Active-duty women face immense obstacles in accessing sufficient reproductive and sexual health care in the military health system, according to a new report by a Washington, D.C., think tank.
In the 49-page "Out of Range: Obstacles to Reproductive and Sexual Health in the Military," the left-leaning Center for American Progress found disparities between female troops' health care and civilian care, including barriers to obtaining common medications and emergency contraception, abortion access, stigma in seeking care and sexism both on the job and within military health policies.
According to the report, rates of sexually transmitted diseases among military women are seven times higher than civilian rates.
And 10 percent of active-duty women get pregnant each year, with more than half the pregnancies thought to be unintended — a rate 50 percent higher than the unintended pregnancy rate among civilian women.
But "contrary to what some may believe, that service women are irresponsible, it appears that accessing appropriate contraception is the real obstacle," wrote CAP researchers Donna Barry, Jessica Arons and Lindsey Rosenthal.
"We don't have answers as to why these rates are so much higher," Barry said. "The 'a-ha' moment out of this was there needs to be a lot more research to find out the reasons for these issues."
But lack of education, access to care and stigma of seeking reproductive and sexual health care, especially while deployed, likely contribute, the report notes.
For example, although Tricare covers contraceptives such as diaphragms, intrauterine devices, sterilization and some birth-control medications, the military health program does not cover other common methods of birth control such as vaginal rings, Depo-Provera and condoms.
And coverage is not equal to that mandated by the Affordable Care Act because women in Tricare must make co-payments for birth control if they do not get their contraception at a military hospital.
Female troops also can have abortions covered by the Defense Department only if their lives are at risk or the pregnancy results from rape or incest — a policy that results in financial hardship for servicewomen, loss of productivity and often, in the case of a pregnancy that forces a woman to leave her command, loss of unit cohesion.
The researchers found that more than one in three women deployed to Operation Iraqi Freedom had a gynecological problem and 15 percent were unable to obtain needed medical care. In one survey, 41 percent of women said their birth control prescriptions were difficult to fill in a deployed setting and half didn't feel comfortable getting care in such settings.
Barry said her organization studied the issue because while there has been some research on women's health in the military, few have taken a comprehensive look that the subject.
With more women choosing the military as a career, she said, DoD needs to review its policies and provide more support.
A Defense Health Agency spokesman said the Pentagon could not comment on a report it had not reviewed but added that the issue of health care for women is a top priority.
"The health of our female soldiers, sailors, airmen and Marines is of the highest importance to us, and DoD is always striving to improve the care we provide," said DHA spokesman Kevin Dwyer.
A 2013 Government Accountability Office report noted that the Pentagon has made strides addressing the needs of deployed service women. The report found that two-thirds of 92 women interviewed said they felt the health needs of women were generally being met during deployment.
Among the biggest complaint GAO analysts heard from deployed service women were concerns over the challenges of getting their medications.
At least one person interviewed added that junior health care providers were limited in their experience and in the scope of procedures they could perform.
But, GAO officials noted, DoD has "put in place policies and guidance that include female-specific aspects to help address the health care needs of service women during deployment."
Barry said her review indicates more needs to be done.
■ Lifting the ban on elective abortions within Tricare and at military treatment facilities.
■ Passing legislation that requires DoD to provide adequate care care for women who have been sexual assault victims.
■ Providing support in units for women who choose to carry their pregnancies to term.
■ Improving access to timely and adequate gynecological care as well as a range of contraceptive options.
"We really need to take the politics out of the policies that guide the care and we need to devote some funding to the research to find out why some of these rates are so might in the military," Barry said.