The military this month celebrated the 75th anniversary of the Women’s Armed Services Integration Act, which allowed women to serve in all branches of the armed forces. Days before that anniversary, Military Times reported that pregnant service women and dependents receiving prenatal care at U.S. Naval Hospital Okinawa in Japan would need to be transported back to the United States to receive pregnancy care due to staffing shortages.
While the Defense Health Agency reversed course shortly afterward, incidents like this are all too common — and serve as a reminder that women have not been integrated into the military.
Senior leaders are failing active duty service women by not openly acknowledging that access to adequate health care during all phases of womanhood continues to plague our military medical system. Specifically, access to prenatal and post-partum health care presents a bleak outlook on what it is like to have a baby as a service woman. The Department of Defense’s own Defense Health Board found that decades of recommendations to bolster gender-specific health care across the services have not led to “sustained improvements.”
Most would be shocked to learn that active duty service women get no choice in the prenatal or post-partum care they receive. They receive care wherever they are based, per government regulations that require active duty personnel to use Tricare Prime insurance, instead of being able to elect coverage through Tricare Select like military dependents. So, all pregnant active duty service women are required to receive care at a military treatment facility, or MTF, at the base they are assigned to if the MTF can “support” such care.
These regulations impact large military populations areas like the National Capitol Region; Colorado Springs, Colorado; San Antonio, Texas; Fort Liberty, North Carolina and Eglin Air Force Base, Florida, where a military treatment facility with obstetrics, labor and delivery and post-partum care exist. Because these areas have large military populations, they likely have the largest populations of active duty service women, who make up roughly 17% of the military.
Allowing pregnant women to choose their service provider results in better medical outcomes, according to a 2012 study that found a women’s perceived amount of control over her birth experience positively impacts the birthing experience. It was not necessarily the type of care that the woman chose but that she had some control over her birth experience. And a 2021 study found that a negative birth experience could have an overall negative impact on women’s health after childbirth to include increased risk of postpartum depression and anxiety.
The fix is simple: Congress should direct that upon a positive pregnancy test, a service woman is given the option to be referred to a provider of her choice within the Tricare network. This would not require any drastic changes to the Tricare system because military providers already have the ability to refer patients to other providers in the Tricare network.
The arguments in favor are simple: if service women have lengthier recoveries postpartum due to negative, traumatic birth experiences, then they are likely to take longer to return to active duty. Studies have found service women tend to leave the military at higher rates than their male counterparts. More specifically, a 2018 Rand Corp. study on addressing barriers to female officer retention in the Air Force found that between the 10 to 13 year marks women officers left the service at higher rates than their male counterparts — a time that just so happens to be right during the middle of their childbearing years, if they joined in their late teens or early twenties. Could it be they leave service at this point to avoid continued shortfalls in medical care especially if they desire to have more children? Is this likely exacerbated if they had a previously negative birth experience? Yes and yes.
Readiness. Recruitment. Retention. This issue touches it all. No woman should be forced to receive maternity health care with no options as to how, where and from whom they receive that care given the data supporting provider choice and its overall positive impact on birth experience and post-partum recovery. But, yet, this is exactly what is happening to active duty service women. Women who have raised their hands to support and defend our nation are stripped of basic healthcare options that most civilian women find commonplace.
It’s an easy fix. Congress should direct provider choice for active duty service women, and the Department of Defense should quickly implement, if Congress chooses to make this welcome change.
Sam Sliney is a mother of two and wife to an Army Green Beret. Since 2014, she has served in the Air Force as a Judge Advocate. Sam is passionate about creating an inclusive Department of the Air Force and Department of Defense to increase lethality of the joint force. Specifically, she advocates for equitable support and accessibility for women during all phases of womanhood, particularly pregnancy and post-partum.
These views are solely those of the author, and do not purport to be the views of the Department of Defense or the U.S. government.
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