By Major General Gale S. Pollock (Ret.), Army Nurse Corps, CRNA, FACHE, FAAN
Even during these partisan times in Congress, and yes, even on an issue, like abortion, that sparks debate, we should agree that women serving in the military deserve the same reproductive health care coverage that other women have in America. Unfortunately, that’s not the case. If our brave women are willing to protect our freedoms, we should protect their freedoms as well.
Although now retired, I served for over 30 years culminating as the Acting Surgeon General and Commander of the Army Medical Department and the 22nd Chief of the Army Nurse Corps. I take great interest in issues affecting the health of the men and women in our armed forces who defend our country and our Constitution.
A servicewoman who has been victimized by rape does not have health insurance coverage should she decide to terminate a resulting pregnancy. Current law allows coverage of abortion only when the woman’s life is endangered. I, and no doubt many others, am disheartened that our servicewomen and military wives and daughters lack the same insurance coverage civilian women have during such a traumatizing period of their lives. Federal employees — including any member of Congress and his or her family member — along with women in prison and women enrolled in Medicaid are appropriately shown compassion and provided access to care. But not women in uniform or the loves ones of men in uniform. To them, Congress has said, “you’re on your own.”
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The existence of the current policy boggles the mind. There is simply no justification for providing these women patriots less care than civilian women. The policy is shameful. Worse, it is disrespectful of the service and sacrifice of every military woman.
Last week, Senator Jeanne Shaheen (NH) introduced an amendment to the National Defense Authorization Act that would rectify this problem and restore basic fairness, enabling servicewomen to have the same health coverage as other women already do.
This is not a tough issue; it isn’t controversial. Current government health programs cover abortion in cases of rape and incest. Similarly, the abortion restrictions in the recently enacted Patient Protection and Affordable Care Act also provide exceptions for survivors of rape and incest. Although Congress hotly debated the contours of those restrictions, access to abortion care for sexual assault survivors was never even questioned. As divisive as the question of abortion has unfortunately become, an overwhelming majority of Americans have the grace and empathy, in the face of violent sexual assault, to allow a woman to make the decision that is best for her and her family. Why haven’t members of Congress done the same when it comes to our military women and families?
So I support the Shaheen Amendment and the senators who have co-sponsored it. But I also know that this past May, the House of Representatives had the opportunity to remedy this grievous wrong and it failed to act. In fact, it suppressed even a debate of the issue. The Senate must do better. Our women in uniform deserve nothing less.
Gale S. Pollock, Major General, U.S. Army (Ret.) served as the Deputy Surgeon General of the United States Army, 22nd Chief of the Army Nurse Corps, and was acting Surgeon General of the United States Army following the retirement of her predecessor.
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 analysisof 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.”
In a series of workshops over a three-day conference in Herndon, Virginia, self-proclaimed medical and scientific experts renewed their debunked efforts to promote the purported links between abortion and a host of negative outcomes, including breast cancer and mental health problems.
Less than two weeks after the Supreme Court rejected the anti-choice movement’s unscientific claims about how abortion restrictions make patients safer, the National Right to Life Convention hosted a slate of anti-choice “experts,” who promoted even more dubious claims that fly in the face of accepted medical science.
In a series of workshops over the three-day conference in Herndon, Virginia, self-proclaimed medical and scientific experts, including several whose false claims have been exposed by Rewire, renewed their efforts to promote the purported links between abortion and a host of negative outcomes, including breast cancer and mental health problems.
Some of those who spoke at the convention were stalwarts featured in the Rewire series “False Witnesses,” which exposed the anti-choice movement’s attempts to mislead lawmakers, courts, and the public about abortion care.
During a Thursday session titled “The Abortion-Breast Cancer Link: The Biological Basis, The Studies, and the Fraud,” Lanfranchi, one of Rewire’s “False Witnesses,” pushed her debunked talking points.
Throughout the presentation, which was attended by Rewire, Lanfranchi argued that there is “widespread fraudulent behavior among scientists and medical organizations to obfuscate the link” between abortion and breast cancer.
In a statement, the irony of which may have been lost on many in the room, Lanfranchi told attendees that sometimes “scientists in the pursuit of truth can be frauds.”Lanfranchi went on to point to numerous studies and texts she claimed supported her theories and lamented that over time, textbooks that had previously suggested a link between abortion and breast cancer in the ’90s were later updated to exclude the claim.
Lanfranchi later pivoted to note her inclusion in Rewire’s “False Witnesses” project, which she deemed an “attack.”
