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Commentary| Volume 21, ISSUE 4, P255-258, July 2011

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A Policy of Discrimination: Reproductive Health Care in the Military

Published:May 16, 2011DOI:https://doi.org/10.1016/j.whi.2011.03.008
A Policy of Discrimination: Reproductive Health Care in the Military
Previous ArticleEditorial Board
Next ArticleAbortion Restrictions in the U.S. Military: Voices from Women Deployed Overseas

      Introduction and Background

      They have preserved our way of life with unwavering patriotism and quiet courage, and ours is a debt of honor to care for them and their families. (

      The White House Office of the Press Secretary. (2010). Proclamation by President Obama on Veterans Day 2010. Available: http://www.america.gov. Accessed November 11, 2010.

      )
      In 2002, the wife of a young U.S. Navy sailor was given the news that her fetus had no brain, a birth defect known as anencephaly (

      Wilson, J. K. (2010). Military health insurance: How abortion is unfairly limited for military members. Available: http://www.associatedcontent.com. Accessed November 26, 2010.

      ). This condition is not compatible with life, and, at 16 weeks of gestation, the couple decided not to continue the pregnancy. In fiscal 1977, over 25,000 abortions were performed in military facilities (
      • Boonstra H.D.
      Off base: The U.S. military’s ban on privately funded abortions.
      Guttmacher Policy Review. 2010; 13
      ,

      Burrelli, D. F. (2008). Abortion services and military medical facilities. CRS Report for Congress: Abortion Services and Military Medical Facilities. Washington, DC: Congressional Research Service. Retrieved from http://assets.opencrs.com/rpts/95-387_20080710.pdf. Accessed November 26, 2010.

      ). However, in 2002 federal law prohibited termination of the pregnancy at the military health care facility where they were stationed. In addition, federal funds could not be used for the abortion (

      10 USC 1093-Sec. 1093. (1996). Performance of abortions: Restrictions. Available: http://codes.lp.findlaw.com/uscode/10/A/II/55/1093.

      ).
      This young family faced a $3,000 medical bill for the abortion procedure at a local civilian clinic, or the pain of going through 5 months of carrying a fetus that would die. Service members make less than civilians in similar occupations and depend on the military for their health coverage (

      Wilson, J. K. (2010). Military health insurance: How abortion is unfairly limited for military members. Available: http://www.associatedcontent.com. Accessed November 26, 2010.

      ). The additional $3,000 was beyond the financial capability of the couple. With the help of family and friends, they were able to overcome the financial burden and obtain the abortion. Had the family been stationed overseas, finding a civilian abortion provider may not have been possible.
      While stationed overseas in the Philippines from 1989 to 1991, one of the authors (J.T.J.) witnessed firsthand the burden of restrictive abortion policy. Active duty women electing to terminate an unwanted pregnancy were forced to make a difficult choice: Take emergency leave and travel to Hawaii for a legal abortion (at their own expense) or obtain an illegal abortion under unsafe conditions locally. Not surprisingly, the burden of unsafe care fell disproportionately on our youngest, most vulnerable junior enlisted personnel.
      The Military Health System (MHS), the medical network within the Department of Defense (DOD), is charged with worldwide provision of health care to all U.S. military personnel. Currently, the MHS delivers health care to approximately 9.6 million service members, veterans, and family members. With a $50 billion budget, 59 hospitals and 364 health clinics, the MHS goal “on and off the battlefield, in times of peace and war . . . is to ensure that the highest standard of care is delivered” (

      Department of Defense (DOD). (2010d). What is the MHS? Available: http://www.health.mil/About_MHS/index.aspx. Accessed November 26, 2010.

      ).
      After the creation of an all volunteer force in 1973, women joined the military with increasing numbers and today make up 15% of active duty personnel (

      Department of Defense (DOD). (2010c). Female active duty military personnel by rank/grade. Available: http://siadapp.dmdc.osd.mil/personnel/MMIDHOME.HTM. Accessed November 26, 2010.

