitative research responses appear be incorporated only as
supporting measures for the quantitative survey data, rather than being testable against it
as suggested by Martin and Turner.16
Facebook advertising is targeted, with the audience selected based on the advertiser’s
requirements and budget.17 Furthermore, 17% of women that participated in the survey
were recruited from military and veteran related Facebook community pages.18 As these
communities tend to attract people of polarised attitudes the bias associated with the
‘volunteer effect’ is even greater.

The sample is not representative of the population. The research incorporated survey data
based on recollected experiences from 10 years previously, and contrasted demographic
data across the same period with current data. The methodology resulted in several
demographics, such as the Army and Marine Corps, and Enlisted ranks being over-

14
?
Grindlay and Grossman, ‘Contraception Access and Use among U.S. Servicewomen during Deployment.’
p168

15
?
Ibid. p 163

16
?
Patricia Yancey Martin and Barry A. Turner, ‘Grounded Theory and Organizational Research’, The Journal of
Applied Behavioural Science 22, no. 2 (1986). P143

17
?
‘How to Target Facebook Adverts’, accessed 14 December 2015,
https://www.facebook.com/business/a/online-sales/ad-targeting-details.

18
?
Kate Grindlay et al., ‘Abortion Restrictions in the U.S. Military: Voices from Women Deployed Overseas.’,
Women’s Health Issues : Official Publication of the Jacobs Institute of Women's Health 21, no. 4 (2011): 259–64,
doi:10.1016/j.whi.2011.04.014. p163
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represented, whilst others, such as the Navy and Air Force, and Officers were under-
represented. Critically, the sample was only 281 servicewoman, which would equate to
0.14% of the 203,695 AD population. If more accurately compared, the 281 surveyed is
even less representative (around 0.07% of the total number of 400,000 post 9/11
servicewomen19).

5. Could a better sample or method have been developed?

As the weaknesses of the research pertain largely to the sample, a better method could
have been developed to ensure it adequately represented the population. Although it is
not evident whether this access was sought, based on the sample methodology it is
evident that the researchers were unable to recruit any participants through US military
channels. Advertising the research using DOD approved means, such as military
intranet/internet gateways,20 noticeboards at military medical centres and through routine
notices/orders would better ensure better representation.

6. Provide an overall constructive assessment about the impact of the paper

assessed and indicate which audiences to whom it would be most relevant.
The impact of this paper is varied. Academically, the impact appears to be low, having
been cited only five times within Google Scholar (including two self-citations); all pertaining
to contraception and collectively cited only 19 times. Ibis Reproductive Health, which
sponsored the research, claims that its research “led to crucial policy changes on
contraceptive access in the military, recently signed into law by President Obama.”21
However, the Ibis website links to a bill that was not enacted in 2014,22 and a subsequent

19
?
Eileen Patten and Kim Parker, Women in the U.S. Military: Growing Share , Distinctive Profile, accessed 12
December 2015, http://www.pewsocialtrends.org/files/2011/12/women-in-the-military.pdf. p4

20
?
Using NIPRNet – for further reference see http://www.usmilcom.com/military.htm

21
?
‘Accomplishments’ (Ibis Reproductive Health), accessed 15 December 2015,
http://www.ibisreproductivehealth.org/about-us/accomplishments.

22
?
‘Access to Contraception for Women Servicemembers and Dependents Act of 2014 (2014; 113th Congress
H.R. 5524)’, accessed 13 December 2015, https://www.govtrack.us/congress/bills/113/hr5524.
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bill introduced in 2015 (but not yet enacted).23 Notwithstanding this, the introduction of a
bill is evidence that the most relevant audience is those whom shape government policy.

Although there is little published evidence that military policy-makers have found relevance
in the research, as it found that a lack of understanding of policies around availability of
contraceptives in many research participants, military unit commanders could find
significant relevance in the recommendations of providing additional counselling to
servicewomen before deploying.

7. Indicate how applicable the current research findings would be in a New Zealand
context
The research has some applicability in the NZ context. In 2014, 17% of the New Zealand
Defence Force (NZDF) were female, with a median age of 27.6 years for NZDF service
members,24 correlating with the survey age range of 18-44 for reproductive age.25
Furthermore, there is little data showing the rate of unintended pregnancies in NZ, with
assumptions made that the rates correlate with the US,26 and none published regarding
NZDF servicewomen. Moreover, females in the NZDF are permitted to serve in all NZ
military operations, and with 17.6% of NZDF personnel deployed on operations each year
being female,27 there is a potential impact on the operational readiness of the NZDF due to
unintended pregnancies. However, as there are different demographics, such as ethnicity
and education, and different policies regarding access to contraceptives, the applicability
of the findings are impacted to a level where the study would require replicating to provide
reliable results.

