U.S. Commander in Iraq to Rescind Policy Punishing Pregnant Soldiers

Jodi Jacobson

The top United States commander in Iraq intends to rescind the policy earlier established by one of his subordinate commanders in Iraq that had placed pregnant soldiers at risk of disciplinary measures.

The Associated Press reports that the top United States commander in Iraq intends to rescind the policy earlier established by one of his subordinate commanders in Iraq that had placed pregnant soldiers at risk of discipline.

According to the AP report, Gen. Ray Odierno has drafted a broad new policy for American forces in Iraq that will
take effect January 1 and will not include the pregnancy provision enacted last month.

The news of General Odierno’s order comes about a week after the pregnancy policy issued by Maj. Gen. Anthony Cucolo
set off widespread criticism. General Cucolo had issued a policy that
would permit the punishment of soldiers who become pregnant and their
sexual partners.

The pregnancy provision was one of a variety of
offenses for which General Cucolo said punishments could range from
minor discipline to a court-martial.

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In a conference call with
reporters earlier this week, according to AP, Cucolo said he would never actually seek to
jail someone over a pregnancy provision. He said the policy was
intended to emphasize the problems created when pregnant soldiers go
home and leave behind a weaker unit.

Earlier reports on the policy suggested it was possible that pregnant soldiers might indeed face court martial or other disciplinary measures.  An ABC News report states: 

Even before the senators took aim at Cucolo’s policy, the general had
backed away from his threat today to court martial women under his
command who got pregnant. His policy statement said violation of the
rule would also apply to the men who get female soldiers pregnant, even
if the couple is married. 

Since November 4th, when the policy was first put in place, four
women soldiers were redeployed because they had become pregnant "in
violation of Cucolo’s order." The four women and two male soldiers ostensibly responsible for two of the pregnancies
received letters of reprimand that will not remain in their permanent
military files, according to ABC News reports.  One of the pregnant soldiers refused to provide the name of her partner.

Cucolo’s policy drew fire from women’s groups such as the National Organization for Women, and human rights groups such as the American Civil Liberties Union, among others.  A letter protesting the policy also was written to Cuculo by four Senators, including Senator Barbara Boxer (D-CA), Senator Kirsten Gillibrand (D-NY), Senator Barbara Mikulski (D-MD) and Senator Jeanne Shaheen (D-NH).

"We can think of no greater deterrent to women contemplating a military
career than the image of a pregnant woman being severely punished
simply for conceiving a child," the senators wrote to Cucolo today.
"This defies comprehension. As such, we urge you to immediately recind
this policy." 

Discsussion of this policy has exposed the lack of consistent access to contraceptive supplies on many bases, and the lack of access particularly to emergency contraception.  The army does not pay for abortion services for female soldiers facing unintended pregnancies; instead soldiers must take leave to fly home and and pay out of their own funds.

John Hutson, a former longtime military judge advocate and currently
the president and dean of Franklin Pierce Law School in New Hampshire, worried that Cucolo’s policy could cause an increase in
abortions overseas. And since military hospitals do not perform such
procedures, female officers may find abortions are available not "in
the way you want them," Hutson said, forcing women to potentially
dangerous providers of such services.

Commentary Contraception

The Double Standard of Military Pregnancy: What Contraceptive Access Won’t Fix

Stephanie Russell-Kraft

Unique military gender politics that make it hard for some servicewomen to ask for birth control also stigmatize them if they get pregnant—especially when that happens at an overseas post or on a deployment. Any effort to increase birth control availability can only be understood against that particular cultural backdrop.

At the beginning of May, pharmaceutical giant Allergan announced that, in partnership with nonprofit Medicines360, it would begin offering its new intrauterine device (IUD) Liletta at a reduced price to military treatment facilities and veterans hospitals across the United States. The company would also support “an educational effort to raise contraception awareness among healthcare providers treating U.S. military service women,” according to its press release.

Military personnel and medical professionals agree Allergan’s initiative represents an important step toward expanding access to the IUD, which along with other long-acting reversible contraceptives (like injections) are particularly well suited to the demands of military training and deployment schedules. But this push to increase IUD use can’t be fully understood outside the context of the unique challenges and stigmas facing women of reproductive age in the U.S. military (who numbered just under 200,000 as of 2011, the latest available data obtained via FOIA by Ibis Reproductive Health).

