Why Aren't Women in Combat Zones Getting Access To Birth Control?

Within the orderly ranks of the military, a growing problem is emerging: Military women working in combat zones are experiencing unintended pregnancies at a rate 50 percent higher than their civilian counterparts as a result of not being able to access contraceptives. In an era when access to birth control is a subject of hot contention, women in the military are already facing a number of unique challenges, and this is an unnecessary addition to their burdens. As a nation, we should be finding this unacceptable — so why can't we get it together on supporting military women with critical health care that fits their needs?

For women in the field, birth control isn't as simple as attending an annual exam and taking advantage of Obamacare to pick up a free prescription from the pharmacy. Health care options are more limited for deployed women, who don't have access to a fully staffed and stocked clinic. Birth control isn't necessarily available near the front lines, where medical care is heavily focused on managing trauma.

Sexually active women also work with the awareness that the Department of Defense will not pay for abortions on bases overseas, and doesn't even allow them to pay for their own procedures in military facilities overseas where abortion could theoretically be offered — they must return to the United States for abortion care, except in situations where their lives are under threat. Commenting on health care for deployed women, NARAL says that: "Women stationed overseas depend on their base hospitals for medical care, and are often situated in areas where local facilities are inadequate, unsafe, or unavailable."

Women account for nearly 15 percent of active duty military, and their ranks are growing. Additionally, the Department of Defense has finally opened up combat positions to women, formalizing an already existing trend — while women weren't "officially" serving in combat before, they did perform "tactical operations" that were suspiciously similar to combat roles. Almost a quarter of a million jobs will emerge for women as a result of the change in policy, which goes into effect in 2016, and the problems with unintended pregnancy will likely escalate as a result, because all military in combat zones have trouble accessing comprehensive health care, including preventative care like contraceptives.

Unexpected pregnancy is a serious problem for military women, as abortions are not covered for servicemembers, thanks to puritanical federal laws. Instead, they have to accept leave and either take time off to have their babies or pay for abortions out of pocket.

Most women in the military are of childbearing age, and they experience an unplanned pregnancy rate of nearly eight percent. This is a serious problem for combat readiness as a whole, because pregnant women cannot continue to serve and must instead return to the U.S. for treatment, and it's unfair to individual women. While many military women plan on having families, some want to focus on career development, and like all women, they have the right to choose the timing of their families — unintended pregnancies put serious stress on their family planning.

Unexpected pregnancy is a serious problem for military women, as abortions are not covered for servicemembers, thanks to puritanical federal laws. Instead, they have to accept leave and either take time off to have their babies or pay for abortions out of pocket. Given the $470 average cost of abortion, this can represent a significant hardship for women. For enlisted personnel, military pay is often unsustainable — some members of the military are on food stamps, and certainly aren't in a position to afford abortions. (The Department of Defense was unable to respond to a request for comment by the time of publication.)

The Service Women's Action Network, one high-profile organization working to improve conditions for women in the military, notes that "Until recently, the reproductive health care needs of service women have largely been ignored by the military. This lack of services reflects the prevailing male-dominant culture of the services and is an indicator of the institutional sexism towards the women who serve in uniform." They know of which they speak — one of the huge barriers to full integration has been repeated insistence from groups like the conservative Center for Military Readiness that women will disrupt combat operations. Given the high rate of military sexual assault, there's an added complexity in this situation as some women may be pregnant against their will — and afraid to speak out about it, since women are often punished for reporting rape.

The obvious alternative is to offer birth control to women in the military so they don't get pregnant in the first place, and the government does so through Tricare, the comprehensive health care plan that covers active duty members of the military. The agency covers a range of prescription birth control methods as well as sterilization, but there's a catch: Just because it's covered doesn't mean it's available. Not all clinics stock all methods, and for women in combat zones, accessing a clinic that provides any kind of birth control, let alone their preferred method, can be a problem. Moreover, women can't lay in an adequate supply of pills in advance of a deployment, as pharmacies typically refuse to provide more than a six month supply. Deployments, meanwhile, last from nine to 12 months.

More women are rising in the ranks to key military positions ... Putting them at a disadvantage by limiting their ability to prevent pregnancy goes against the commitment to provide those who serve with the tools they need to do so — and it sets military women back as they attempt to do their jobs like everyone else.

With women on the move, they have to deal with the added complexity of not necessarily knowing where they'll be and when, relying instead on unstable supplies of birth control that can be highly variable and totally unpredictable. Information about what's available may be incomplete and outdated, and military facilities don't necessarily stock non-prescriptions methods for purchase. One of the most obvious approaches to reform is, of course, the promotion of reversible long-term methods of birth control like hormonal IUDs, which can be removed when women want to pursue pregnancy.

These aren't good fits for all women, however, and military women shouldn't be compelled to use a specific method simply because it's convenient for their health care providers. Instead, the military should be treating birth control as another key clinical need alongside other medications stocked as a standard in clinics, including those in combat zones, and women should be able to stock up prior to deployments as well, providing double insurance that they can get what they need.

Moreover, of course, men need to be holding up their end of the deal. Women shouldn't be held solely responsible for birth control, as men can take preventative measures like using condoms — which offer the added protection of preventing STI transmission. While condoms aren't covered through Tricare because they're available over the counter, they could be provided affordably to members of the military of any gender, particularly men interested in having sex, as it does, after all, take two to tango.

As the role of women in the military expands, we're seeing huge progress. More women are rising in the ranks to key military positions, like Navy Admiral Michelle Howard and General Ann Dunwoody, and women are representing American armed forces across the world. Putting them at a disadvantage by limiting their ability to prevent pregnancy goes against the commitment to provide those who serve with the tools they need to do so — and it sets military women back as they attempt to do their jobs like everyone else.

As we rapidly face down the mandate to integrate women into combat operations, we need a plan now for reforming contraceptive policies, or our military women could be in trouble come January.