23
?
‘Access to Contraception for Women Servicemembers and Dependents Act of 2015 (H.R. 742)’, accessed 13
December 2015, https://www.govtrack.us/congress/bills/114/hr742.

24
?
Maximising Opportunities for Military Women in the New Zealand Defence Force (Wellington, 2014),
http://www.defence.govt.nz/reports-publications/evaluation-report-maximising-opportunities-military-women-nzdf/
contents.html. p32

25
?
Grindlay and Grossman, ‘Contraception Access and Use among U.S. Servicewomen during Deployment.’

26
?
Susheela Singh, Gilda Sedgh, and Rubina Hussain, ‘Unintended Pregnancy: Worldwide Levels, Trends, and
Outcomes’, Studies in Family Planning 41, no. 4 (2010): 241–50, doi:10.1111/j.1728-4465.2010.00250.x.

27
?
Maximising Opportunities for Military Women in the New Zealand Defence Force. p32
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8. What additional factors might need to be considered to replicate this

methodology in a New Zealand (NZ) Context?
In order to consider replicating the methodology in a NZ context, several additional factors
would have to be considered. Firstly, due to the population of servicewomen in the NZDF
being around 1/30th of the US Military, either a greater response rate or smaller sample
size, along with considerations of the ethical risks generated through a smaller sample,
would be required to ensure adequate representation. Secondly, a better understanding of
the causal factors of unintended pregnancies (e.g. in an operational theatre or on leave out
theatre, consensual sex or rape, etc.). Lastly, the sampling methodology would require
refinement, with greater engagement through formal NZDF channels such as NZDF Health
Services and the NZDF Intranet.
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References
‘Access to Contraception for Women Servicemembers and Dependents Act of 2014 (2014;
113th Congress H.R. 5524).’ Accessed 13 December 2015.
https://www.govtrack.us/congress/bills/113/hr5524.
‘Access to Contraception for Women Servicemembers and Dependents Act of 2015 (H.R.
742).’ Accessed 13 December 2015.
https://www.govtrack.us/congress/bills/114/hr742.
‘Accomplishments.’ Ibis Reproductive Health. Accessed 15 December 2015.
http://www.ibisreproductivehealth.org/about-us/accomplishments.
Ebrahim, Shah, and Ann Bowling. Handbook of Health Research Methods : Investigation,
Measurement and Analysis. Maidenhead: McGraw-Hill Education, 2005.
Grindlay, Kate, and Daniel Grossman. ‘Contraception Access and Use among U.S.
Servicewomen during Deployment.’ Contraception 87, no. 2 (2013): 162–69.
doi:10.1016/j.contraception.2012.09.019.
Grindlay, Kate, Susan Yanow, Kinga Jelinska, Rebecca Gomperts, and Daniel Grossman.
‘Abortion Restrictions in the U.S. Military: Voices from Women Deployed Overseas.’
Women’s Health Issues : Official Publication of the Jacobs Institute of Women's
Health 21, no. 4 (2011): 259–64. doi:10.1016/j.whi.2011.04.014.
‘How to Target Facebook Adverts.’ Accessed 14 December 2015.
https://www.facebook.com/business/a/online-sales/ad-targeting-details.
Johnson, R Burke, and Anthony J Onwuegbuzie. ‘Mixed Methods Research: A Research
Paradigm Whose Time Has Come.’ Educational Researcher 33, no. 7 (2004): 14–26.
doi:10.3102/0013189X033007014.
Lindberg, Laura Duberstein. ‘Unintended Pregnancy among Women in the US Military.’
Contraception 84, no. 3 (2011): 249–51. doi:10.1016/j.contraception.2011.01.017.
Martin, Patricia Yancey, and Barry A. Turner. ‘Grounded Theory and Organizational
Research.’ The Journal of Applied Behavioural Science 22, no. 2 (1986).
Maximising Opportunities for Military Women in the New Zealand Defence Force.
Wellington, 2014. http://www.defence.govt.nz/reports-publications/evaluation-report-
maximising-opportunities-military-women-nzdf/contents.html.
Patten, Eileen, and Kim Parker. Women in the U.S. Military: Growing Share , Distinctive
Profile. Accessed 12 December 2015.
http://www.pewsocialtrends.org/files/2011/12/women-in-the-military.pdf.
Singh, Susheela, Gilda Sedgh, and Rubina Hussain. ‘Unintended Pregnancy: Worldwide
Levels, Trends, and Outcomes.’ Studies in Family Planning 41, no. 4 (2010): 241–50.
doi:10.1111/j.1728-4465.2010.00250.x.