Despite theoretically having access to a wide variety of contraceptive options, women in the military still report higher rates of unplanned pregnancy than their civilian peers, and it remains somewhat of a mystery exactly why. What is clear is that the unique military gender politics that make it hard for some women to ask for birth control also stigmatize them if they get pregnant—especially when that happens at an overseas post or on a deployment. Any effort to increase birth control availability, including Allergan’s, can only be understood against that particular cultural backdrop.

Nearly every time a U.S. military branch changes policies to include more women, critics raise the old argument that allowing women into the service, particularly in combat roles, will lead to sex between soldiers and thereby distract from the mission. Because of that, the military generally prohibits sex during deployments between service members not married to each other (exact policies vary across the branches and across units, and some are less strict). Taken as a whole, the U.S. military’s policy basically amounts to an abstinence-only approach, with women shouldering nearly all of the risk and blame when soldiers do decide to have sex on deployment.

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Bethany Saros, who enlisted in the Army as an 18-year-old in 2002, faced this blame head-on when she became pregnant by a fellow soldier during a 2007 tour in Iraq.

Although condoms were available to soldiers at her deployment site, Saros did not use birth control. Her decision not to end the pregnancy meant her deployment was over, and Saros recalls meeting several other pregnant women in Kuwait while they all waited to get shipped back. “I felt like a pariah, and I think the other girls did too,” she said.

“It’s not like anyone does this on purpose,” Saros explained. “The fathers of these babies, they don’t get any problems, and they were screwing around just as we were.”

Across all branches of service, pregnant women are typically not allowed to serve on deployments, and, though the length of time varies by branch, women are not allowed to deploy in the six to 12 months after they give birth. According to spokespeople from each of the branches, the reasoning behind the policies is to protect servicewomen and give them the time they need to recover from birth. All of the women I spoke with for this piece told me that soldiers—both male and female—often believe a woman who gets pregnant right before or during a deployment is simply trying to avoid her work.

“The first thing someone talked about when a woman got pregnant was that she was trying to get out of a deployment,” said Lauren Zapf, a former Naval officer, mental health clinician, and fellow with the Service Women’s Action Network. “Whereas if men announce that they’re going to have a baby, there’s a lot of backslapping and congratulations.”

According to Ibis Reproductive Health’s analysis of Department of Defense data, about 11 percent of active-duty military women reported an unintended pregnancy in 2008 and 7 percent reported an unintended pregnancy in 2011—in both years, this was far more than the general population. Younger, less educated, nonwhite women were much more likely to become pregnant unintentionally, as were those who were married or living with a partner, according to Ibis. Contrary to military lore, the pregnancy rates did not differ between those women who had deployed and those who didn’t during that time, the study found.

It remains unclear why exactly military women have higher reported rates of unplanned pregnancy than their civilian counterparts, but one reason has likely been their inconsistent access to birth control and limited access to abortion services. As with most institutions, there’s a difference between official policy and what happens on a day-to-day basis on military bases and in medical exam rooms. Just because most military branches officially require routine birth control consultations doesn’t mean women will always get them, according to Ibis researcher Kate Grindlay, who is one of very few independent researchers looking into this issue.

“One of the challenges that we found [in our research] was that these things were not being done in a consistent way,” Grindlay said. “Some providers having these conversations in a routine way, some weren’t.”

Access to birth control—and the conversations that lead up to it—has improved greatly for military women in the past 20 years. Elizabeth McCormick, a former Black Hawk pilot who served in the Army from 1994 to 2001, recalled that “no one talked about birth control” in any of her pre-deployment medical events in the 1990s. By contrast, some of the women I spoke with who served more recently said they didn’t have issues getting the care they needed.

However, in a 2010 Ibis survey of deployed women, 59 percent of respondents said they hadn’t discussed contraception with a military health-care provider before deployment and 41 percent said they had difficulty obtaining the birth control refills they needed while away from home. Servicewomen also reported being denied an IUD because they had not yet had children, even though nulliparous women can use the devices.

These inconsistencies are part of the problem Allergan says it hopes to address with its education efforts for military health-care providers. The company hasn’t explicitly said what those efforts will look like.

Another part of the problem, according to former Marine Corps officer and Cobra helicopter pilot Kyleanne Hunter, might be cultural. Conversations with military medical providers likely present another major barrier to proper contraceptive care because most military doctors are not only men, but also officers, who, outside the context of a hospital exam room, can give orders that must be respected.

