Posted in Reposted Articles

Considering the loss of abortion protection for our sailors, marines, and their spouses

Background reading

Although the SECDEF has vowed to maintain access to reproductive rights, we have already entered a time of uncertainty. Although many states that rushed to overturn Roe v. Wade laws are not fleet concentrations, there are likely over 15,000 active duty Navy personnel in states whose trigger laws were enacted in July 2022.

Update 17-Aug-2022: DoD Q&A about post-Dobbs care

Number of active duty Navy and Marines in States that are moving to ban pregnancy termination:

  • Texas (6,164 active duty Navy personnel / 2,282 active duty Marines)
  • Mississippi (4,742 / 447)
  • Oklahoma (1,647 / 558)
  • Tennessee (1,634 / 150)
  • Missouri (233 / 1,440)
  • Louisiana (398 / 761)
  • Utah (50 / 92)
  • Kentucky (53 / 89)
  • Arkansas (10 / 109)
  • Idaho (33 / 41)
  • South Dakota (4 / 14)
  • North Dakota (2 / 14)
  • Wyoming (2 / 8)

How can Navy physicians help?

Talk to your sailors, marines, and their family about this issue! Young servicemembers may be wary of starting this discussion. So create a safe space in the exam room or clinic to discuss their concerns. Train corpsmen on women’s health. Educated HMs act as your agent, sharing insight with patients (in the clinic) and other junior servicemembers (in casual settings).

Consider how you will react to challenging logistic and potentially ethically tough situations. If you are operational, find out what kind of support the CO gives to requests for travel for abortion services so that you can better counsel your patients as to their options.

Navy Pregnancy Instructions

Know the governing instructions. Current instructions do not provide guidance on the nuances of the recent legal changes, but they are essential background. My Navy HR’s AD pregnancy page has links to the relevant documents:

Emergency Contraception Options

When possible, educate servicemembers and patients on their emergency contraceptive options BEFORE they need them!

  • Levongesterol, 1.5 mg (Plan B One Step) – Available over the counter at any military pharmacy in any state, 1 dose.  2.5% pregnancy rate if taken within 120 hours, about half that if taken within 72 hours.
  • Ulipristal, 30 mg (Ella) – Requires prescription, 1 dose.  1.3% pregnancy rate if taken within 120 hours.
  • Copper IUD – 0.1% pregnancy rate if placed within 120 hours.
  • Mirena IUD – One large NEJM study suggests similar effectiveness to copper IUD, insufficient data for CDC to recommend yet.

Connecting Patients to Resources

Several organizations can connect patients to information and funding.

Medical Termination of Pregnancy

To be clear, military physicians working in an MTF may only offer treatment to terminate a pregnancy in cases of a nonviable pregnancy, rape, or to save the mother’s life. But it is helpful to understand the most likely treatment options in early pregnancy that may be offered at outside facilities (or online).

Mifepristone and Misoprostol for Undesired Pregnancy of Unknown Location

Preventing Future Pregnancies