"It's My Dark Secret": A Qualitative Study on the Abortion Experiences of US Active-Duty Servicewomen

The Hyde Amendment limits US military abortion care and coverage for active-duty servicewomen (ADSW). ADSW face numerous barriers to care when seeking an abortion. The purpose of this study was to explore the lived experiences of US servicewomen who had an abortion while serving on active duty.

Researchers conducted a qualitative secondary analysis of free-text response data using thematic analysis. We developed the codebook using a modified version of Coast et al.'s (2018) framework for Trajectories of women's abortion related care. Data were collected between December 2021 to June 2022 and included N = 178 participants who self-reported having an abortion while serving on active duty in the US military.

Most participants (n = 122, 62%) cited unplanned pregnancy as their reason for having an abortion. Some participants (n = 22, 12%), identified as having a "medically necessary" abortion (i.e., miscarriage, ectopic pregnancy). Emergent themes included lack of understanding about abortion care, financial and logistical barriers to accessing abortion care often exacerbated by military policies, lack of medical privacy, and subpar care received from military treatment facilities during pregnancy options counseling or TRICARE covered abortion care.

ADSW experience systemic barriers to care and often seek care outside of the military medical system to protect their privacy. Military healthcare professionals do not provide adequate pregnancy options counseling or patient education regarding pregnancy loss. The US Department of Defense should enact policies ensuring access to abortion care to maintain the physical well-being and mission readiness of servicewomen.