Young female enlisted service members who have internalized the military’s rigid power structures might be reluctant to speak honestly and openly about reproductive care, posited Hunter, who’s currently a University of Denver PhD candidate studying the national security impact of integrating women into western militaries. She said the same dynamic often prevents women from coming forward after they have been sexually assaulted by a fellow service member.

“It adds one more layer to what’s already an uncomfortable conversation,” Hunter said.

When Bethany Saros returned to Fort Lewis, Washington, after leaving Iraq for her pregnancy, a conversation with a male doctor solidified her decision to quit the Army altogether.

“I had to go through a physical, and there was a Marine doctor, and he said, ‘Was there enough room on the plane for all the pregnant ladies that came back?’” she told me, still taken aback by the incident.

Grindlay said efforts like Allergan’s to increase the use of IUDs in the military are “very beneficial” to servicewomen. She also applauded a provision in the 2016 National Defense Authorization Act to require standardized clinical guidelines for contraceptive care across the armed forces. Under the new provisions, women in the armed forces must receive counseling on the “full range of methods of contraception provided by health care providers” during pre-deployment health care visits, visits during deployment, and annual physical exams.

But there’s still work to be done in order for the military to provide full access to reproductive health care, particularly when it comes to abortion. Tricare, the military’s health and insurance provider, only covers abortions “if pregnancy is the result of rape or incest or the mother’s life is at risk,” and certain countries in which the military operates ban the procedure altogether.

In a sampling of 130 online responses for a medication abortion consultation service reviewed by Ibis in 2011, several military women reported considered using “unsafe methods” to try to terminate a pregnancy themselves, according to Grindlay. One of the women, a 23-year-old stationed in Bahrain, said she had been turned away by five clinics and had contemplated taking “drastic measures.”

According to the 2011 Ibis report, many women sought abortions so that they could continue their military tour. Others feared a pregnancy would otherwise ruin their careers.

Virginia Koday, a former Marine Corps electronics technician who left the service in 2013, said in a phone interview that women can face losing their rank or getting charged for violating military policy if they become pregnant overseas. “Getting pregnant in Afghanistan is good cause to terminate your own pregnancy without anyone finding out,” she said.

“The unspoken code is that a good soldier will have an abortion, continue the mission, and get some sympathy because she chose duty over motherhood,” wrote Bethany Saros in a 2011 Salon piece about her unplanned pregnancy.

For these women, one act of unprotected sex had the potential to derail their career. For the men, it was just a night of fun.

Kyleanne Hunter said that while she doesn’t have a “whole lot of sympathy” for women who become pregnant on deployments (they’re not supposed to be having sex in the first place, she argues), she disagrees with the double standard that allows the men involved to escape punishment.

“Both parties need to be held exactly to the same accountability standards,” said Hunter. “If the woman is punished, then whoever she is involved with should be punished a well, because it takes two. She’s not alone in it. There’s no immaculate conception going on there.”

Analysis Politics

Advocates: Bill to Address Gaps in Mental Health Care Would Do More Harm Than Good

Katie Klabusich

Advocates say that U.S. Rep. Tim Murphy's "Helping Families in Mental Health Crisis Act," purported to help address gaps in care, is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.

The need for reform of the mental health-care system is well documented; those of us who have spent time trying to access often costly, out-of-reach treatment will attest to how time-consuming and expensive care can be—if you can get the necessary time off work to pursue that care. Advocates say, however, that U.S. Rep. Tim Murphy’s (R-PA) “Helping Families in Mental Health Crisis Act” (HR 2646), purported to help address gaps in care, is not the answer. Instead, they say, it is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.

“We believe that this legislation will result in outdated, biased, and inappropriate treatment of people with a mental health diagnosis,” wrote the political action committee Leadership Conference on Civil and Human Rights in a March letter to House Committee on Energy and Commerce Chairman Rep. Fred Upton (R-MI) and ranking member Rep. Frank Pallone (D-NJ) on behalf of more than 100 social justice organizations. “The current formulation of H.R. 2646 will function to eliminate basic civil and human rights protections for those with mental illness.”

Despite the pushback, Murphy continues to draw on the bill’s mental health industry support; groups like the American Psychiatric Association (APA) and the National Alliance on Mental Illness (NAMI) back the bill.

Murphy and Rep. Eddie Bernice Johnson (D-TX) reintroduced HR 2646 earlier this month, continuing to call it “groundbreaking” legislation that “breaks down federal barriers to care, clarifies privacy standards for families and caregivers; reforms outdated programs; expands parity accountability; and invests in services for the most difficult to treat cases while driving evidence-based care.”

