Barriers to birth control—from policies that portray sex as taboo to restrictions on long-term medical procedures—may be contributing to unintended pregnancies among U.S. servicewomen in combat
Women in the U.S. Armed Forces have made significant inroads in the struggle for gender parity, including a recent victory that opened combat positions to women. But they face an important consideration that their male peers never have to take into account when choosing to enter the military—unintended pregnancy.
On the heels of a January study in Contraception that found women in the U.S. armed forces have difficulty obtaining birth control from military health clinics, many women have recently begun speaking out about potential solutions. The situation is of particular concern given two recent findings: one, a strikingly high number of servicewomen—as many as one in eight—get pregnant unintentionally while on duty; and two, sexual assault in the armed forces is on the rise. The problem is especially acute for those serving in combat overseas in places like Iraq and Afghanistan.
The study’s authors, global health specialist Kate Grindlay and gynecologist Daniel Grossman, surveyed 281 women who had served in combat in the U.S. Armed Forces overseas anytime since 2001. Among the team’s findings: military health professionals are not adequately informing women about the contraceptive methods available to them while in combat. As a result, more than one third of servicewomen surveyed said that while in combat zones, they did not have access to their preferred method of birth control.
Worse, military supervisors act as if sexual interaction does not occur, effectively preventing women from discussing or obtaining reliable methods of birth control, says Maricela Guzman, co-founder of civil rights nonprofit Service Women’s Action Network (SWAN) and a vocational rehabilitation specialist at the Department of Veterans Affairs. “The military has this idea that if it provides birth control, it’s condoning sex. They think, if we give out the pill, we’re allowing it to happen,” Guzman says.
Sixty percent of servicewomen who participated in the study say they never spoke with a military medical representative before deployment about getting birth control while on tour, despite the military’s stance that pre-deployment health counseling is necessary. “Every female service member should be counseled regarding contraception prior to deployment,” U.S. Air Force surgeon general liaison Donna Tinsley told Scientific American in an e-mail, “Whether they see a gynecologist, nurse practitioner or primary care provider, discussion about contraception choices/use is standard in a woman's health screening examination,” she wrote.
Of the women who did manage to see a medical representative, many cited logistical problems with the conventional methods they were prescribed. Servicewomen reported difficulties carrying multiple packs of pills from base to base, problems taking pills at the same time each day while in combat and patches falling off in severe climates.
Although Tinsley contended the military provides “the full spectrum of contraception” to female service members, the study found that servicewomen are often discouraged from using long-acting methods of birth control, such as IUDs, because some women are told they must have already given birth in order to qualify.
The problem of supply may lie with the Department of Defense, whose Basic Core Formulary, the required list of medications available at every military treatment facility, does not include most longer-acting forms of birth control. Emergency contraception, known as plan B, wasn’t added until a lawsuit filed by the American Civil Liberties Union mandated its inclusion in 2010. To guarantee access to long-term contraception, Tinsley wrote, use of longer-acting methods “should be initiated prior to deployment.” She added that most other contraception—with the exception of the contraception ring NuvaRing, which must be refrigerated—“is available through field medical facilities, but the service member should have their own 90-day supply when she deploys.”
What is on the “required” list? The monthly pill (in its various chemical formulations) and the weekly patch (estradiol). Condoms aren’t on the list, but they are handed out at some treatment facilities, says Katy Otto at SWAN.
Ensuring that medications are available to combat soldiers is difficult. But the military has succeeded in providing a variety of vital medications—including insulin, anticonvulsants, antidepressants, antipsychotics and a host of other drugs—to combat soldiers, many of whom rely on these medications to maintain a quality of life necessary to carry out complicated missions that often involve life-or-death decisions.
Adding longer-acting contraceptives to the Formulary would drastically improve servicewomen’s health, Grindlay notes, because it ensures that women have coverage that is discreet and dependable. “Servicewomen should either be able to get longer-acting birth control or they must be assured access to refills—that’s critical,” she says.