By Sandra Basu

"After three decades of a policy that discriminated against women who put their lives on the line of duty for us, I'm proud of my colleagues in both houses of Congress and of both parties who are going to allow us to right this wrong" - Sen. Jeanne Shaheen (D-NH)

WASHINGTON — A controversial new law expands the circumstances when DoD funds can be used to pay for abortions to include cases of rape or incest. Previously, DoD-funded abortions were only permitted when the life of the mother was deemed to be in danger.

DoD spokesperson Cynthia O. Smith told U.S. Medicine that abortions could be performed at military treatment facilities (MTF) in cases of rape or incest on a private-pay basis even before the passage of the 2013 National Defense Authorization Act (NDAA). Now, she said, abortions in these circumstances can be performed both in MTFs and outside of MTFs at no cost to the pregnant woman.

The change in law drew passionate responses from both sides of the issue.

“After three decades of a policy that discriminated against women who put their lives on the line for us, I’m proud of my colleagues in both houses of Congress and of both parties who are going to allow us to right this wrong,” amendment sponsor Sen. Jeanne Shaheen (D-NH) said in a written statement.

A spokesperson for the Catholic Medical Association told U.S. Medicine, however, that the organization “regrets that the final version of the defense authorization bill” allowed federal funding for abortions following rape or incest.

“This new policy will lead to more abortions being performed, resulting in the deaths of more innocent children and harm to the physical, emotional and spiritual well-being of women,” the spokesperson said.

*****************

Opinion poll:
Should DoD be required to pay for abortions in cases of rape and incest as well as danger to the life of the mother?

Please click here to participate in this month's U.S. Medicine readership poll.

*****************

Abortion Debate

The issue of abortions in DoD has long been controversial. A 2011 Congressional Research Service (CRS) report on the subject noted that from Aug. 31, 1976, to Aug. 31, 1977, approximately 26,000 abortions were performed in military hospitals or through CHAMPUS, the precursor to TRICARE.

In 1979, however, a law was passed that prohibited DoD from using federal funds for abortion services at military hospitals in almost all cases. According to the CRS report, military hospitals overseas still reportedly performed approximately 1,300 private-pay abortions in FY1979. These abortions were reportedly allowed because, at certain overseas locations, safe civilian facilities were not always available to perform the procedure.

In 1988, the abortion ban was extended, and women were prohibited from obtaining abortion care at overseas military facilities, even if they paid for it themselves. In 1993, President Bill Clinton lifted the ban on privately-funded abortion services at military medical facilities, but Congress later changed Clinton’s military policy abortion to allow privately funded abortions only in the case of incest and rape. Furthermore, federal funds for abortions continued to be allowed only when the life of the mother was in danger. This is how the law has remained until the change last month.

The most recent legislation, known as the Shaheen amendment received widespread attention from both sides of the issue. This legislation sought to permit TRICARE coverage of abortions for military women and dependents in cases of rape and incest.

“For Senator Shaheen and the pro-abortion lobby, this is the next step toward their goal of abortion-on-demand, paid for by the taxpayers, on every single military facility. The vast majority of Americans oppose taxpayer funding of abortion, putting this change in policy outside the mainstream,” said Marjorie Dannenfelser, president of the pro-life group, Susan B. Anthony List, in a written statement.

Meanwhile, in December, before the passage of the law, dozens of former military leaders, including former Secretary of State Colin Powell, a retired four-star general and former Acting Army Surgeon General Maj. Gen. Gale Pollock (ret.), wrote a joint letter to lawmakers, asking for their support for the changes.

“Restoring abortion coverage to our servicewomen and military family members who are survivors of rape and incest would bring the Department of Defense in line with the policy that governs other federal programs, such as Medicaid or the Federal Employee Health Benefit program,” the letter stated. “At the very least, our military women deserve the same access to care as civilian women who rely on the federal government for their health care.”

DoD Physicians

Even with the new law, however, DoD physicians and other healthcare providers are not required to perform or participate in elective abortions if they have moral objections. Officials said the current DoD policy “remains in effect.”

That policy, stated in a 1994 memorandum, stipulates that “health care providers who, as a matter of conscience or moral principle, do not wish to perform elective abortions shall not be required to do so. This shall apply only to providers directly involved in performing the abortion procedure itself, such as physicians, nurses, and anesthesia and operating room personnel. Health care providers may be required to perform abortion procedures to save the life of the mother.”

Still, the impact of the new law concerned some religious groups. Air Force Col. Donald Thompson, MD, (ret.), the Christian Medical and Dental Associations’ director of Global Health Outreach, said the change in law may now increase the pressure for rape victims who become pregnant to have abortions, because they will be funded by DoD. That could take pressure off of military leaders to address the “real issues” regarding sexual assaults and violence, he suggested.

In addition to posing ethical issues for healthcare providers, broader funding for abortions could also increasingly burden MTFs, he said.

“If it becomes a higher priority it could push some of our combat injured to the side. It could certainly raise competition for the OR,” he told U.S. Medicine.

In addition, finding physicians to perform the abortions may prove difficult, Thompson suggested. A 2011 CRS report pointed out that after President Clinton made abortions more accessible for military personnel, before Congress changed his policy, it did not have the effect of “greatly increasing access to abortion services.” One of the reasons cited was the difficulty in the military of finding healthcare professionals willing to perform the procedure.