Policy Knowledge and Abortion Access for US Active-Duty Servicewomen: A Mixed-Methods Study

More than 80,000 US military servicewomen are stationed in states enforcing abortion bans. US Department of Defense (DOD) policies must adhere to the Hyde Amendment, which restricts abortion coverage. Little research exists regarding active-duty servicewomen's (ADSW) knowledge of these policies or their experiences accessing abortion care. This study examines the reproductive health policy knowledge and lived experiences of ADSW who have accessed abortion care.

A 24-item questionnaire was designed to measure reproductive health policy knowledge and explore reproductive health experiences among ADSW. Via secondary analysis, a subset of 178 participants self-reported obtaining an abortion while on active duty. A convergent mixed-methods design (quantitative and qualitative) was used.

Most participants (65%; n = 115) did not know TRICARE covered abortion costs in cases of rape or incest; 77% (n = 137) erroneously believed they required leadership permission to get an abortion; and 87% (n = 155) did not know they were entitled to convalescent leave to recover after an elective abortion. More than half (53%; n = 94) took personal leave to access abortion care; 46% (n = 82) traveled more than one hour; 48% experienced financial difficulties; 31% (n = 55) experienced negative professional repercussions; 16% (n = 29) received convalescent leave; 92% (n = 164) were not offered mental health counseling; and 77% (n = 137) felt they would have benefited from mental health counseling postabortion. Qualitative themes included a systemic lack of DOD abortion policy knowledge and lived experiences of accessing abortion care (eg, financial burdens, stigma).

Given the systemic lack of policy knowledge reported among study participants, the DOD should develop and implement a standardized abortion policy and access training for military health care professionals, leadership, and service members. Policies ensuring access to abortion should be adopted, codified, and implemented uniformly across all branches of service.