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Some of the stated goals of HR 2646 are important: Yes, more inpatient care beds are needed; yes, smoother transitions from inpatient to outpatient care would help many; yes, prisons house too many people with mental illness. However, many of its objectives, such as “alternatives to institutionalization” potentially allow outpatient care to be mandated by judges with no medical training and pushed for by “concerned” family members. Even the “focus on suicide prevention” can lead to forced hospitalization and disempowerment of the person the system or family member is supposedly trying to help.

All in all, advocates say, HR 2646—which passed out of committee earlier this month—marks a danger to the autonomy of those with mental illness.

Victoria M. Rodríguez-Roldán, JD, director of the Trans/GNC Justice Project at the National LGBTQ Task Force, explained that the bill would usurp the Health Insurance Portability and Accountability Act (HIPAA), “making it easier for a mental health provider to give information about diagnosis and treatment … to any ‘caregiver’-family members, partners or spouses, children that may be caring for the person, and so forth.”

For the communities she serves, this is more than just a privacy violation: It could put clients at risk if family members use their diagnosis or treatment against them.

“When we consider the stigma around mental illness from an LGBT perspective, an intersectional perspective, 57 percent of trans people have experienced significant family rejection [and] 19 percent have experienced domestic violence as a result of their being trans,” said Rodríguez-Roldán, citing the National Transgender Discrimination Survey. “We can see here how the idea of ‘Let’s give access to the poor loved ones who want to help!’ is not that great an idea.”

“It’s really about taking away voice and choice and agency from people, which is a trend that’s very disturbing to me,” said Leah Harris, an organizer with the Campaign For Real Change in Mental Health Policy, also known as Real MH Change. “Mostly [H.R. 2646] is driven by families of these people, not the people themselves. It’s pitting families against people who are living this. There are a fair number of these family members that are well-meaning, but they’re pushing this very authoritarian [policy].”

Rodríguez-Roldán also pointed out that if a patient’s gender identity or sexual orientation is a contributing factor to their depression or suicide risk—because of discrimination, direct targeting, or fear of bigoted family, friends, or coworkers—then that identity or orientation would be pertinent to their diagnosis and possible need for treatment. Though Murphy’s office claims that psychotherapy notes are excluded from the increased access caregivers would be given under HR 2646, Rodríguez-Roldán isn’t buying it; she fears individuals could be inadvertently outed to their caregivers.

Rodríguez-Roldán echoed concern that while disability advocacy organizations largely oppose the bill, groups that represent either medical institutions or families of those with mental illnesses, or medical institutions—such as NAMI, Mental Health America, and the APA—seem to be driving this legislation.

“In disability rights, if the doc starts about talking about the plight and families of the people of the disabilities, it’s not going to go over well,” she said. “That’s basically what [HR 2646] does.”

Rodríguez-Roldán’s concerns extend beyond the potential harm of allowing families and caregivers easier access to individuals’ sensitive medical information; she also points out that the act itself is rooted in stigma. Rep. Murphy created the Helping Families in Mental Health Crisis Act in response to the Sandy Hook school shooting in 2012. Despite being a clinical psychologist for 30 years before joining Congress and being co-chair of the Mental Health Caucus, he continues to perpetuate the well-debunked myth that people with mental illness are violent. In fact, according to the Department of Health and Human Services, “only 3%-5% of violent acts can be attributed to individuals living with a serious mental illness” and “people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population.”

The act “is trying to prevent gun violence by ignoring gun control and going after the the rights of mentally ill people,” Rodríguez-Roldán noted.

In addition, advocates note, HR 2646 would make it easier to access assisted outpatient treatment, but would also give courts around the country the authority to mandate specific medications and treatments. In states where the courts already have that authority, Rodríguez-Roldán says, people of color are disproportionately mandated into treatment. When she has tried to point out these statistics to Murphy and his staff, she says, she has been shut down, being told that the disparity is due to a disproportionate number of people of color living in poverty.

Harris also expressed frustration at the hostility she and others have received attempting to take the lived experiences of those who would be affected by the bill to Murphy and his staff.

