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DOD Looks to Ensure Access to Reproductive Health Care

Secretary of Defense Lloyd J. Austin III signed a memo today designed to ensure that service members and their families can access reproductive health care and to support Department of Defense health care providers concerned about potential risks while providing federally authorized care. 

The memo — "Ensuring Access to Reproductive Health Care" — directs actions on reproductive health care in the wake of the Supreme Court's decision in Dobbs v. Jackson Women's Health Organization, which overruled prior precedent and concluded that the Constitution does not confer a right to abortion. 

The Dobbs ruling "has impacted access to reproductive health care, with readiness, recruiting and retention implications for the force," Austin wrote.  

Many states have subsequently revived or enacted legislation that significantly restricts access to abortion care. All told, according to a recent RAND study, 450,000 service members now live in states where abortion is restricted. 

After the Supreme Court released their decision on June 24, Austin said in a written release that "nothing is more important to me or to this department than the health and well-being of our service members, the civilian workforce and DOD families. I am committed to taking care of our people and ensuring the readiness and resilience of our force. The department is examining this decision closely and evaluating our policies to ensure we continue to provide seamless access to reproductive health care as permitted by federal law."

Women make up 17% of the force and are the fastest growing subpopulation in the military. Defense officials have stressed that women's health is important to the overall readiness of America's military. 

Under federal law, DOD funds and facilities may only be used to perform abortions where the life of the mother would be endangered if the fetus were carried to term or in a case in which the pregnancy is the result of an act of rape or incest. The most recent statistics show that between 2016 and 2021, a total of 91 abortions were performed in military medical treatment facilities. 

Following the Dobbs decision, women who are in states with restrictive abortion laws may have to travel to other states to receive reproductive health care, including abortion-related care. They may incur out-of-pocket expenses and have to take more time away from work or their families in order to access reproductive health care.  

The memo Austin released today looks to preserve privacy for service members, protect DOD health care providers, reduce barriers to ensure access to reproductive health care and improve the awareness of contraception and family planning resources for service members and other eligible beneficiaries. 

The memo directs the department to "establish additional privacy protections for reproductive health care information for service members." These policies will include guidance to DOD health care providers when reproductive health care information may be shared with commanders and standardizing and extending the timeframes for service members to notify their commanders about a pregnancy. Commanders will be issued guidance that reminds them that they must both display, and act with, objectivity and discretion when handling reproductive health care matters. 

Austin writes in the memo that all these actions must ensure service members have the time to make private decisions about reproductive health care, while also maintaining the responsibility of commanders to meet operational requirements and obligations to protect the health and safety of those in their care. 

The memo directs DOD officials to develop programs to support DOD health care providers, who may be concerned about legal or licensure risks. The Attorney General has already made clear that federal employees who carry out their duties by providing federally authorized reproductive health services must be allowed to do so free from the threat of liability.  DOD's new programs will add to the existing legal protections and help ensure that DOD health care providers can appropriately care for their patients consistent with federal law.  These programs will include reimbursement of fees for providers who wish to get licensed in a different state and support for providers who are subject to adverse action for appropriately performing their official duties.  

Access is key for service members, as they and their families are often required to travel or move to meet operational requirements.   

"The practical effects of recent changes are that significant numbers of service members and their families may be forced to travel greater distances, take more time off from work, and pay more out of pocket expenses to receive reproductive health care," the secretary wrote.  

The memo directs the creation of a uniform administrative absence policy for service members for non-covered reproductive health care and establishes travel and transportation allowances for service members and their dependents, as appropriate. It also directs the amendment of travel regulations to facilitate official travel to access non-covered reproductive health care that is unavailable within the local area of a service member's permanent duty station. The policies will address reproductive health care not covered by the Department of Defense, such as non-covered abortion services and certain non-covered assisted reproductive technology services, such as in vitro fertilization. While allowances will cover travel and transportation costs, service members are responsible for fees associated with non-covered reproductive health care. These actions will be taken consistent with federal law and operational requirements. 

The department offers contraception and family planning services, and this will not change, Austin wrote. He has directed additional actions to improve awareness of resources and support. The department will expand walk-in contraceptive services at all military medical treatment facilities with appropriate clinical capacity. DOD will also implement a comprehensive contraception education campaign and enhance information on Military Health System websites and in military medical treatment facilities about the kinds of reproductive health care available, including emergency contraception. These sites will also provide points of contact for beneficiaries to get help if they have trouble accessing reproductive health care in the Military Health System.

The department will continue to evaluate policies to ensure continued, seamless access to reproductive health as appropriate and consistent with federal law. 

"There is no higher priority than taking care of our people, and ensuring their health and wellbeing," Austin wrote.

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