The Navy Is the Best Service for Access to This Care

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Navy Lt. Tasha Gallegos, right, talks to a patient at Naval Hospital Pensacola
Navy Lt. Tasha Gallegos, right, talks to a patient about contraceptive options during an office visit at Naval Hospital Pensacola, Fla. While resources and the availability of walk-in clinics for contraception counseling have increased across the Defense Department, a recent study found significant barriers for service women’s health care and family planning. (Jason Bortz/U.S. Navy)

The days of "Love Boat" ridicule for the Navy over unplanned pregnancies are a distant memory now.

The destroyer tender USS Arcadia gained the nickname during the Gulf War when at least 36 of its service women had to be transferred off the ship while deployed to the Persian Gulf due to pregnancies.

In the years since, the Navy has surpassed the other services in providing access to contraceptives, including those considered the most foolproof and effective.

Nearly 30% of Navy and Marine women were using long-acting reversible contraceptives, or LARCs, by 2019, according to a study in the current issue of the Defense Health Agency's monthly medical journal.

By contrast, less than a quarter of Air Force women were using the intrauterine devices and hormonal implants, which are nearly 100% effective in preventing pregnancy, and fewer than 20% of Army women were.

"Navy medicine continues to prioritize both contraception education and contraception access for sailors and Marines," Navy spokeswoman Angela Steadman said in an email. "We recognize that contraception is not only for family planning purposes, but is also incredibly important to our active duty women for menstrual management and operational readiness should they desire it."

The study showed increases in LARC use since 2016, when the Navy opened walk-in contraceptive clinics offering same-day services without an appointment to increase access to contraceptive counseling and prescriptions.

As of February, the Navy had more than 22 such clinics, usually held once weekly, including at bases in Europe. The Army had five, including a monthly clinic at Landstuhl Regional Medical Center, and the Air Force had one.

The Defense Health Agency is now considering whether to mandate them at all military treatment facilities.

"The Navy has done a really great job with those clinics," said Army Lt. Col. Erin Keyser, the director of the gynecologic surgery and obstetrics program at Brooke Army Medical Center.

Keyser said that after the walk-in clinics patterned on the Navy's were launched at Fort Sam Houston, Texas, it took on average two hours for a patient to be provided with a LARC or other contraception.

That was compared with the average of eight hours it took when troops had to make appointments, often with different providers.

"Especially for young service women, it was a struggle, needing two or three appointments, and the delays that caused," Keyser said.

Overall LARC use in the services increased from 21.9% to 23.9% between 2016 and 2019, the study found, while usage of short-acting contraceptive use, such as hormonal rings, patches and oral contraceptives, decreased from 28.3% to 24.9%.

LARCs are more effective than other types of birth control because they're not reliant on the user, medical officials said.

The Centers for Disease Control and Prevention and the American Congress of Obstetricians and Gynecologists recommend LARCs as the most effective means for preventing unintended pregnancy in women and adolescents. Some are also helpful in menstrual suppression, which can be welcome for service members during deployment.

But obstetrician Dr. Nisha Verma said it is important that providers discuss values and preferences with patients to decide together on the "best" contraceptive.

"It's really very individual," she said. "I'm always cautious about making sure we're not pushing it on people. Condoms might be the best for one person."

Barriers remain for servicewomen's health care, however.

Many female troops have said they received no contraceptive briefing before deployment, studies have shown, and fears of being reprimanded for sexual activity during deployment have caused some to forgo contraceptives.

Expert recommendations mandating pre-deployment women's health visits, ideally three months in advance so that any problems with contraceptives could be remedied, have been rejected, Keyser said.

But one of the most glaring omissions in service women's health care, according to clinicians, is the absence of abortion services.

The military does not perform abortions, and it pays for them only in cases of rape, incest or life endangerment. It also has no data pertaining to abortions.

A study by the research organization Ibis Reproductive Health found that service women with unplanned, unwanted pregnancies often avoided military treatment facilities because they feared stigma, lack of confidentiality and career impacts.

The study also found that some of those who did visit a military clinic "reported feeling upset or abandoned by the lack of options, counseling and referral" for abortion care.

Texas, which is home to numerous military bases, recently banned nearly all abortions, including in rape and incest cases. The ban challenges the 1973 U.S. Supreme Court ruling in Roe v. Wade that legalized abortion nationwide.

"We're still in discussions whether we follow state or federal law," Keyser said, referring to abortions for rape, incest or life endangerment.

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