Study: Female Active Duty Soldiers Face Many Barriers to Care

Dr. Dan Grossman

Several studies reveal that female active duty soldiers in the U.S. military face many barriers to access to reproductive health care.

Much of the discussion surrounding the yet-unapproved National Defense Authorization Act for 2011 has focused on the future of “Don’t Ask, Don’t Tell.”  But the Senate version of this bill contains another controversial provision that would reverse the prohibition on use of military facilities for elective abortions, though women would have to pay for the services themselves.  Although a small step, this would be an important advance toward recognizing the significant contribution that women bring to our armed forces. 

Women make up approximately 14 percent of active duty forces, and 97 percent are of reproductive age.  Like the general U.S. population, unintended pregnancy is common among women in the military, despite policies aimed at restricting sexual contact.  The unfortunate reality is that not all sexual activity is consensual, with as many as one-third of female soldiers reporting being a victim of sexual assault.

Ibis Reproductive Health is conducting several studies aimed at understanding the experiences of women in the U.S. military seeking reproductive health care, and our research has uncovered many barriers faced by active duty soldiers.  In an online survey, about one-quarter of women who had been deployed overseas reported difficulties obtaining a birth control method at military facilities.  Women complained of problems making an appointment with a clinician to obtain contraception, the lack of availability of certain methods, an inability to get enough supplies at one time, as well as concerns about the confidentiality of services.  Those who wanted an IUD before deployment found it particularly hard to access due to restrictions about who was eligible for the method—restrictions that are not based on the most up-to-date clinical evidence.

But the biggest challenge is faced by military women deployed abroad who find themselves with an unintended pregnancy.  Federal policy under U.S. Code 1093 states that no Department of Defense facility or funds may be used for abortion except when the life of the pregnant woman is at risk.  If a pregnancy is the result of rape or incest, the abortion may be performed at a military facility, but the woman must pay for it out of pocket.  Despite these latter exceptions, and the known high rates of sexual assault against servicewomen, very few abortions take place at military facilities. 

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Why do women in the military decide to seek abortion?  In our research, women with an unintended pregnancy had a strong desire to complete their tour of duty and continue serving their country, and they did not want to disrupt their service by returning home because of the pregnancy.  Beyond this, their reasons were similar to those of most women who make this difficult choice:  because it’s the wrong time in their life to have a child, because they don’t have the financial resources to support a child, because they’re worried the pregnancy will adversely affect their career, or because they were raped, among others. 

The ban on abortion care at military facilities is particularly difficult for women deployed in active combat zones, where their mobility is severely limited.  In addition, abortion is illegal in Iraq and Afghanistan except to save the life of the pregnant woman, meaning most women can’t access care off base.  Indeed, a woman’s only option to access safe abortion care may be to take personal leave to return home and pay for the service herself.  Such a requirement makes it difficult for a woman to keep her decision confidential and can delay accessing services.  It also takes her away from the job she enlisted to do.

So what’s the solution?  Military policy needs to catch up with the recently issued U.S. Medical Eligibility Criteria for Contraceptive Use and make the full range of birth control options easily available to everyone—especially long-term methods like the IUD or implants that would be most convenient during deployment.  The recent decision to make emergency contraception a required medication on the military’s basic core formulary is an encouraging step, but more work is needed to ensure widespread access to all birth control methods. 

And when a woman in the military is faced with an unintended pregnancy, she should have the same access to care and support as American women not in the military, regardless of whether she decides to continue the pregnancy or not.  Supporting the troops means supporting their reproductive rights as well.

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