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More than 40% of troops face limited or no access to abortion care

More than 40% of troops face limited or no access to abortion care

  • Lt. Col. Paula Neemann, 15th Healthcare Operations Squadron clinical medicine flight commander, demonstrates several birth control options, such as an intrauterine device, at the 15th MDG’s contraceptive clinic at Joint Base Pearl Harbor-Hickam, Hawaii, in 2021.
    2nd Lt. Benjamin Aronson/U.S. Air Force.Lt. Col. Paula Neemann, 15th Healthcare Operations Squadron clinical medicine flight commander, demonstrates several birth control options, such as an intrauterine device, at the 15th MDG’s contraceptive clinic at Joint Base Pearl Harbor-Hickam, Hawaii, in 2021.

When J, a Marine Corps reservist, served on active duty during the troop surge in Iraq, she found herself unexpectedly pregnant just a couple of months before her unit was set to deploy. At first, she wasn’t sure what she wanted to do. But ultimately, she chose to have an abortion.

Because her unit was entering the busy build-up period preceding a deployment, when her absence would be noticed, and because the Marines in her unit were going through medical testing, J had to tell her commander. First, though, she needed to gather her courage.

“I didn’t know what his viewpoints were,” she says. “I worried how it would color his opinion of me.”

Then she had to find an abortion provider. Because federal law largely prohibits abortion care on military bases, J went to a local Planned Parenthood. There, she learned she was too far along for a medical abortion and Planned Parenthood couldn’t offer her a surgical abortion. Even though J lived in a large city in California, where abortion was fully legal, she couldn’t find a clinic that could provide her an abortion before she deployed. So J took two days of leave—fudging a story to the Marines in her unit about why she was disappearing—and a friend drove her hours away to a clinic in another city.

“I wanted to deploy,” J says. “It was what I had trained to do as a Marine.”

Today, she thinks about the Marines coming up behind her who might not have the same option.

“I think of my younger junior enlisted and their knowledge of where to even get information and access, as well as how much more their lives are controlled by a chain of command,” she says. “Where are these providers? Are they close to bases? Are they not?”

A new analysis from the RAND Corporation estimates that four in 10 active-duty military women are now stationed in states where they currently or shortly will have no or extremely limited access to abortion care—a situation that could worsen the military’s ongoing recruiting crisis.

While contraceptive use can help prevent unintended pregnancies, RAND researchers also found that fewer than half of all service women receive the annual contraceptive counseling mandated by the Defense Department, and some active-duty women reported that military health care providers had pressured them to use certain types of contraceptives. One-third of active-duty women surveyed said they would feel more comfortable getting birth control from a nonmilitary doctor.

The findings cast into sharp relief the obstacles military women and families face in obtaining reproductive health care following the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization earlier this summer.

“The scope is huge,” says Kyleanne Hunter, a senior political scientist at RAND and an author of the report. “It impacts women’s access to all forms of legitimate health care that is needed.”

Even before the Supreme Court struck down Roe v. Wade, abortion care for military women was extremely limited. Federal statute prohibits TRICARE, the military’s health care system, from providing abortions except in cases of rape or incest, or when the mother’s life is at risk. RAND researchers estimate that before Dobbs, between approximately 2,500 and 4,100 military women had abortions annually. Between 2016 and 2021, military hospitals performed just 91 abortions—a figure that also includes abortions performed on civilian dependents, like wives and daughters, reported. Data about covered abortions provided in nonmilitary hospitals is not readily available.

Service women seeking noncovered abortions in states with restrictions typically must request leave to travel out of state for the procedure. Following the repeal of Roe, 80,000 active-duty women now live in states with little to no abortion access. In fact, two of the  military’s three largest bases—Fort Campbell and Fort Hood—sit in states where abortion is illegal.

“Women [may] travel out of state to get abortion care, which is going to be time away from the unit, it’s going to be increased expenditure,” Hunter says.

In May, following the leaked draft of the Dobbs decision, the Army and the Air Force removed commanders’ ability to deny medical leave to service members who seek abortions. But the other services have not followed suit, and guidance from the Department of Defense after the Supreme Court decision clarified that department-wide leave policies remained unchanged.

Even if units grant women time off (leave) for an abortion, the cost can be prohibitive. For a woman stationed at Fort Hood, the nearest legal abortion clinic is in Wichita, Kansas—some 500 miles away. The RAND analysis estimates the total cost for the trip, including gas, lodging, and the procedure itself, could top $1,100. Many junior enlisted service members make less than $2,200 a month, meaning obtaining a legal abortion could eat up more than half a month’s pay.

These obstacles apply not only to active-duty women, but also to military dependents, such as wives and daughters, as well as to civilian women, who make up more than a third of the Defense Department’s civilian workforce. Forty-three percent of women in DOD’s civilian workforce live in states where abortion access is banned or limited, and more than four in 10 military men are married to women who will also see their abortion access curtailed if they are stationed in certain states.

“We talk about it often in these abstract terms,” Hunter says. “But when you start saying 40% of our service women, 40% of the men’s dependents that are [in those states] are going to have their access to the whole range of health care restricted, that’s a pretty powerful finding.”

‘It’s recruitment, retention, readiness’

The rate of unintended pregnancies is 50% higher among active-duty women than it is among civilian women, according to Defense Department data. The Women’s Reproductive Health Survey—the first comprehensive survey of service women’s health in decades, which was also released Tuesday—found that more than half of active-duty women who experienced an unintended pregnancy in the last year were not using birth control. Nearly a quarter of women who had an unintended pregnancy used birth control incorrectly.

The stigmatization of female reproductive health in a predominantly male environment and a lack of education on the topic likely contribute to the higher rate of these pregnancies. And while contraception is covered by the military, in practice, birth control isn’t always easy to access. The Women’s Reproductive Health Survey found that 20% of military women felt pressured by their health care provider to use certain types of birth control, regardless of whether it aligned with their personal preferences.

“Making sure that women understand the breadth of options that they have can prevent a lot of different potential negative consequences,” says Sarah Meadows, a senior sociologist at RAND and a co-author of the study.

According to DOD policy, health care providers in the military system must provide annual contraceptive “counseling on the full range of contraceptive methods.” But only one in four women reported receiving the counseling during their annual health assessment. One in five received it prior to deploying.

Clearer information about birth control options and easier access can help women avoid mistimed or unwanted pregnancies. But women also use contraceptives for a range of other reasons, from reducing menstrual cramps to ensuring regular periods to treating acne.

“This becomes really important in the post-Dobbs world as well, because there are already conversations around how the Dobbs decision is going to impact contraceptive care,” Hunter says.

The full implications of how the Dobbs decision will impact military women—and men—remains to be seen. In a House Armed Service Committee hearing in July, Defense Undersecretary for Personnel and Readiness Gil Cisneros said the military continues to study the issue. “We are looking at how each state is affecting us,” Cisneros said.

In his testimony, Cisneros also answered questions from lawmakers about whether the Dobbs ruling would affect women joining, and staying in, the military—questions the RAND report also raises.

“Once you start thinking about the potential consequences and that cascade of consequences, and it’s the big R’s. It’s recruitment, retention, readiness—you can even throw in resilience if you want,” Meadows says. “Those things add up to national security.”

Editors Note: This article first appeared on The War Horse, an award-winning nonprofit news organization educating the public on military service. Subscribe to their newsletter

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