News Law and Policy

Senate Armed Services Committee Votes to End Military Ban on Insurance Coverage of Abortion Care for Rape and Incest

Jodi Jacobson

The Senate Armed Services passed an amendment today to the National Defense Authorization Act (NDAA) that would end the ban on insurance coverage of abortion care for military women and dependents who experience rape or incest. 

A change was made to this article at 11:37 a.m. on May 24th, 2012 to correct an error and clarify portions of existing law. The changes are apparent in the piece itself.

The Senate Armed Services passed an amendment today to the National Defense Authorization Act (NDAA) that would end the ban on insurance coverage of abortion care for military women and dependents who experience rape or incest. 

The amendment was introduced by Senator Jeanne Shaheen (D-NH). In November 2011, anti-choice senators refused to allow the Shaheen amendment to come to the floor, so the 2012 NDAA was signed into law with the ban in place. Today’s vote affects the FY 2013 NDAA.

There are some 400,000 women in the United States Armed Forces; they and their families receive health care and insurance through the Department of Defense’s Military Health System. The department currently denies coverage for abortion care except when a pregnant woman’s life is endangered. Unlike other federal bans on abortion coverage, the military ban provides no exception for insurance coverage in cases of rape and incest.

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As a result, those seeking safe abortion care after rape or incest must pay out-of-pocket for such care at a military facility. But because physicians on military bases are prohibited from providing abortion care, it is not actually available to military women in need even under the narrow conditions technically allowed.

According to the American Civil Liberties Union, the current law says the following:

10 USC 1093(a) says “Restrictions on Use of Funds: funds available to the DoD may not be used to perform abortions except where the life of the mother would be endangered if the fetus were carried to term.”  

and

10 USC 1090(b) says “Restriction of Use of Facilities: no medical treatment facility or other facility of the DoD may be used to perform an abortion except where the life of the mother would be endangered if the fetus were carried to term or in a case which the pregnancy is the result of an act of rape or incest.”  

The first is referred to as “the rape and incest insurance coverage ban,” and the second “the facilities ban.”

Taken together, here is what they mean for service women: 

  • If your life is endangered, you can have an abortion on a military treatment facility and the government will pay for it. 
  • If you’re pregnant because of rape or incest, you can have the abortion on a military treatment facility but there is no Department of Defense insurance coverage available to cover the procedure (i.e. you have to pay for it yourself).
  • If you need an abortion for any other reason (e.g. the condom breaks, fetal anomaly, etc ), too bad – can’t do it on a military treatment facility and DoD won’t pay for it.

As a result, servicewomen who are pregnant due to rape are left uncovered, and servicewomen facing an unintended pregnancy from contraceptive failure or unprotected sex are often forced to choose between taking leave and traveling far distances to an American provider, seeking services from a local, unfamiliar health care facility (if abortion is legal and they are not in a combat zone), having an unsafe procedure, or attempting to self-induce an abortion.

The Shaheen Amendment, if passed by Congress and signed by the President, would address one of these issues by bringing the military’s health insurance policy in line with the policy that governs other federal programs, such as Medicaid and the Federal Employees Health Benefit Program and as a result enable  servicewomen to receive insurance coverage for abortion care.  (Another amendment, the MARCH Act, which has not been passed, would address both pieces by ensuring funding for rape and incest (i.e. Shaheen Amendment) and enabling women to access safe abortion on base for any reason, though this would be paid out of pocket with no DoD funds involved (this latter portion comes originally from the Burris amendment 2010). 

The Shaheen amendment is strongly supported by military leaders, physicians, and servicewomen themselves.  

“Women who put their lives on the line fighting for our freedom shouldn’t be denied reproductive health care services,” said Gale Pollock, Major General, US Army (Ret.).

“The Shaheen Amendment restores fairness to discriminatory legislation that denies servicewomen access to the healthcare they need. At the very least, our servicewomen deserve the same level of coverage as other women who rely on the government for their health care.”

“Servicewomen promise to support and defend the Constitution and our country,” said Cindy McNally, Chief Master Sergeant, US Air Force (Ret.). “It’s unconscionable to turn our backs on them in their time of need. We owe it to them — and to ourselves — to get this one right.”

“The Shaheen amendment is greatly needed. It’s simply unfair to deny our military women the same abortion coverage that other government employees have,” said Dennis Laich, Major General, US Army (Ret.). “Our servicewomen fight every day for us – it’s time we fight for them.” 

“This is about equity,” said Senator Shaheen. “Civilian women who depend on the federal government for health insurance – whether they are postal workers or Medicaid recipients – have the right to access affordable abortion care if they are sexually assaulted. It is only fair that the thousands of brave women in uniform fighting to protect our freedoms are treated the same.”

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.”

Roundups Politics

Campaign Week in Review: Clinton’s ‘Military Families Agenda’ Includes Calls for Family Leave, Child Care

Ally Boguhn

As part of her plan, Clinton would move to “ensure that family leave policies meet the needs of our military families so that, for example, new parents, as practical and consistent with mission, can care for their families at a pivotal moment.”

