For women in the military, birth control can be a battle
Next year, the military will lift restrictions on women in combat, which may open up as many as 245,000 jobs that have been off limits to women. But women who deploy overseas may continue to face obstacles in another area that can have a critical impact on their military experience: contraception.
It's not a minor issue. Rates of unintended pregnancy among women in the military are 50 percent higher than those of women in the general population. And because of federal rules, their insurance does not generally cover abortion.
Tricare, the health care plan for more than 9 million active and retired members of the military, covers most contraceptive methods approved by the Food and Drug Administration. Active-duty servicemembers pay nothing out of pocket. Spouses and dependents of servicemembers may face co-payments in some instances.
But all methods aren't necessarily available at every military hospital and clinic, and overseas, for example, women may have difficulty getting refills of their specific type of birth control pill.
Nancy Duff Campbell, co-president of the National Women's Law Center, says, "It is unfortunate that here we have the military, that has one of the best health care systems in the country, and where we still have a gap is in contraception."
Fifteen percent of active-duty servicemembers are women, and 97 percent of them are of childbearing age.
In a 2013 study, based on more than 28,000 responses to a Department of Defense survey, researchers found that after adjusting for the larger concentration of young women in the military, the rate of unintended pregnancy among military women was 7.8 percent, compared with 5.2 percent among women in the general population.
"It's critically important to address unintended pregnancy in the military, because it can be particularly damaging to women's careers, and it's hard to access abortion care," says Daniel Grossman, a study co-author who is vice president for research at Ibis Reproductive Health, a research and advocacy group.
Abortion is provided at a military facility or covered by military health care only if a woman's life is in danger or if the pregnancy is a result of incest or rape. Women who want an abortion in other circumstances must use a non-military health care provider and pay for the procedure out of pocket, according to Department of Defense health officials.
Coverage for emergency contraception, meanwhile, has recently been expanded to all active-duty servicewomen and female beneficiaries without cost-sharing.
It can be challenging to use contraceptives while deployed overseas for many reasons. There is the problem of trying to schedule a daily birth control pill when traveling across time zones, and desert conditions may make a contraceptive patch fall off. Women are allowed a 180-day supply of contraceptives before deploying. But obtaining refills of the same pill can be difficult, some women reported in a 2010 survey about access to contraception during deployment.
Sixty-three percent of the 281 women surveyed — who because of the design of the survey were not necessarily representative of all military women — said they used birth control for at least part of their deployment, and a majority noted that they weren't counseled about using contraception for either pregnancy prevention or menstrual suppression before deploying.
Pre-deployment counseling that specifically addresses contraception could help counter confusion and ensure that women have access to birth control methods that meet their needs, say advocates and policymakers with expertise in women's health in the military.
Contraceptive and reproductive counseling is a covered benefit under Tricare, according to military health system officials, and it is an expected component of good clinical practice.
The House and Senate versions of the Pentagon's spending bill for the coming fiscal year contain measures that would affect contraception coverage in the military. The Senate version of the bill would guarantee family planning education and counseling, while the House version would make available a broad range of FDA-approved contraceptives at military treatment facilities and ensure that women have enough contraceptives to last for the duration of their deployment. A congressional conference committee is working to write a compromise between those two bills.
Defense Department officials said they had no comment on the pending legislation.
This column is produced through a collaboration between The Post and Kaiser Health News, an editorially independent news service that is a program of the Kaiser Family Foundation.