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.