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Abortion Need among U.S. Servicewomen: Evidence from an Internet Service

Published:December 19, 2019DOI:https://doi.org/10.1016/j.whi.2019.10.006

      Abstract

      Introduction

      U.S. servicewomen have high rates of unintended pregnancy, but federal policy prohibits abortion provision at military treatment facilities and military insurance coverage of abortion, except in cases of rape, incest, or a life-endangering pregnancy. Such restrictions pose challenges to abortion access for servicemembers, particularly during deployment. We aimed to explore the experiences of U.S. servicewomen when accessing abortion during overseas tours and deployment.

      Methods

      We reviewed de-identified data from email inquiries and online consultation forms from U.S. servicewomen or military spouses seeking medication abortion from the telemedicine service Women on Web between January 2010 and December 2017. We used descriptive statistics and inductively coded textual responses to describe client characteristics, circumstances of pregnancy, reasons for abortion, and barriers to abortion care.

      Results

      Our sample included data for 323 individuals. Reasons for abortion related to military service included disruption of deployment, fear of military reprimand, and potential career impacts. Additionally, servicemembers faced barriers to abortion access related to overseas military deployment or tour, including a lack of legal abortion in-country, limited financial resources, language barriers, travel restrictions, and a lack of confidentiality.

      Conclusions

      U.S. military servicewomen stationed in countries where safe, legal abortion is restricted or unavailable face deployment-related barriers to abortion care, which compound those barriers they may face regardless of deployment status. Removal of federal bans on the provision and coverage of abortion care and improved education about existing regulations could improve access to timely abortion care and in some cases allow servicewomen who wish to obtain abortion care to remain deployed.
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      Biography

      Laura Fix, MSW, is a Project Manager at Ibis Reproductive Health whose focus is on abortion at later gestational ages, telemedicine for medication abortion provision, and reproductive health care for populations facing multiple barriers to care.

      Biography

      Jane W. Seymour, MPH, is a Project Manager at Ibis Reproductive Health and doctoral student in epidemiology at Boston University School of Public Health. Her work focuses on applying epidemiologic methods to assess access to health care, particularly contraception and abortion.

      Biography

      Daniel Grossman, MD, Director, Advancing New Standards in Reproductive Health and Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, focuses on improving access to contraception and safe abortion in the United States, Latin America, and sub-Saharan Africa.

      Biography

      Dana M. Johnson, MPA, is a PhD student at the LBJ School of Public Affairs, University of Texas at Austin. Her research interests combine healthcare and social policy, with a focus on policies that impact reproductive healthcare access.

      Biography

      Abigail R.A. Aiken, PhD, is an assistant professor at the LBJ School of Public Affairs, University of Texas at Austin. Her research focuses on impacts of laws and policies restricting access to abortion, as well as self-managed abortion.

      Biography

      Rebecca Gomperts, MD, is founder and director of Women on Waves, a Dutch nonprofit organization, and Women on Web, a telemedical abortion service. She received her PhD at Karolinska University. Her research interests are abortion care and rights.

      Biography

      Kate Grindlay, MSPH, Associate at Ibis Reproductive Health, oversees a program to move an oral contraceptive over the counter in the United States. She also manages a portfolio of research focused on innovative approaches to reproductive health access in underserved communities.