Women in the US military describe infertility rates that are approximately three-times higher than the general population, according to a new report.
And they subsequently face challenges gaining access to infertility care, as well as problems following unintended pregnancies and accessing birth control, according to the report, which documents the state of reproductive healthcare among women in the military.
The results are alarming for numerous reasons, says retired Army Col Ellen Haring, CEO of the Service Women's Action Network (SWAN), which published the report.
"First, over 30% of servicewomen and women veterans suffer from infertility, a far higher rate than their civilian sisters, which leads one to conclude that it may be service connected," said Haring in a press statement issued by SWAN.
"Second, the military doesn't appear to be tracking this health risk and when women present with infertility, they receive limited care," Haring added.
"Women who serve this country should not be jeopardizing their opportunity to have a family," she stressed.
A Third of Military Women Have Problems Becoming Pregnant
There are over 369,000 servicewomen and more than 2 million women veterans in the United States. Servicewomen comprise more than 17% of the military force and 10% of the veteran population, rates that are predicted to increase exponentially in the coming years.
The comprehensive survey included 799 women in the military in four categories: veterans (not retired), retired military, National Guard and Reserve, and those on active duty.
Across all categories, 33% of women reported problems becoming pregnant who were actively trying to do so, with a rate of 30% of women retirees, 33% of women in the National Guard and Reserve, and as high as 37% of women on active duty.
"This is dramatically higher than the national average," the authors say, noting that only about 12% of women in the general population — according to data from the Centers for Disease Control and Prevention (CDC) — have "impaired fecundity," or difficulty becoming pregnant after actively trying for 1 year or being able to carry a pregnancy to live birth.
According to the CDC, age is a key factor for infertility, and the report notes that job commitments cause some women in the military to delay having children.
And access to infertility care is limited. Only five military hospitals offer a full range of infertility treatments, waiting lists for care at those centers are long, and servicewomen often have to pay some of the costs for their own treatment, according to the report.
Infertility care at Veterans Health Administration (VHA) hospitals is only provided if women veterans can show their infertility is related to service.
Women veterans who don't know the cause of their infertility seem to be treated on a random basis depending on the VHA hospital and provider they see. Some are completely denied care and others receive limited care.
Alternative options for infertility care include using the military Tricare coverage for treatment at civilian providers. However, Tricare only covers limited tests and procedures and does not cover in vitro fertilization, which can cost approximately $15,000 for just one round of treatment.
In addition to barriers to care at hospitals, some women reported being denied infertility treatment because they were unmarried or gay, which directly violates military policy.
"While it is official policy to provide infertility services regardless of sexual orientation or marital status, our research found that reality does not match policy," the authors say.
Overall, causes of the unusually high rates of infertility in the military and barriers to care need to be better addressed.
In follow-up interviews, women who believe their infertility may be the result of military service, for example, related to exposure to toxins on the job, during deployments and on military installations where they live, or because of wearing ill-fitting equipment, often designed for men, gave further details of how they think this contributed to their inability to have children.
"These data clearly cry out for more research to pinpoint the high levels of infertility...but in the interim military women whose infertility is likely linked to military service should be afforded access to all available infertility diagnosis and treatments at no cost," the authors emphasize.
Accessing Birth Control a Challenge for Some
In terms of other reproductive issues, a more positive note from the SWAN report was that 95% of women in active duty reported having access to their preferred method of birth control.
Some caveats, however, include the fact that women officers have greater access to care than enlisted women, and when women leave active duty, their access to preferred methods of birth control declines substantially.
Access to birth control is also limited for servicewomen during deployment to remote locations, with causes including prescriptions that simply did not provide enough birth control cover for an entire deployment.
Another barrier is birth control prescriptions are sometimes denied by providers who cite General Orders that prohibit sexual activity during deployment.
But many women who use birth control are not doing so to prevent pregnancy, the authors observe, but rather to control or suppress their menstrual cycles or for other health reasons.
The bottom line is that "providers should not be allowed to deny servicewomen birth control because of General Orders that govern sexual activity," they say.
Unintended Pregnancies, Access to Abortion Very Limited
Meanwhile, as many as 35% of pregnancies of retired military women were listed as unintended.
Unintended pregnancy rates among women currently serving were significantly lower, however, at 15% among those in the National Guard and Reserve and 13% among those on active duty.
Options for women with unintended pregnancies are severely restricted in the military, as the only choice within the healthcare system is to carry the child to term, unless the pregnancy is the result of rape or incest, or if the mother is at risk.
Among 81 women included the report who indicated they had terminated a pregnancy, four of the 10 women who indicated their unintended pregnancies were the result of rapes had their pregnancies terminated in military treatment facilities (MTF).
The remainder reported terminating their pregnancies through procedures performed at, for example, Planned Parenthood. They reported receiving little or no help from MTF or VHA providers, even after seeking assistance from them.
And many women who did undergo terminations reported a lack of follow-up care. In one case, a servicewoman reported being given only 24 hours of rest after obtaining an abortion and not receiving the care she needed when a bleeding complication arose.
"The attitude was basically 'You made this choice, you deal with it,'" the woman said in the survey.
"Although military and veteran healthcare providers cannot provide abortions themselves, they could advise military women on where to get them and they should certainly provide follow-up care," Haring indicated.
"Instead, servicewomen who seek abortions, a constitutionally guaranteed right, are shamed and denied care by military providers, endangering their health and decreasing military readiness," she added.
Overall, the report sheds important light on the multitude of unique challenges women in the military face in terms of their reproductive health and the need for some improvements, the authors stress.
"Military women deserve access to the full range of reproductive healthcare services to ensure mission-readiness, optimize their own health and well-being and that of their families, enable career advancement, and to decide if, when, and how to start a family," they conclude.
The authors have reported no relevant financial relationships.
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Cite this: Infertility Rates 'Far Higher' in Military Women Versus Civilians - Medscape - Dec 21, 2018.