Serving Those Who Serve? Restrictions on abortion Access to safe, legal abortion services is essential to access for servicemembers, a person’s health and central to their economic and social veterans, and their well-being. Everyone deserves access to, and comprehensive dependents coverage for, safe abortion services in their communities, and that includes members of our military and their families. Yet servicemembers and their dependents, as well as veterans, face unjustified, hardline restrictions on their access to abortion. Federal law prohibits the Department Overall, the rate of unintended pregnancy of Defense from providing abortion in the Armed Forces is higher than among services at military treatment facilities, the general population.5 An analysis of the and the TRICARE insurance program 2011 Survey of Health Related Behaviors from covering such services, except when found that seven percent of active-duty a pregnancy is the result of rape, incest or women of reproductive age reported an when the life of the pregnant person is at unintended pregnancy in the previous risk. The Veterans Health Administration year. That same year, 4.5% of women of (VHA), which provides health services to reproductive age in the general U.S. popu- veterans, does not provide or cover abor- lation reported an unintended pregnancy.6 tion services under any circumstances. This issue brief — the first in a three-part Bans on abortion care and coverage series — discusses the unique barriers adversely impact veterans, servicemem- servicemembers, veterans and their bers and their families, including the dependents face in accessing abortion women and transgender men whose care. First, we explain the restrictions on service is vital to the national security abortion for active duty servicemembers of the United States. Women comprise and their dependents, and describe the more than 17 percent of the Armed Forces institutional barriers servicemembers face and ten percent of veterans.1 As of 2017, when they are forced to seek care off base, TRICARE covered 1,563,727 women such as restrictions on leave and travel and of reproductive age, including female mandatory disclosure of confidential med- spouses and dependents. Women are also ical information. Then, we describe the now the fastest growing cohort within the financial and logistical barriers imposed veteran community.2 Additionally, an on servicemembers and their dependents estimated several thousand transgender due to TRICARE’s abortion coverage men who serve on active duty and in the ban, and the myriad of state abortion Guard or Reserve Forces,3 as well as thou- restrictions patients may encounter while sands of transgender military dependents,4 seeking care off base. Finally, we detail the are covered by TRICARE and may be absolute bans on abortion coverage and Issue Brief impacted by the military’s abortion ban. provision for veterans in the VHA system. 2 ACTIVE DUTY SERVICEMEMBERS care outside the military healthcare AND THEIR DEPENDENTS FACE system is amplified for servicemembers NUMEROUS BARRIERS TO who are posted onboard a ship. “Went in for [a] UTI, was brought in ACCESSING ABORTION and told I had a positive pregnancy The process of obtaining leave or an For decades, federal law has prohibited test. They had already written approved pass can be difficult. General me a script for prenatal vitamins the Department of Defense (DOD) from leave and pass policies are set by each as if I had no other choice than to providing abortion services at military branch of the armed forces, and their carry forward with the pregnancy. treatment facilities (MTFs) except in policies may vary from base to base, I asked about the abortion pill and cases of rape or incest or to save the life they said ‘no, military medicine sometimes even between units within of the pregnant patient. Known as the does not allow it.’ I asked where bases.9 A request may require providing “facilities ban,” this prohibition forces I could go as an alternative and necessary documentation and servicemembers and their dependents at they had no info. It was horren- explanations for the request, and prior dous care and I’m a nurse!” home and abroad to access care off base approval from the unit commander, and outside the military healthcare system. a process that may take days or weeks.10 Doing so often comes with substantial risk, logistical barriers and at great cost. Such Moreover, obtaining medical leave to seek Navy Officer, Veterani costs and delays undermine access to safe, treatment is not guaranteed.11 For example, legal, and affordable abortion services. under Army regulations, the decision to grant a leave request is entirely discre- Until recently, the TRICARE insurance tionary.12 If a servicemember is denied program, which provides coverage to permission to travel for the abortion or servicemembers and their