Is Abortion a Matter of National Security?
Synopsis
Joining the military means relinquishing control over so many aspects of your life. For women, it also means being ready to sacrifice yourself for a country that isn’t willing to provide access to necessary health care — or grant full bodily autonomy.
In March 2023, five days before Andrea* was scheduled to deploy to Iraq, she found out she was pregnant. It wasn’t a planned pregnancy—she regularly took birth control pills—nor was she ready to have a child, personally, professionally, or financially. But as an Army captain stationed in Texas, a state with one of the country’s strictest abortion bans, she was unsure of her options.
Andrea reached out to her Army physician, a primary care doctor, but bringing up abortion “was difficult,” she tells ELLE. Even though they were friendly, she felt uncomfortable going to a coworker with something so sensitive. The doctor consulted with a military OB/GYN before informing Andrea that her military health care plan, called TRICARE, doesn’t cover abortion unless in cases of rape, incest, or danger to the life of the pregnant person. The doctor’s hands were tied, but he told Andrea that he would update her medical status to “non-deployable” and refer her to the military OB/GYN for pregnancy support. When she reiterated that she wanted an abortion, he suggested finding a clinic away from the base, reassuring her that he would reinstate her deployable status as soon as possible, so that she could still go to Iraq. “I could not get any care,” Andrea says. “It essentially came down to, ‘find somewhere [else] that is willing to help you.’”
Given that many states with big military bases also heavily restrict abortion access— including Texas, Georgia, Florida, Arizona, and the Carolinas—Andrea’s challenges are far too common. A 2023 report from Rand Health estimates that 40 percent of active duty female service members stationed in the U.S. either have no or severely restricted access to abortion. Of those women, 95 percent are of reproductive age. And because service members have no control over where they are stationed, they might sign up for the military and be placed in a state where abortion care is almost impossible to access.
Over the last few years, nearly every branch of the military has faced a decline in enlistment numbers for a number of reasons: the percentage of people who qualify for service has dropped; the economy is doing well with low unemployment; recruiters say young people are increasingly disinterested in enlisting.
It goes without saying that joining the military is already a big commitment. It means signing up to relinquish control over so many aspects of your life. For women, it also means being ready to sacrifice yourself for a country that isn’t always willing to provide access to necessary health care—or grant you full bodily autonomy. But the military’s restrictive reproductive health policies aren’t just hurting its own, they also pose immediate danger to the institution itself, and in turn, could threaten our national security.
Since Roe v. Wade was overturned in 2022, more and more abortion-seekers have been turning to medication abortion, which now accounts for more than half of all abortions in the country. The process involves taking two separate pills called mifepristone and misoprostol. So when a lawsuit seeking to overturn the Food and Drug Administration’s approval of mifepristone reached the Supreme Court earlier this year, some military experts began to worry how a potential ban on the medication would further restrict reproductive health access for women in the military.
Nonpartisan organization Vet Voice Foundation, which empowers veterans to become policy advocates, began reaching out to former military officials and national security leaders to find out whether abortion should be considered a matter of national security. In late January, the group filed an amicus brief to the Supreme Court stating that the continued lack of reproductive health care access—and the prospect of forcing people to carry unwanted or unsafe pregnancies to term—could have devastating impacts on the military’s recruitment efforts. It is the first time a national security argument has been made in a reproductive health care case at such a high level.
I could not get any care. It essentially came down to, ‘find somewhere [else] that is willing to help you.’
One of the military officials who signed the brief, former Secretary of the Army Louis Caldera, believes it is important to make serving in the military an “attractive” proposition. “It partly has to do with the pride of having served your country, but service members need to walk away with more than pride,” Caldera tells ELLE. They also need to feel safe. Caldera says anything that makes the military a less welcoming environment for women will impact the ability to recruit at a time when the Army, Navy, and Air Force are already in crisis with low numbers.
Speaking about his own daughters, Caldera says he’d feel proud, but cautious about them joining the military. “We respect that it [would be] our child’s decision to serve our country, and we’re proud of them for that,” he explains. “But we don’t expect our daughters, by virtue of being willing to serve their country, to expose themselves to sexual violence, sexual harassment, or to lose the freedoms they have in civilian life.”
The myriad barriers service members face trying to access abortion care is not new. The brief filed to SCOTUS cites multiple stories of women who have had problems seeking care, even before Roe was overturned. One of those women, a major in the Army, was denied an abortion for a nonviable, wanted pregnancy. Even though her health was at serious risk, that woman said that TRICARE wouldn’t cover her abortion, or subsequent follow-up care, because her life wasn’t in immediate danger.
In an email cited in the brief, she wrote: “I’d experienced loss in combat, but this was worse because I was alone. We have a support system in place for combat loss. This was the first time in my career where I was completely alone. I have never felt of so little value. After twenty years of service, being told I’m not worth anything until my life was in danger. It was completely dehumanizing.” She also said that she ended up using medication abortion to terminate the pregnancy, which she had to acquire outside of military health care.
As abortion care becomes more and more difficult to access across the U.S., service members are having to travel further than ever before. If Andrea had been in a state where abortion was legal, she could have scheduled an appointment nearby without taking significant leave. But she was in Texas.