“We were one of 14 people that were on this site … as liars,” said Lanfranchi as she showed a slide of the webpage. “Now when people Google my name, instead of my practice coming up,” Rewire’s story appears.
Priscilla Coleman, another “False Witness” best known for erroneously claiming that abortion causes mental health problems and drug abuse, similarly bemoaned her inclusion in Rewire’s project during her brief participation in a Thursday session, “The Conspiracy of Silence: Roadblocks to Getting Abortion Facts to the Public.”
After claiming that there is ample evidence that abortion is associated with suicide and eating disorders, Coleman suggested that many media outlets were blocking the truth by not reporting on her findings. When it came to Rewire, Coleman wrote the outlet off as a part of the “extreme left,” telling the room that “if you look deeply into their analysis of each of our backgrounds, a lot of it is lies … it’s bogus information.”
An extensive review conducted by the American Psychological Association in 2008, however, found “no evidence sufficient to support” claims such as Coleman’s that “an observed association between abortion history and mental health was caused by the abortion.”
Rounding out the medical misinformation pushed in that session was Eve Sanchez Silver, the director and founder of the International Coalition of Color for Life. According to the biography listed on her organization’s website, Silver bills herself as a “bioethicist” who focuses on “the Abortion-Breast cancer link.”
Silver, who previously worked at the Susan G. Komen Foundation but left, she said, after finding out the organization gave money to Planned Parenthood, spent much of her presentation arguing that abortion increases the risk of breast cancer. She also detailed what she referred to as the “Pink Money Cycle,” a process in which, as she explained, money is given to Komen, which in turn donates to Planned Parenthood. As Silver told it, Planned Parenthood then gives people abortions, leading to more cases of breast cancer.
The seemingly conspiracy-driven theory has popped up in several of Silver’s presentations over the years.
Though Komen does in fact provide some funding to Planned Parenthood through grants, a July 2015 press release from the the breast cancer organization explains that it does “not and never [has] funded abortion or reproductive services at Planned Parenthood or any grantee.” Instead, the money Planned Parenthood receives from Komen “pays for breast health outreach and breast screenings for low-income, uninsured or under-insured individuals.”
On Saturday, another subject of Rewire’s “False Witnesses” series, endocrinologist Joel Brind, doubled down on his claims about the link between abortion and breast cancer in a workshop titled “New American Export to Asia: The Cover-Up of the Abortion-Breast Cancer Link.”
Brind described the Indian subcontinent as the ideal place to study the purported link between abortion and breast cancer. According to Brind, “The typical woman [there] has gotten married as a teenager, started having kids right away, breastfeeds all of them, has lots of them, never smokes, never drinks, what else is she going to get breast cancer from? Nothing.”
When it came to research from Asia that didn’t necessarily support his conclusions about abortion and breast cancer, Brind chalked it up to an international cover-up effort, “spearheaded, obviously, by our own National Cancer Institute.”
Although five states require counseling for abortion patients that includes the supposed link between abortion and breast cancer, Brind told Rewire that the link has become “the kind of thing that legislators don’t want to touch” because they would be going “against what all of these medical authorities say.”
Brind also dedicated a portion of his presentation to promoting the purported cancer-preventing benefits of glycine, which he sells in supplement form through his company, Natural Food Science LLC.
“If I sprain my ankle it doesn’t swell up, the injury will just heal,” Brind claimed, citing the supposed effects of glycine on inflammation.
In a Thursday session on “the rise of the DIY abortion”, panelist Randall O’Bannon questioned the U.S. Food and Drug Administration’s (FDA) March update to regulations on mifepristone, a drug also known as RU-486 that is used in medical abortions. Noting that the drug is “cheap,” O’Bannon appeared to fret that the new regulations might make abortion more accessible, going on to claim that there could be “a push to make [the drug] available over the counter.”
O’Bannon claimed there are “documented safety issues” associated with the drug, but the FDA says mifepristone is “safe and effective.” A 2011 post-market study by the agency of those who have used the drug since its approval found that more than 1.5 million women had used it to end a pregnancy in the U.S. Of those women, just roughly 2,200 experienced an “adverse event.”According to the Association of Reproductive Health Professionals, mifepristone “is safer than acetaminophen,” aspirin, and Viagra.
Speculating that misoprostol, another drug used in medication abortions, was less effective than medical experts say, O’Bannon later suggested that more embryos would “survive” abortions, leading to an “increased numbers of births with children with club feet, webbed toes, and fingers [and] full and partial facial paralysis.”
According to the World Health Organization, “Available data regarding a potential risk of fetal abnormality after an unsuccessful medical abortion are limited and inconclusive.”