dependents, any of the multiple visits mandated by only covered abortions performed to save some states, they could be left without the life of the patient. In 2012, Congress “I am a member of the armed access to the health care that they need. passed an amendment to the Defense forces currently serving in Conversely, if they leave base to obtain Bill offered by Sen. Jeanne Shaheen that Afghanistan. I am here with my care without obtaining prior approval or husband and was unaware that permits abortion coverage in the case of miss scheduled duty due to unexpected the pills I take to prevent malaria rape or incest.7 While Senator Shaheen’s delays or difficulties in reaching the facil- can counteract my birth control amendment brings DOD policies in line ity, they risk facing serious disciplinary pills. My husband is as shocked as with most other federal policies on insur- I am. We do not want a child now; consequences civilians do not encounter.13 ance coverage for abortion, the underlying we have a job to do here. Due to restriction still imposes a substantial the military’s no-abortion policy, Leave requests and other I am pretty desperate. It isn’t like hardship on the vast majority of service- internal regulations can force you can even go off base here, and members and dependents whose abortions servicemembers to disclose you can’t just say you need medi- are not covered by TRICARE and results in confidential medical information cal leave without saying why.” financial hardship and emotional distress to their superiors for servicemembers and military families. Because the process of obtaining leave or an approved pass may require servicemem- Anonymous, Afghanistanii The facilities ban forces servicemembers to seek care off bers to disclose the reason for requesting base, but institutional barriers leave to their superiors, the facilities ban may prevent them from leaving often forces servicemembers to reveal private medical information to persons Servicemembers cannot simply leave who are under no legal obligation to protect base to travel to far away clinics at will.8 their privacy. This leaves their sensitive For example, their ability to travel outside personal information vulnerable to abuse their base may be severely restricted or disclosure. Moreover, some military by rules requiring them to obtain leave branches require servicemembers to dis- or be on an approved pass, granted by close their pregnancies to their superiors a superior. The difficulty of obtaining 3 regardless of their pregnancy intentions. For example, Navy guidelines require ser- vicemembers who learn they are pregnant to “promptly confirm[] their pregnancy “Two years ago, as a young single woman in the Air Force, I found out I was and inform[] their commanding officer.”14 pregnant. I knew I couldn’t talk to my immediate supervisor because he was The guidelines do not appear to make an a Catholic priest. You see, my job in the armed services was “Chaplain’s Assistant.” So instead, I went to the next level in my chain of command. In return exception for servicemembers who do for requesting time off, I was verbally reprimanded and told that I had sinned in not intend to continue their pregnancy. the eyes of God and was going to hell if I didn’t repent immediately.” Lack of insurance coverage of abortion imposes a substantial barrier to care Julie,* Japaniii * name changed to protect the storyteller’s privacy TRICARE does not provide insurance coverage for abortions except in the case or rape or incest or to save the life of the patient. But for many people, coverage for abortion care means the difference between getting the health care they need and being denied that care. For many servicemembers but particu- larly for junior servicemembers, the cost “I found out I was pregnant in the months leading up to my deployment and of an abortion can be prohibitive. For didn’t feel comfortable telling my doctor or chain of command for fear of example, the base pay of a Private (E1) retribution. I took a day of liberty after finally talking to my chief about it, he was nice but it was incredibly uncomfortable and later on he told the entire with less than two years of experience is chiefs’ mess about it. […].” less than $21,000 a year.15 The costs of the abortion may increase while a ser- vicemember waits for approval for their Active Duty Navy Enlistediv leave or pass to be granted, because the cost of an abortion rises as a pregnancy proceeds. Costs may also be compounded by additional expenses related to travel and hotel stays when servicemembers are denied care at their military base. Servicemembers who are already living near the poverty line and are turned away from obtaining an abortion or who are unable to afford abortion services DOD schools were eligible for free meals Recent research shows that a woman are at great risk of falling into poverty.