There are still huge gaps that remain in contraceptive care. It’s such a failure of the system.
Andrea remembers researching Planned Parenthood clinics near her base, but none of them could help her. She typed her zip code into the Planned Parenthood website, zooming out beyond Texas to see where she might go. She considered Oklahoma and New Mexico, but decided on a clinic in Colorado Springs, which was near a military base where her friend lived. They didn’t have an opening for another three weeks, but Andrea didn’t want to delay her deployment for too long—especially since she held a leadership position and had a key role in her upcoming Iraq mission. She explained her situation to the clinic, which made space for a D&C appointment the following week.
After notifying her immediate commander about her trip to Colorado for the abortion, Andrea requested five days of personal leave in order to be authorized to go out of state. She paid out of pocket for travel, lodging (including two days of post-op recovery), and the procedure itself, which totaled to about $1,800.
Five months before Andrea had her abortion, the Department of Defense had announced a new policy for military members and their families that standardized the coverage of travel and transportation funds for non-covered reproductive health care, including abortion and fertility care like IVF. The DoD also granted service members administrative absence for up to 21 days without taking personal leave. The new policy was met with mixed reactions, but one of the loudest critics was Alabama Senator Tommy Tuberville who, for most of last year, led an unprecedented blockade against confirming military officials in protest of the reproductive health policy. He held up more than 400 military promotions for a policy that was only used 12 times between June and December 2023.
“The travel transportation allowances are crucial to making sure that service members can get the care they need,” Jackii Wang, a senior legislative analyst at the National Women’s Law Center, tells ELLE. But the obvious reality is that everyone needs to know about it in order to maximize the benefit, she says, adding, “the question we have is: ‘How is it reaching military service members and their dependents?’”
The policy went into effect two days after Andrea had her abortion, but nobody in the military that she’d spoken with when seeking medical guidance had informed her about it. Wang says that people join the military with the expectation of having comprehensive health care. “Then, you are denied abortion care and…fertility care, for the most part, and there are still huge gaps that remain in contraceptive care,” she says “It’s such a failure of the system.”
Ahead of her abortion in Colorado, Andrea’s provider contacted TRICARE seeking coverage for an IUD for Andrea, who had tried to get an IUD twice before at a military clinic, but found the dilation process too painful to proceed. When Andrea asked for medicine at the military clinic to ease the pain, she was told that women, “typically don’t get or need pain management.” Andrea’s doctor at Planned Parenthood wanted to take advantage of the fact that she would be under sedation, but TRICARE ultimately declined coverage for the IUD. Planned Parenthood offered to cover the cost and insert the IUD during the procedure, which Andrea accepted. “[The provider] was very empathetic to my situation, and I’m so very grateful,” she says.
When Andrea returned to Texas, she navigated tricky questions and snarky comments from senior male service members wondering if she had been trying to get out of her deployment. Her battalion commander had fully honored her request for privacy, but by then he was already stationed with their unit in Iraq and unable to intervene on her behalf when people higher up started questioning why she hadn’t deployed yet. Andrea was still managing her physical and emotional recovery when she flew out to her mission three weeks later. “I probably deployed a little too soon,” she says. “I was just so focused on getting out to Iraq as soon as possible to minimize the narrative that was being created about why I wasn’t in Iraq. I was just trying to avoid that prying—that’s what kind of caused me to hurry up and go.”
The mission lasted for about six months, in a very remote location. There were no OB/GYNs on–site, just emergency medicine physicians, physician assistants, and surgeons. Since her abortion wasn’t on her military medical record, she felt uncomfortable telling military physicians in Iraq about her continued cramping and pain. Instead, she managed to get by on over-the-counter medicine, like Tylenol, until returning stateside.
The military’s critical lack of reproductive health care access for female service members doesn’t just affect abortion-seekers like Andrea. Like the loss of Roe proved in the civilian world, restricting rights has far-reaching effects. Janessa Goldbeck, the CEO of Vet Voice Foundation, summarizes the scale at which the lack of comprehensive reproductive health care could affect national security. “All of these things are major deterrents for people who are considering joining the military,” she says. “And I say ‘people,’ because it isn’t just women or people with reproductive organs, but men who have families or wives, or daughters who are thinking about having a baby, starting a family through IVF, or wanting to access necessary health care in case a pregnancy goes awry.” One of the “major reasons why young people say they now don’t want to join is because of the lifestyle,” Goldbeck adds. “Now you’re compounding that by saying you might not have access to health care or the ability to start a family.”
Andrea is currently trying to freeze her eggs, so that she has options if she decides she wants to start a family one day. Once again, she’ll have to pay out of pocket for cryopreservation or, in the future, IVF. “I fear another unintended pregnancy [due] to birth control failure and certainly don’t feel comfortable starting a family while in the service,” she says. “This experience has made me confident that reproductive health while on active duty isn’t reliable.” For Andrea, and so many others, it’s hard to deny that the military, which she has given so much of her adult life to, will continue to fall short.
*Andrea asked to use a pseudonym, for privacy reasons.
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