Military Women's Reproductive Health

Sgt. Delaney Dean works with Capt. Decilia Neely, a Master Fitness Trainer to adjust exercises to meet her fitness goals throughout her pregnancy. (U.S. Army)

Women were granted the right to serve by the Women's Armed Services Integration Act of 1948. The Act’s combat exclusions were lifted gradually, starting in 1993. The final ban on direct ground combat was lifted in 2013. Today, women are indispensable to the military and DoD at large. As 51% of the population—better educated and less prone to crime than males—women are also a significant recruitment pool. 

Reproductive health is a key issue for all women. It is also a political lightening-rod in the wake of the 2022 SCOTUS decision that the regulation of abortion is reserved to the states. Shortly thereafter, some states severely restricted access. This inevitably impacts military women, stationed across the U.S. and abroad.

Ready access to contraceptives and healthcare is important for all women. Everyone should try to make wise choices in all aspects of their lives. Military women—entrusted with lethal actions—should be particularly responsible in all matters, to include physical, mental, and reproductive health.

Abortion should never be deemed a method of birth control. Rape, incest and maternal health should always be allowable exceptions. Abortion should remain legal, rare, and safe. Thousands of women have died over the centuries in botched, “back alley” abortions. With widely-available contraceptives, unwanted pregnancy could—and should—be prevented. Better education should make abortion an exception in women’s reproductive health care. 

The Judeo-Christian tradition—the foundation of our Republic—places the life and future fertility of the mother ahead of the fetus. So does the vast majority of medical professionals. All life is sacred. But if a life must be sacrificed, the mother takes precedence. 

It’s difficult to state with precision how many abortions there are in the U.S.. The Centers for Disease Control (CDC) and the Guttmacher Institute have tracked abortions for 50 years. But their research methods are different. The CDC relies on information voluntarily reported by states’ health agencies. Its totals don’t include figures from California, Maryland, New Hampshire, or New Jersey. Guttmacher surveys every provider across the U.S.. Its figures are higher because they account for all 50 states and D.C.

The last time the CDC reported a national total for abortions is 2021: 625,978 in the reporting 46 states plus D.C.—up from 597,355 in 2020.The last year Guttmacher reported a national total was 2020: 930,160 abortions in all 50 states and D.C.

The number of abortions rose after Roe v. Wade legalized the procedure, reaching a peak in the late 1980s. Since then, abortions have decreased at “a slow yet steady pace.” Guttmacher reported that in 2020 there were 14.4 abortions in per 1,000 women aged 15-44–a major decline from 29.3 per 1,000 in 1981.

Since the Food and Drug Administration approved “abortion pills” in 2000, their use has steadily increased. 56 percent of abortions in 2021 involved pills.

According to the CDC, the majority of women who had abortions (57%) were in their 20s; 31% were in their 30s. Teens (12-19) accounted for 8%. The vast majority (87%) were unmarried.

Among those aged 15-44, there were 28.6 abortions per 1,000 Black women in 2021; 12.3 per 1,000 Hispanics; 6.4 per 1,000 Whites; and 9.2 per 1,000 others.

The reasons for abortion are as varied as the women seeking them. The CDC does not track this information. Per Guttmacher, rape, incest, or pregnancy complications account for only 3% of the total. 

The vast majority of abortions are during the first trimester. In 2021, 93% of abortions occurred by 13 weeks. An additional 6% were performed between 14-20 weeks, and 1% at 21 weeks or more.

About 2% of abortions involve some type of complication for the woman. Most are minor. In 2020, 6 women died due to complications. Since 1990, the annual number of deaths has ranged from 2-12. Abortion is safe and should remain so.

These statistics don’t address the emotional toll of terminating a pregnancy. Later-term abortions are particularly traumatic, as the fetus is a fully formed human, able to survive outside the womb. Fortunately, second trimester abortions constitute only 6% of the total. Third trimester procedures are even rarer—1%. According to recent polling, 70% of Americans oppose third trimester and 55% oppose second trimester abortions. https://news.gallup.com/poll/321143/americans-stand-abortion.aspx. Few, however, realize how uncommon those procedures are.

The reasons for later-term abortions vary. Some women don’t realize they are pregnant until after the 12th week. For the 75% of patients who live at—or below—the poverty line, the issue is money. The Federal government and 33 states prohibit Medicaid from paying for abortions.

Most often, later-term abortions are due to maternal health. Now that abortion is banned in some states—and the penalty is jail for the physician and legal consequences for the institution—ready access in life-threatening circumstances is much harder. https://www.american.edu/cas/news/roe-v-wade-overturned-what-it-means-whats-next.cfm. 

The above data pertains to the general population. DoD does not publish abortion statistics. But it’s a reasonable assumption that the military reflects the society it serves.

10 U.S.C. 1093(a) states that “DoD funds “may not be used to perform abortions except where the life of the mother would be endangered if the fetus were carried to term, or in a case…of rape or incest.”

On Oct 20, 2022, DoD issued a memorandum authorizing funds and time off for pregnant servicewomen to obtain an abortion. OSD issued an implementing memorandum on Feb 16, 2023. That same day, Headquarters Defense Human Resources Activity issued a memo authorizing travel and transportation.

The memoranda direct DoD to: Waive notification of the chain of command until 20 weeks after conception; allow 21 days’ administrative absence; grant follow-on convalescent leave; provide travel and transportation allowances.

It’s a fair question whether tax dollars should pay for expenses associated with non-covered abortions. It’s reasonable to expect that, barring acute financial hardship—unfortunately not atypical among junior personnel—the burden should be on the individual. It’s also a fair question how often travel is necessary when pills—how most abortions are performed—are available via tele-health. 

What’s not a question is that the current policy impacts readiness by taking personnel off duty on short notice.

Delayed notification of the chain of command is particularly problematic. Obfuscation could result in assignments harmful to both mother and fetus. Worse, concealing a pregnancy until the 5th month fosters distrust within the unit and its leadership. Last but not least, when a woman fails to perform due to an advancing but undisclosed pregnancy, the entire team is imperiled. With lives and mission in the balance, that’s an unacceptable risk. 

Dr. Lani Kass served in the Department of Defense with honor and distinction for nearly 30 years. These views are her own.