Time to Curb Unintended Military Pregnancies

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Army

From a 1996 Army study

The U.S. military faces numerous challenges. Among these are the burgeoning costs of healthcare and persistently limited participation of women.

Practical solutions exist which can tackle both of these problems simultaneously.

To be sure, these problems are serious. According to the U.S. Census Bureau’s Statistical Abstract, total Department of Defense healthcare expenditures grew from $13.7 billion in 2000 to $36.5 billion in 2009, a nearly 30% average annual growth.

Just as seriously, despite progress in the 1970s and 80s, the proportion of women in the various services remains well below 25%. This has been true even in the service academies where concerted effort is made to recruit and retain female students.

A major factor driving women to refrain- and/or dropout from service is mistimed pregnancy. Like Fantine of Hugo’s Les Miserables, women’s control over their pregnancy is critical to their participation in reputable work. In fact, the statement “women [enlistees of fiscal year 1984] left primarily at their own request because of pregnancy” from a 1990 GAO report, Women in the Military: Attrition and Retention, remains fairly true in 2013.

Unwanted pregnancies are a significant contributor to healthcare expenditures. Indeed, according to the April 2012 issue of Medical Surveillance Monthly Report (MSMR), more than 13% of total bed days, and about 5% of total lost work days in 2011, among all U.S. service members were pregnancy and delivery-related.

Also, according to the July 2007 MSMR, about half of all pregnancies to military women were “mistimed or unwanted at the time of conception.”

A new study in the February 2013 issue of Obstetrics and Gynecology reports that “eleven percent of [military] women reported an unintended pregnancy in the prior 12 months,” and that this trend grew worse from 2005 to 2008.

These findings, combined with the added knowledge that repeated studies have demonstrated low rates of contraception use by servicewomen of reproductive age, clearly delineate an area in need of focused attention by the Defense Department’s Military Health System.

Remedy of this situation is prudent, not only as a cost- saving measure, but more importantly as a policy of just and fair treatment of women. It’s especially relevant given the Pentagon‘s recent decision to open front-line combat posts to women.

A focused unwanted/unintended pregnancy prevention education campaign, combined with greater availability of the most effective methods of contraception, i.e. intrauterine devices and injectable or implantable contraceptives, will help improve the health of servicewomen and reduce costs significantly.

Some politicians or religious figures might raise concerns about contraceptive use leading to promiscuity among members of the armed forces. This concern is the traditional argument against contraception, but has never been scientifically substantiated. Sexual activity is a complex behavior related to many factors far more commanding than fear of pregnancy — including family ties and expectations, peer-group membership and character traits like impulsivity.

However, there is no denying that fewer unwanted pregnancies will mean fewer abortions, improved health for women, greater participation (recruitment and retention) of women in the military, and a smaller healthcare bill for the nation’s taxpayers

The Military Health Service should act now.

Artin Terhakopian is a psychiatrist and a major in the U.S. Army, but the views expressed here are his own. In the last decade, he worked at Walter Reed Army Medical Center in Washington, D.C., the William Beaumont Army Medical Center in El Paso, Texas, and the 10th Combat Support Hospital while it was deployed to Iraq. He is currently a student at the Command and General Staff College at Fort Leavenworth, Kansas.

5 comments
ScienceWoman
ScienceWoman

Thanks for writing this piece!  The issue of women’s reproductive health and their participation/advancement in their careers is very real that transcends beyond the military setting. As you suggest, education and availability of resources are key, but should not be limited only to women.  Many can be affected, at individual and organizational levels, by pregnancy and its sequels; knowledge and awareness can foster support that’s of mutual benefit.  And this does not mean women should “ask for permission” or defer pregnancy indefinitely, but to time it according to the balance of readiness and biological limit that ought to be recognized.  The decision is ultimately a personal one; the cost of unintended pregnancy is unfortunately real and is also tremendous at societal and moral levels.