      ). Additionally, women compose almost 17% of the military reserves and National Guard (
      Women in Military Service for America (WIMSA)
      Statistics on women in the military.
      Women in Military Service for America, 2009
      http://www.womensmemorial.org/PDFs/StatsonWIM.pdf
      ). Female dependents served by the MHS number 4.6 million as of December 2009 (
      TRICARE Management Activity (TMA)
      Department of Defense Evaluation of the TRICARE Program Fiscal Year (FY) 2010 Report to Congress.
      The TRICARE Management Activity (TMA), Health Program Analysis and Evaluation Directorate (TMA/HPA&E), in the Office of the Assistant Secretary of Defense (Health Affairs) (OASD/HA), Washington, DC2010
      ). In response to the growing number of women serving in the military, the MHS adapted to the need for more female-specific health care by increasing resources for all aspects of women’s health including breast care, pregnancy, and women’s health care in forward-deployed medical facilities.
      Correspondingly, the Department of Veterans Affairs (VA) began providing medical care for female veterans in 1988 (
      Department of Veterans Affairs (VA)
      Women veterans health care: About the program.
      Women Veterans Health Care. 2010; (Available:) (Accessed November 26, 2010)
      http://www.publichealth.va.gov/womenshealth/about.asp
      ). At present, women are the most rapidly growing segment of the care-eligible veteran population (
      • Goldzweig C.
      The state of women Veterans’ health research.
      JGIM: Journal of General Internal Medicine. 2006; 21: S82-S92
      ). The goal of the VA’s Women Veteran Health Program is “to be a national leader in the provision of health care for women, thereby raising the standard of care for all women” (
      Department of Veterans Affairs (VA)
      Women veterans health care: About the program.
      Women Veterans Health Care. 2010; (Available:) (Accessed November 26, 2010)
      http://www.publichealth.va.gov/womenshealth/about.asp
      ). The MHS and VA have adapted to the growing numbers of female patients in many effective and admirable ways (

      Department of Defense (DOD). (2010d). What is the MHS? Available: http://www.health.mil/About_MHS/index.aspx. Accessed November 26, 2010.

      ,
      Department of Veterans Affairs (VA)
      Women veterans health care: About the program.
      Women Veterans Health Care. 2010; (Available:) (Accessed November 26, 2010)
      http://www.publichealth.va.gov/womenshealth/about.asp
      ).

      Health Care Gap

      Despite these extensive efforts, there remain several significant health care disparities between active duty, reserve, and female dependents served by the MHS and civilian women in the United States. The pregnancy rate of forward-deployed female soldiers is 13% per year (
      TRICARE Management Activity (TMA)
      Department of Defense Health Care Quality Report to Congress.
      TRICARE Management Activity, Office of the Chief Medical Officer (OCMO), Clinical Quality Division, in the Office of the Assistant Secretary of Defense (Health Affairs) (OASD/HA), Washington, DC2009
      ). Most of these pregnancies are unplanned and occur among younger, enlisted service members 18 to 25 years old (
      • Custer M.
      Unintended pregnancy rates among a US military population.
      Paediatric and Perinatal Epidemiology. 2008; 22: 195-200
      ). General Order Number 1 “prohibits sexual relationships in the field,” yet unintended pregnancies remain the leading cause of U.S. servicewomen’s evacuation from combat zones (
      • Christopher L.A.
      Women in war: Operational issues of menstruation and unintended pregnancy.
      Military Medicine. 2007; 172: 9-16
      ).
      Unintended pregnancies occur despite freely available contraceptives provided by the MHS. Research has shown that contraceptive failure is a result of ineffective training and lack of knowledge about contraceptives and their use, as well as cultural norms in the military that equate contraceptive use with promiscuity (
      • Chung-Park M.S.
      Contraceptive decision-making in military women.
      Nursing Science Quarterly. 2007; 20: 281-287
      ,
      • Chung-Park M.
      Emergency contraception knowledge, attitudes, practices, and barriers among providers at a military treatment facility.
      Military Medicine. 2008; 173: 305-312
      ). Additionally there are few data regarding the use of the most effective, long-acting, reversible contraceptive (LARC) methods, such as intrauterine devices, injections, and implants in this population. Side effects of hormonal methods that are related to contraceptive compliance issues are also under-investigated among military women.
      Another problem with contraception in the MHS is access. Although free of charge, access to birth control is not without price. One active duty soldier reported “and you can buy condoms at the PX if you have the nerve to do it in front of 50 onlookers” (

