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.
Article info
Publication history
Published online: December 19, 2019
Accepted:
October 30,
2019
Received in revised form:
October 5,
2019
Received:
January 24,
2019
Footnotes
This research was made possible by general support funding from The David and Lucile Packard Foundation. There are no financial conflicts to disclose. Laura Fix had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Identification
Copyright
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.