EuterpeMuse
EuterpeMuse

Men can be so quick to assume they know how a women's body should be managed.  Generations of legislators without military experience have tried to legislate military functions. 

First, it is wrong to ASSUME military women are irresponsible, and definately don't ASSUME they're willing to be "temporarily" sterilized or foced to use a particular form of birth control. 

What the article fails to address is how difficult it can be for women to get regular medical attention.  A married enlisted friend had an ectopic pregnancy that exploded her ovary because she was unable to see anyone above a corpsman for weeks.  This sent her into a deep depression that she also couldn't get adequate medical attention for.

Even if a women were able to get an appointment at a medical facility, it may be at some distance and require herculean efforts to find transportation and time off.  Should the worst happen and an unintended pregnancy occur, military women are often denied access to abortion because they serve in countries where abortion is illegal, and scheduling timely transport to a legal country can be tricky under the best circumstances.

These realities are not the fault of women.  I think the real question is, if women are going to be in the military, are they going to receive adequate access to medical care, or are they going to be treated and managed like cattle?

GuySlater
GuySlater

While "11%" of the women reported an " unintended pregnancy," sounds like a large amount, it comes down to 2.75 pregnancies per 100 women.  Not that large a number.  (And one that does not reflect a true number of pregnant soldiers.  There are unaccounted for "intended" pregnancies missing from the total figure.)  The loss of duty time and the money needed to sustain the military mission during one pregnancy by a female soldier is another question.  Their pay and allowances continue even though they are NOT available for full duty for part of the time, and not available for duty AT ALL for another.

There are medically acceptable methods of preventing contraception.  These methods, one for males, one for females, temporarily sterilize the person, require surgical intervention, and are reversible.  The method for males may still be experimental involving the implanting of a two-way valve along each vas deferens.  The method for females is to tie her Fallopian tubes.

I would suggest that all persons joining the military undergo either of these two prevention measures.  At the same time I would suggest that the Department of Defense (DOD) institute a policy of not allowing married personnel to join, and to disallow marriage while in the service. The expenses of "Dependent" housing, separate rations (the allowance given to military personnel because they do not eat in the "mess hall" (dinning facility for the PC), medical care for the non-military dependents, including children, the cost of erecting and maintaining schools for military "brats" (a common term used to identify children of military members), and any of the myriad expenses not associated with the military mission could be, eventually, eliminated.

If we are to continue to have an "all volunteer" force, than we should have a force that is not trying to perform the twin tasks of soldier and spouse/parent, and should also expect more from those volunteers than is the present case.  And I speak from the experience of an NCO (retired) who was a husband and father, a supervisor of pregnant soldiers, and one who tried to perform those "twin tasks."  Sometimes successfully, but I fear most times not.

art.terhakopian
art.terhakopian

@GuySlater

11% may be a small number but it is per year. So you get another 11% next year and every year after. And as you mentioned, a pregnancy lasts 9 months plus the post-partum period of medical attention – so it’s long and costly. As for tubal ligation, it is difficult to reverse and a surgical procedure as is vasectomy; although vasectomy is far less risky a surgical procedure. As for reducing unintended pregnancies, the most reliable and cost-efficient medical method are intrauterine devices and injectable or implantable contraceptives. I’m saying medical methods since I consider abstinence a patient directed initiative and not a medial method and consider health behavior change more of a public health and culturally driven process than a medical one.

GuySlater
GuySlater

@art.terhakopian @GuySlater  " The method for females is to tie her Fallopian tubes."  Notice I did NOT say "tubal ligation," which I consider to be as permanent as a vasectomy is on males.  Both methods I did mention are supposedly reversible. 

As for the fallacy of abstinence:  Mother Nature, or "God" (the same entity in my mind) made those just past puberty the most susceptible to the bodily urges necessary for procreation; i.e. they are the horniest of our breed.  Abstinence does not, and will not, work in the long run.  If it did, our population would shrink, rather than grow.  I agree with your comment that it is NOT a medical method.

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