      Heraldnet. (2004). Abortion becomes issue for military. Available: http://www.military.com/NewsContent/0,13319,FL_abortion_081904,00.html. Accessed November 26, 2010.

      ). In her forward-deployed unit, women had been warned of “harsh punishment” for becoming pregnant (

      Joyce, K. (2009). Military abortion ban: Female soldiers not protected by Constitution they defend [Essay]. Religion Dispatches. Available: http://www.religiondispatches.org/archive/politics/2111/. Accessed November 26, 2010.

      ). She noted, “The Army had even stopped handing out condoms to her unit,” apparently hoping the lack of protection would curtail sexual activity (

      Heraldnet. (2004). Abortion becomes issue for military. Available: http://www.military.com/NewsContent/0,13319,FL_abortion_081904,00.html. Accessed November 26, 2010.

      ).
      In the distant past, pregnant servicewomen were summarily discharged from military service. Today, they are transferred out of forward-deployed units without further recourse. Not only does this result in loss of combat readiness for the unit, but often jeopardizes the career of the pregnant soldier or sailor (

      Alliance for National Defense: A Positive Voice for Military Women. (2005). Pregnancy and military operations. Available: http://www.4militarywomen.org/Pregnancy.htm. Accessed November 28, 2010.

      ,
      • Christopher L.A.
      Women in war: Operational issues of menstruation and unintended pregnancy.
      Military Medicine. 2007; 172: 9-16
      ). The expenses associated with training, deployment, and discharge of pregnant active duty women represent additional costs and burdens to military preparedness.
      Despite the military and personal consequences of intercourse and pregnancy, it is clear that “birth control and no-sex rules aren’t working” (

      Heraldnet. (2004). Abortion becomes issue for military. Available: http://www.military.com/NewsContent/0,13319,FL_abortion_081904,00.html. Accessed November 26, 2010.

      ). In a more practical approach, emergency contraception (EC) has been approved for women in forward-deployed units (

      Kolbi-Molinas, A. (2010). Military lifts ban on emergency contraception reproductive freedom project. Available: http://www.aclu.org. Accessed November 29, 2010.

      ). The decision to provide female enlistees with “emergency contraception” was based on a recommendation by an independent advisory panel of military doctors and pharmacists. The new policy means EC will become a standard part of every medical facility’s formulary, including those on bases in Iraq and Afghanistan. Unfortunately, access to EC will still require being seen by a military health care provider and admission by the woman that sexual relations have occurred.
      Fear of discipline and career-damaging consequences makes disclosure of intercourse risky. An Army warrant officer who was stationed in Baghdad reported that some pregnant soldiers in “her unit opted to perform abortions on themselves rather than face disciplinary measures” (

      Heraldnet. (2004). Abortion becomes issue for military. Available: http://www.military.com/NewsContent/0,13319,FL_abortion_081904,00.html. Accessed November 26, 2010.

      ). Although military physicians take the same Hippocratic Oath as civilian physicians, they also take an oath to serve the U.S. Constitution and their commanding officers. These conflicting mandates can lead to loss of confidentiality and privacy in the military care system. With the possibility of reprimand, reassignment, or worse, it seems EC may still remain out of reach for forward-deployed women soldiers and sailors despite the new DOD directive (
      • Duke M.R.
      • Ames G.M.
      Challenges of contraceptive use and pregnancy prevention among women in the U.S. Navy.
      Qualitative Health Research. 2008; 18: 244-253
      ).