“I’ve talked to thousands of families … he’s actively opposed to talking to us,” she said. “Everyone has tried to engage with [Murphy and his staff]. I had one of the staffers in the room say, ‘You must have been misdiagnosed.’ I couldn’t have been that way,” meaning mentally ill. “It’s an ongoing struggle to maintain our mental and physical health, but they think we can’t get well.”

Multiple attempts to reach Murphy’s office by Rewire were unsuccessful.

LGBTQ people—transgender, nonbinary, and genderqueer people especially—are particularly susceptible to mistreatment in an institutional setting, where even the thoughts and experiences of patients with significant privilege are typically viewed with skepticism and disbelief. They’re also more likely to experience circumstances that already come with required hospitalization. This, as Rodríguez-Roldán explained, makes it even more vital that individuals not be made more susceptible to unnecessary treatment programs at the hands of judges or relatives with limited or no medical backgrounds.
Forty-one percent of all trans people have attempted suicide at some point in their lives,” said Rodríguez-Roldán. “Once you have attempted suicide—assuming you’re caught—standard procedure is you’ll end up in the hospital for five days [or] a week [on] average.”

In turn, that leaves people open to potential abuse. Rodríguez-Roldán said there isn’t much data yet on exactly how mistreated transgender people are specific to psychiatry, but considering the discrimination and mistreatment in health care in general, it’s safe to assume mental health care would be additionally hostile. A full 50 percent of transgender people report having to teach their physicians about transgender care and 19 percent were refused care—a statistic that spikes even higher for transgender people of color.

“What happens to the people who are already being mistreated, who are already being misgendered, harassed, retraumatized? After you’ve had a suicide attempt, let’s treat you like garbage even more than we treat most people,” said Rodríguez-Roldán, pointing out that with HR 2646, “there would be even less legal recourse” for those who wanted to shape their own treatment. “Those who face abusive families, who don’t have support and so on—more likely when you’re queer—are going to face a heightened risk of losing their privacy.”

Or, for example, individuals may face the conflation of transgender or gender-nonconforming status with mental illness. Rodríguez-Roldán has experienced the conflation herself.

“I had one psychiatrist in Arlington insist, ‘You’re not bipolar; it’s just that you have unresolved issues from your transition,'” she said.

While her abusive household and other life factors certainly added to her depression—the first symptom people with Bipolar II typically suffer from—Rodríguez-Roldán knew she was transgender at age 15 and began the process of transitioning at age 17. Bipolar disorder, meanwhile, is most often diagnosed in a person’s early 20s, making the conflation rather obvious. She acknowledges the privilege of having good insurance and not being low-income, which meant she could choose a different doctor.

“It was also in an outpatient setting, so I was able to nod along, pay the copay, get out of there and never come back,” she said. “It was not inside a hospital where they can use that as an excuse to keep me.”

The fear of having freedom and other rights stripped away came up repeatedly in a Twitter chat last month led by the Task Force to spread the word about HR 2646. More than 350 people participated, sharing their experiences and asking people to oppose Murphy’s bill.

In the meantime, Sen. Lamar Alexander (R-TN) has introduced the “Mental Health Reform Act of 2016” (SB 2680) which some supporters of HR 2646 are calling a companion bill. It has yet to be voted on.

Alexander’s bill has more real reform embedded in its language, shifting the focus from empowering families and medical personnel to funding prevention and community-based support services and programs. The U.S. Secretary of Health and Human Services would be tasked with evaluating existing programs for their effectiveness in handling co-current disorders (e.g., substance abuse and mental illness); reducing homelessness and incarceration of people with substance abuse and/or mental disorders; and providing recommendations on improving current community-based care.

Harris, with Real MH Change, considers Alexander’s bill an imperfect improvement over the Murphy legislation.

“Both of [the bills] have far too much emphasis on rolling back the clock, promoting institutionalization, and not enough of a preventive approach or a trauma-informed approach,” Harris said. “What they share in common is this trope of ‘comprehensive mental health reform.’ Of course the system is completely messed up. Comprehensive reform is needed, but for those of us who have lived through it, it’s not just ‘any change is good.'”

Harris and Rodríguez-Roldán both acknowledged that many of the HR 2646 co-sponsors and supporters in Congress have good intentions; those legislators are trusting Murphy’s professional background and are eager to make some kind of change. In doing so, the voices of those who are affected by the laws—those asking for more funding toward community-based and patient-centric care—are being sidelined.

“What is driving the change is going to influence what the change looks like. Right now, change is driven by fear and paternalism,” said Harris. “It’s not change at any cost.”

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