Starting this year, for the first time in 22 years, military women and dependents pregnant by rape or incest won’t have to pay for their own abortions.

Starting this year, for the first time in 22 years, military women and dependents pregnant by rape or incest won’t have to pay for their own abortions.

A provision in the National Defense Authorization Act signed into law last month provides military women the same coverage to which Medicaid recipients and prison inmates have been entitled. It’s being hailed by some as an important advance in reproductive rights for servicewomen.

“We’ve been working on this I don’t know how long,” said Vicki Saporta, president of the National Abortion Federation, a professional association of abortion providers in North America. “This really was a huge step.”

But what sort of difference the change makes in the day-to-day lives of military women remains to be seen, depending on rules still being written on how the policy is to be implemented.

For instance, how will it be established that a pregnancy was due to rape or incest? Would the woman have to provide a police report? Would that trigger a criminal investigation? Would she be required to identify the man, often a fellow servicemember, who raped her?

Only a fraction of women, whether military or civilian, who are raped report it to authorities, studies show, and incest victims’ reports to authorities are rarer yet.

Another question is where military rape and incest victims would get the procedure done, particularly women and girls overseas where civilian doctors aren’t available to them or abortion is illegal.

Will those women be transported elsewhere by the government? Or will military doctors be trained and willing to perform abortions after decades of a ban on the procedure?

Number of abortions limited

Military hospitals and clinics worldwide in 1988 were banned by the Defense Department from providing abortions, with two exceptions: Military doctors could perform an abortion for a woman whose life was endangered by her pregnancy, and it would be paid by insurance; and, they could provide a rape victim with an abortion if she paid for it herself.

Yet military facilities in the last decade have performed only about four abortions a year, according to a 2012 Congressional Research Office report. None of those was for rape victims.

In the past 18 months, two women stationed in Europe whose lives were endangered by their pregnancies received insured abortions, according to Tricare. Both were referred to host-nation facilities.

Military women once had wide access to abortion and made use of it. In one year in the mid-1970s, some 26,000 servicewomen and dependents got abortions. Most of them were done in military hospitals, and all of them were covered by insurance, according to the CRO report.

Tightening restrictions

But in 1976, the so-called Hyde Amendment banned using federal funds for most abortions in the United States, and Congress began restricting military abortion.

In 1978, Congress restricted insured military abortions to cases of life endangerment, permanent health damage or cases of rape or incest. According to that measure, the rape or incest had to have been “reported promptly to a law enforcement agency or public health service.”

The next year, the health exception was removed. In 1980, the rape was required to have been reported within 72 hours; the incest-reporting requirement was dropped.

In 1981, the restrictions tightened further: No abortions were to be covered by military insurance except those in which carrying a pregnancy to term could kill the mother. Abortions for all other reasons had to be paid out of pocket.

By the mid-1980s, the number of abortions performed by military doctors, including paid abortions, had dropped to about 30 a year. And in 1988, DOD banned abortions in its facilities except in cases of rape and incest.

In 1993, President Bill Clinton ordered the facilities ban for overseas military hospitals to be lifted. Congress restored the ban the following year. In any event, its yearlong suspension had little effect. Not one among 44 doctors surveyed in U.S. Army Europe in 1994 would perform abortions — citing lack of training, workload, personal beliefs and command opposition — nor would any in the Pacific theater, according to the CRO report.

“We know of military doctors who were willing to do it but who weren’t allowed to,” Saporta said.

A doctor’s perspective

Among them was Dr. Jeffrey Jensen, a Navy doctor from 1988 through 1992 and now director of women’s health research at the Oregon Health Center University.

While posted at Subic Bay in the Philippines, Jensen said, he routinely saw Navy women with life-threatening infections after a botched local abortion in a country where abortion is illegal. To him, the military’s refusal to provide elective abortions to servicewomen is “appalling.”

Jensen said women should not be coerced into continuing unwanted pregnancies, and that caring for the health of its troops should be the military’s responsibility. “The military abdicates that responsibility,” he said.

“To penalize active-duty women and dependents — it’s an awful affront to social justice,” Jensen said. “Women should not be burdened by their biology.”

Young enlisted military women have a significantly higher rate of unintended pregnancy than the general U.S. civilian population, despite free contraception, studies have shown.

Whether they terminate these pregnancies at the same rate as civilians — about 4 in 10 of unintended pregnancies are aborted, usually within the first few weeks — is unknown. But many abortion clinics in the U.S. offer a military discount.

Experts estimate that some 5 percent of rape victims become pregnant. But the number of military women impregnated by rape is also unknown.

The Defense Department estimated some 19,000 sexual assaults occurred in the military in 2010, ranging from unwanted touching to rape. According to the survey on which the estimate is based, about a quarter of the assaults had been rape, including oral and anal rape.

Few of those women had reported being victimized to authorities, in part because of the lack of privacy that follows as numerous people in the chain of command are notified.

Similar problems face military servicewomen seeking an abortion, particularly those stationed overseas. Female troops must get commanders’ permission for a leave or absence from duty. Commanders may not be sympathetic for religious or other reasons.

A general’s perspective

Army Maj. Gen. Anthony Cucolo, for instance, determined that the way to discourage soldier pregnancy in his Iraq command in 2009 was to punish pregnant soldiers, possibly even by court-martial.

The fathers, if identified, would also be punished, decreed Cucolo, now commandant of the U.S. Army War College. Soldiers at that time in Iraq were prohibited from having sex, and a pregnant soldier had to be evacuated from deployment. So for Cucolo, the onus was on the women.

“The message to my female soldiers is that I need you for the duration,” Cucolo said in an interview at the time about the policy. “Please think before you act.”

The DOD policy change succeeded this year for several reasons, experts say: a continuing focus on military sexual assault; widely reviled remarks by Republican lawmakers in the campaign season saying that “legitimate” rape doesn’t result in pregnancy or was intended by God; and the fact that servicewomen, who have served in two wars, have had less abortion coverage than prison inmates and poor women eligible for Medicaid.

The National Right to Life Committee did not respond to an email for comment, but the anti-abortion group supports outlawing abortions for rape and incest victims.

“Subjecting her to an abortion only compounds the initial violence of the rape,” according to the organization’s website.

Austin Camacho, a spokesman for Tricare’s Management Activity, said formulating guidance for the new law would take months, and when it would take effect was unknown.

montgomeryn@estripes.osd.mil