      Abortion Care

      Even with easier access to EC and better contraceptive use unplanned pregnancy will still occur when young, mostly single, men and women spend months together (
      • Biggs R.L.
      The impact of pregnancy on the individual and military organization: A postpartum active duty survey.
      Military Medicine. 2009; 174: 61-75
      ). In the United States, the option of terminating an unplanned pregnancy is commonly available and legal. This basic reproductive health care service is not provided by the MHS. With almost half of pregnancies in the United States unplanned (

      Guttmacher Institute. (2010, May 2010). Facts on induced abortion in the United States. Available: http://www.guttmacher.org/pubs/fb_induced_abortion.html. Accessed November 28, 2010.

      ), it is unrealistic to expect there will not be unplanned pregnancy among women depending on health care from the MHS. Currently, abortion is banned in military hospitals, even with private funding. Therefore, access to safe and legal abortion services through a MHS facility is not available to the 100,000-plus women serving overseas, female veterans living overseas or female family members living on foreign bases (

      NARAL Pro-choice America Foundation. (2010b). Lift the ban on privately funded abortion services for military women overseas. Available: http://www.prochoiceamerica.org/media/fact-sheets/abortion-private-ban-military-women.pdf. Accessed November 26, 2010.

      ).
      The subject of abortion in this country is both emotional and controversial. Nevertheless, abortion is a common and legal medical procedure in the United States. Therefore, it is both reasonable and ethically consistent for the MHS to allow access to this legal procedure to its active duty personnel, dependents, and veterans. Under current law, federally funded facilities are prohibited from offering termination of pregnancy unless the woman’s life is in danger or when the pregnancy is the result of rape or incest (

      10 USC 1093-Sec. 1093. (1996). Performance of abortions: Restrictions. Available: http://codes.lp.findlaw.com/uscode/10/A/II/55/1093.

      ). If the pregnancy is the result of rape or incest, the woman may obtain a procedure, but must pay for the abortion with personal funds. With the rising rates of sexual assault in the armed forces (

      Department of Defense (DOD). (2010b). Department of defense fiscal year 2009 annual report on sexual assault in the military. Available: http://www.sapr.mil/media/pdf/reports/DoD_Fiscal_Year_2010_Annual_Report_on_Sexual_Assault_in_the_Military.pdf. Accessed November 26, 2010.

      ), it is unconscionable not to fund termination of pregnancy from rape for our service members and veterans.
      In the MHS, if a woman’s life is in danger because of her pregnancy, she is likely to be referred to civilian providers for termination because fewer than four abortions per year have been performed at DOD facilities for the past 8 years (

      Burrelli, D. F. (2008). Abortion services and military medical facilities. CRS Report for Congress: Abortion Services and Military Medical Facilities. Washington, DC: Congressional Research Service. Retrieved from http://assets.opencrs.com/rpts/95-387_20080710.pdf. Accessed November 26, 2010.

      ). For forward-deployed soldiers and their families, as well as veterans living in other countries, referral often leads to considerable delays in obtaining abortion care. Although abortion procedures have a very low complication rate, this does increase with increasing gestational age (
      • Boonstra H.D.
      Off base: The U.S. military’s ban on privately funded abortions.
      Guttmacher Policy Review. 2010; 13
      ,

      Guttmacher Institute. (2010, May 2010). Facts on induced abortion in the United States. Available: http://www.guttmacher.org/pubs/fb_induced_abortion.html. Accessed November 28, 2010.