This week on the campaign trail, Democratic presidential candidate Hillary Clinton released her agenda for helping military families, and anti-choice voters remain ambiguous about Donald Trump’s positions on abortion.

Clinton Releases Plan to Expand Family Leave and Access to Child Care for Military Families

Clinton released her “Military Families Agenda” on Tuesday, detailing the former secretary of state’s plan, if elected, to support military personnel and their families.

“Military families, who serve alongside our service members, are vital to the strength of our military and the health of our nation,” reads Clinton’s plan. “Ensuring our military families have the support they need to balance service to the nation with the demands of family life helps our nation attract and retain the most talented service members.”

As part of her plan, Clinton would move to “ensure that family leave policies meet the needs of our military families so that, for example, new parents, as practical and consistent with mission, can care for their families at a pivotal moment.”

Clinton also vowed to improve access to child care for both active duty and reserve service members “both on- and off-base, including options for drop-in services, part-time child care, and the provision of extended-hours care, especially at Child Development Centers, while streamlining the process for re-registering children following a permanent change of station (PCS).” ​She did not say exactly what these improvements would entail.

“Service members should be able to focus on critical jobs without worrying about the availability and cost of childcare,” continues Clinton’s proposal.

Paid family leave has been a critical issue for Democrats on the campaign trail, and both Clinton and rival Democratic candidate Sen. Bernie Sanders (I-VT) rolled out clarifications and additional details about their proposals on the issue in January. Though the two candidates support similar federal policies, they would pay for them in different ways, with Clinton proposing raising taxes on the wealthy and Sanders pushing a payroll tax on workers and their employers.

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Clinton released a plan in early May to address the rising cost of child care in the United States, proposing that the federal government cap child-care costs at 10 percent of a family’s income, though the candidate’s campaign has yet to release details on how it would be implemented and funded.

Analysis conducted by the Economic Policy Institute (EPI) in 2015 found that increasingly, “child care is out of reach for working families,” and in in 33 states and Washington, D.C., child-care costs were higher than the average cost of in-state tuition at public universities.

Anti-Choice Voters Unsure About Trump’s Stance on Abortion

Recent polling found that the majority of voters who describe themselves as “pro-life” aren’t sure about whether they agree with presumptive Republican nominee Trump’s position on abortion.

The poll, conducted by Gallup during the first week of May, found that 63 percent of anti-choice respondents were unable to say whether they agreed or disagreed with Trump’s stance on abortion. Almost equal shares of anti-choice respondents said they agreed or disagreed with the Republican candidate: 19 percent agreed while 18 percent disagreed.

The majority of overall respondents—56 percent—had “no opinion” on whether they agreed with Trump on abortion or not. Just 13 percent of those polled agreed.

Meanwhile, 38 percent of those polled who considered themselves “pro-choice” said they agreed with Clinton’s position on abortion while 47 percent had “no opinion.” Twenty-two percent of all people surveyed said they agreed with Clinton, while 32 percent disagreed and 46 percent had no opinion.

Gallup’s findings follow months of ambiguity from both Republicans and the anti-choice community about Trump’s position on reproductive rights. Though Trump has consistently pushed his opposition to abortion on the campaign trail, his past statements on “punishing” abortion patients should abortion become illegal, and willingness to change the GOP platform on abortion to include exceptions for cases of rape, incest, and life endangerment have landed him in hot water with some conservatives.

Anti-choice activists, however, are slowly starting to warm to the presumptive Republican nominee. Troy Newman, president of the radical group Operation Rescue, signaled he may be willing to back Trump in a blog post in May instructing the candidate to “earn” the anti-choice vote. Priests for Life and the Susan B. Anthony List officials both backed Trump in statements to the Washington Times, though they had previously spoken out against the Republican.

What Else We’re Reading

Eric Alterman explains in a piece for the Nation that the media’s willingness to provide a false equivalency to both sides of every issue “makes no sense when one side has little regard for the truth.”

“I don’t want to sound too much like a chauvinist, but when I come home and dinner’s not ready, I go through the roof,” said Trump in a 1994 interview with ABC News when discussing his romantic relationships. “I think that putting a wife to work is a very dangerous thing …. If you’re in business for yourself, I really think it’s a bad idea.”

Sanders spotlighted Native American communities while campaigning in California ahead of the state’s primary. “This campaign is listening to a people whose pain is rarely heard—that is the Native American people,” said Sanders at a Sunday campaign rally. “All of you know the Native American people were lied to. They were cheated. Treaties they negotiated were broken from before this country even became a country. And we owe the Native American people a debt of gratitude we can never fully repay.”

Fusion’s Jennifer Gerson Uffalussy questions why Trump has said so little about the the Zika virus.

CNN embedded in a chyron a fact-check on Trump’s false claims about nuclear weapons.

Ohio removed thousands of voters from the state’s voter registration rolls because those voters had not cast ballots since 2008, in a move that could reportedly help Republicans in the state. Though states do occasionally cleanse their rolls, “only a handful [of states] remove voters simply because they don’t vote on a regular basis,” reports Reuters.

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