      ). Additionally, there is the cost of MEDEVAC, loss of combat unit assets, and the lost investment in training the soldier (
      • Albright T.S.
      Pregnancy during Operation Iraqi Freedom/Operation Enduring Freedom.
      Military Medicine. 2007; 172: 511-514
      ,
      • Belmont P.J.
      Disease and nonbattle injuries sustained by a U.S. Army brigade combat team during Operation Iraqi Freedom. [Article].
      Military Medicine. 2010; 175: 469-476
      ).
      In foreign countries where abortion is legal, women may seek abortion care outside the MHS. This is no easy task, however. In the words of one service member: “I will never forget the humiliation I felt. . . . I was turned away by my doctors. . . . Although I serve in the military, I was given no translators, no explanations, no transportation and no help for a legal medical procedure” (

      National Abortion Federation. (2010). The ban on privately funded abortion care at overseas military bases forces women to compromise their privacy, dignity, and safety. Available: http://www.prochoice.org/policy/congress/women_military.html. Accessed November 26, 2010.

      ). In countries where abortion is illegal, with no other option available, the military requires female service members to return home within 2 weeks of confirmed pregnancy (

      Clark, A. (2010). Abortion coming to the military? Broadsheet. Available: http://www.salon.com/life/broadsheet/2010/06/14/abortion_military. Accessed November 26, 2010.

      ). Veterans and female dependents must travel, often at great expense, to receive abortion care (
      • Keenan N.L.
      Time to end the ban on military women’s access to abortion.
      Reproductive Rights, Women in Uniform. 2010; (Available:) (Accessed November 26, 2010)
      http://womensrights.change.org
      ).

      History of Abortion in the MHS

      In the 1960s, abortions were “quietly” provided at military facilities, even in states where abortion was illegal (
      • Ponder K.L.
      Damage control: Unintended pregnancy in the United States military.
      The Journal of Law, Medicine & Ethics. 2010; 38: 386-395
      ). In 1970, orders were issued allowing military hospitals to perform abortions when “medically necessary or when the mental health of the mother is threatened.” However, in 1971 President Nixon ordered military facilities to abide by state abortion laws effectively stopping abortion care in states where the procedure was illegal (
      • Boonstra H.D.
      Off base: The U.S. military’s ban on privately funded abortions.
      Guttmacher Policy Review. 2010; 13
      ,
      • Crawford E.D.
      Under siege: Freedom of choice and the statutory ban on abortions on military bases.
      The University of Chicago Law Review. 2004; 71.4: 1549-1582
      ). In 1975, the DOD directed military facilities to provide abortions in accordance with the 1973 Roe v. Wade Supreme Court decision (

      National Committee for a Human Life Amendment. (2010). Military policy toward abortion. Available: http://www.nchla.org/datasource/ifactsheets/7militaryfactsheet.13.10.pdf. Accessed November 26, 2010.

      ). Over 20,000 abortions were performed annually in military facilities during the mid 1970s (

      Burrelli, D. F. (2008). Abortion services and military medical facilities. CRS Report for Congress: Abortion Services and Military Medical Facilities. Washington, DC: Congressional Research Service. Retrieved from http://assets.opencrs.com/rpts/95-387_20080710.pdf. Accessed November 26, 2010.

      ).
      In 1976, the Hyde Amendment passed by the House of Representatives as part of the Department of Labor and Health, Education, and Welfare Appropriation Act, prohibited use of federal funds for abortion except when the mother’s life is endangered by her pregnancy (

      Alliance for National Defense: A Positive Voice for Military Women. (2008). Military women should have full access to reproductive health care retrieved. Available: http://www.4militarywomen.org/Healthcare.htm. Accessed November 28, 2010.

      ,

      Henshaw, S. K., Joyce, T. J., Dennis, A., Finer, L. M., & Blanchard, K. (2009). Restrictions on Medicaid funding for abortions: A literature review. Available: http://www.guttmacher.org/pubs/MedicaidLitReview.pdf. Accessed November 28, 2010.

      ). Starting in 1979, a similar amendment was attached annually to the DOD appropriations bill, and eventually codified in Title 10 of the U.S. Code as part of the Omnibus Defense Authorization Act of 1985 (
      • Crawford E.D.
      Under siege: Freedom of choice and the statutory ban on abortions on military bases.
      The University of Chicago Law Review. 2004; 71.4: 1549-1582
      ). See Table 1 for Title 10 of the U.S. Code, part a and part b. Even after this loss of funding, service members overseas could still obtain abortions in military facilities by paying out-of-pocket. This practice continued until June 1988, when a memorandum issued by Dr. William Mayer, then-Assistant Secretary of Defense (Health Affairs), prohibited the use of overseas military medical facilities for abortions. In 1993, newly elected President Clinton immediately reversed this ban on abortion in military facilities allowing “abortion services to be provided, if paid for entirely with non-DOD funds” (

      Burrelli, D. F. (2008). Abortion services and military medical facilities. CRS Report for Congress: Abortion Services and Military Medical Facilities. Washington, DC: Congressional Research Service. Retrieved from http://assets.opencrs.com/rpts/95-387_20080710.pdf. Accessed November 26, 2010.

      ,

      Joyce, K. (2009). Military abortion ban: Female soldiers not protected by Constitution they defend [Essay]. Religion Dispatches. Available: http://www.religiondispatches.org/archive/politics/2111/. Accessed November 26, 2010.

      ). In 1995, Congress passed an amendment restricting use of federal facilities for abortion, resulting in what is now 10 USC Sec 1093(b), prohibiting the use of a “medical treatment facility or other facility of the Department of Defense” to perform an abortion except for maternal life-endangerment or in the case of rape or incest (

      NARAL Pro-Choice America Foundation. (2010a). Lift the ban on federally funded abortion services for military victims of rape and incest. Available: http://www.prochoiceamerica.org/media/fact-sheets/abortion-ban-military-sexual-assault.pdf. Accessed November 26, 2010.

      ). Attempts to reverse this policy have been rejected by congress.
      Table 110 USC Sec.1093. Performance of Abortions: Restrictions
      (a) Restriction on use of fundsFunds available to the Department of Defense may not be used to perform abortions except where the life of the mother would be endangered if the fetus were carried to term.
      (b) Restriction on use of facilitiesNo medical treatment facility or other facility of the Department of Defense 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 in which the pregnancy is the result of an act of rape or incest.

      Conclusion

      The Military Health Service (MHS) was created to fulfill President Abraham Lincoln’s promise to veterans: “To care for him who shall have borne the battle and for his widow and his orphan” (
      • Barbara J.S.
      “To care for him who shall have borne the battle and for his widow and his orphan” (Abraham Lincoln): The Department of Veterans Affairs polytrauma system of care.
      Archives of Physical Medicine and Rehabilitation. 2008; 89: 160-162
      ). For at least 200 years, women have been part of the defense force of our nation, and are now serving in higher numbers than ever before. From 1980 to July 25, 2009, the DOD reports 2,495 women killed while on active duty (

      Department of Defense (DOD). (2010a). Active duty military deaths: Race/ethnicity summary (as of July 25, 2009). Available: http://www.fas.org/sgp/crs/natsec/RL32492.pdf. Accessed November 26, 2010.

      ). There are now 1.8 million female U.S. veterans (

      Department of Veterans Affairs (VA). (2007). Veteran population demographics. Available: http://www1.va.gov/VETDATA/Demographics/Demographics.asp.

      ).
      Unplanned pregnancy continues to be a problem in both the U.S. civilian population and among users of the MHS. If a female service member decides the time is not appropriate for childbearing, she will have a hard time exercising her right to a procedure that is both legal and safe in the nation she defends. The prohibition of abortion care at military treatment facilities using private funds is unfair and discriminatory. Women soldiers and sailors unduly bear the consequences of sexual activity and they should not have to sacrifice their careers if pregnancy occurs. Nor should they be denied comprehensive reproductive care because they have had the courage to join the military and protect the freedoms afforded others by their service.

      Recommendations

      • 1.
        All military personnel receive targeted and appropriate sex education including recommendations for the use of highly effective LARC methods that do not require user intervention (IUDs, implants, and injections).
      • 2.
        An anonymous, routine system for contraception distribution among forward-deployed personnel must be developed and implemented. At the very least, condoms and EC must be available to all service members without the need to admit to prohibited activity.
      • 3.
        Women service members need to be deployed with a suitable contraception method already in place, such as LARC, multiple packs of oral contraceptives, or multiple doses of EC with scheduled, routine follow-up in theater. The military requires all soldiers and sailors to be vaccinated against yellow fever and anthrax. Protection against unintended pregnancy should be equally routine.
      • 4.
        Military health care providers must be allowed to provide completely confidential reproductive health care. This reassurance is necessary to convince young soldiers that accessing military care will not result in negative repercussions to their careers.
      • 5.
        The private funding ban on abortions at MHS facilities must be lifted. Additionally, the conversation should be broadened to reverse or limit the scope of the Hyde amendment, because it is unacceptable that military active duty women or dependents should self-finance abortions required because of sexual assault or for genetic or fetal abnormalities.
      • 6.
        Manual vacuum aspiration, a simple 10-minute clinic procedure, and medical abortion using mifepristone and misoprostol should be provided at every military health facility. Both procedures are within the scope of practice of primary care physicians and offer safe and effective means of managing early first trimester abortion, both elective and spontaneous. Having trained personnel and equipment available to provide this basic reproductive health service at overseas military health facilities would increase mission readiness and prevent the need for MEDIVAC.

      References

      1. 10 USC 1093-Sec. 1093. (1996). Performance of abortions: Restrictions. Available: http://codes.lp.findlaw.com/uscode/10/A/II/55/1093.

        View in Article
        • Albright T.S.
        Pregnancy during Operation Iraqi Freedom/Operation Enduring Freedom.
        Military Medicine. 2007; 172: 511-514
        View in Article

      3. Alliance for National Defense: A Positive Voice for Military Women. (2005). Pregnancy and military operations. Available: http://www.4militarywomen.org/Pregnancy.htm. Accessed November 28, 2010.

        View in Article

      4. Alliance for National Defense: A Positive Voice for Military Women. (2008). Military women should have full access to reproductive health care retrieved. Available: http://www.4militarywomen.org/Healthcare.htm. Accessed November 28, 2010.

        View in Article
        • Barbara J.S.
        “To care for him who shall have borne the battle and for his widow and his orphan” (Abraham Lincoln): The Department of Veterans Affairs polytrauma system of care.
        Archives of Physical Medicine and Rehabilitation. 2008; 89: 160-162
        View in Article
        • Belmont P.J.
        Disease and nonbattle injuries sustained by a U.S. Army brigade combat team during Operation Iraqi Freedom. [Article].
        Military Medicine. 2010; 175: 469-476
        View in Article
        • Biggs R.L.
        The impact of pregnancy on the individual and military organization: A postpartum active duty survey.
        Military Medicine. 2009; 174: 61-75
        View in Article
        • Boonstra H.D.
        Off base: The U.S. military’s ban on privately funded abortions.
        Guttmacher Policy Review. 2010; 13
        View in Article

      9. Burrelli, D. F. (2008). Abortion services and military medical facilities. CRS Report for Congress: Abortion Services and Military Medical Facilities. Washington, DC: Congressional Research Service. Retrieved from http://assets.opencrs.com/rpts/95-387_20080710.pdf. Accessed November 26, 2010.

        View in Article
        • Christopher L.A.
        Women in war: Operational issues of menstruation and unintended pregnancy.
        Military Medicine. 2007; 172: 9-16
        View in Article
        • Chung-Park M.S.
        Contraceptive decision-making in military women.
        Nursing Science Quarterly. 2007; 20: 281-287
        View in Article
        • Chung-Park M.
        Emergency contraception knowledge, attitudes, practices, and barriers among providers at a military treatment facility.
        Military Medicine. 2008; 173: 305-312
        View in Article

      13. Clark, A. (2010). Abortion coming to the military? Broadsheet. Available: http://www.salon.com/life/broadsheet/2010/06/14/abortion_military. Accessed November 26, 2010.

        View in Article
        • Crawford E.D.
        Under siege: Freedom of choice and the statutory ban on abortions on military bases.
        The University of Chicago Law Review. 2004; 71.4: 1549-1582
        View in Article
        • Custer M.
        Unintended pregnancy rates among a US military population.
        Paediatric and Perinatal Epidemiology. 2008; 22: 195-200
        View in Article

      16. Department of Defense (DOD). (2010a). Active duty military deaths: Race/ethnicity summary (as of July 25, 2009). Available: http://www.fas.org/sgp/crs/natsec/RL32492.pdf. Accessed November 26, 2010.

        View in Article

      17. Department of Defense (DOD). (2010b). Department of defense fiscal year 2009 annual report on sexual assault in the military. Available: http://www.sapr.mil/media/pdf/reports/DoD_Fiscal_Year_2010_Annual_Report_on_Sexual_Assault_in_the_Military.pdf. Accessed November 26, 2010.

        View in Article

      18. Department of Defense (DOD). (2010c). Female active duty military personnel by rank/grade. Available: http://siadapp.dmdc.osd.mil/personnel/MMIDHOME.HTM. Accessed November 26, 2010.

        View in Article

      19. Department of Defense (DOD). (2010d). What is the MHS? Available: http://www.health.mil/About_MHS/index.aspx. Accessed November 26, 2010.

        View in Article

      20. Department of Veterans Affairs (VA). (2007). Veteran population demographics. Available: http://www1.va.gov/VETDATA/Demographics/Demographics.asp.

        View in Article
        • Department of Veterans Affairs (VA)
        Women veterans health care: About the program.
        Women Veterans Health Care. 2010; (Available:) (Accessed November 26, 2010)
        http://www.publichealth.va.gov/womenshealth/about.asp
        View in Article
        • Duke M.R.
        • Ames G.M.
        Challenges of contraceptive use and pregnancy prevention among women in the U.S. Navy.
        Qualitative Health Research. 2008; 18: 244-253
        View in Article
        • Goldzweig C.
        The state of women Veterans’ health research.
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      Biography

      Janet C. Jacobson, MD, is a Family Planning Fellow at the Department of OB/GYN, University of Utah School of Medicine. Her research interests include female genital tract microflora and contraception. Dr. Jacobson served as a pilot in the U.S. Navy from 1992 to 2002. She accrued approximately 1900 flight hours and 302 carrier arrested landings in her primary aircraft the F/A-18 Hornet. She resigned her commission as a Lieutenant Commander in 2002.

      Biography

      Jeffrey T. Jensen, MD, MPH, is the Leon Speroff Professor and Vice Chair, Research Director, Women’s Health Research Unit, Department of OB/GYN, at the Oregon Health & Science University. He is also an Affiliate Scientist at the Oregon National Primate Research Center. His research interests include novel nonhormonal highly selective targets for female contraception, nonsurgical sterilization and contraceptive health benefits. Dr. Jensen served as an OB/GYN in the Medical Corps of the U.S. Naval Reserve on active duty between 1988 and 1992. He spent 2 years as Head of the Department of OB/GYN, U.S. Naval Hospital Subic Bay, the Philippines. He resigned his commission as a Lieutenant Commander in 1992.

      Article info

      Publication history

      Published online: May 16, 2011
      Accepted: March 28, 2011
      Received in revised form: March 28, 2011
      Received: December 1, 2010

      Footnotes

      The authors report no conflicts of interest. No funding was received for this work.

      Identification

      DOI: https://doi.org/10.1016/j.whi.2011.03.008

      Copyright

      © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

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