Air Force Staff Sgt. Octavia James has helped fellow airmen navigate the difficult choices faced by women in the military when they are contemplating an abortion.
People usually seek James out when they don’t feel comfortable going to a commanding officer. She has invited airmen to stay in her apartment in Norfolk, Va., while they recover from an abortion. She recalls once having to help a friend out of the shower because her sedation was slow to wear off.
“Every person's different,” she said. “Everybody recovers different, everybody needs different things after, and everybody's seeking an abortion for a different reason. So I can't tell you what's best for you. But if you need me, I'm here.”
Seeking an abortion has always presented unique challenges for women in the military. For decades, a measure known as the Hyde amendment has banned federal funding for most abortions, and only allows military doctors to perform abortions in the case of rape, incest or where the life of the mother is at stake.
But more than two years after the Supreme Court overturned Roe v. Wade, striking down the constitutional right to abortion, the obstacles for members of the military have only gotten harder. Some 40% of women in the military now serve in states with abortion bans or expanded abortion restrictions.
This new landscape has left many service members scrambling to navigate their options, having to figure out how to travel — sometimes hundreds of miles from base — even though they’re not free to leave whenever they want. The military has tried to make it easier by creating a policy that allows extra leave and paid travel for women seeking an abortion outside of the military, but the policy was used just 12 times from June to December last year, according to the Pentagon.
Instead, women in the military are often relying on an ad-hoc peer support system that many compared to an “underground railroad” of military women helping one another, according to interviews with more than 40 current and former service members, advocates and researchers..
“Women are coming up with their own solutions,” said Caitlin Clason, a former Army captain and fellow at the University of Pennsylvania who researches how women in the military access abortion. “As a healthcare provider, we can do better for these service women who have volunteered to serve our country, and we should do better.”
Women are going where they feel welcome
A short drive from James’ home in Norfolk, Virginia Beach has become part of an informal network of military towns seeing an increase in military clients as state laws change. The area has the highest concentration of U.S. Navy personnel in the world. The city also has the most military clients for Planned Parenthood in Virginia, according to the organization.
“I think a lot of military folks have friends in other areas with a high military population. So if I'm stationed in Jacksonville, I might know someone in Virginia Beach that I can stay with,” said Merrin Cenicola, a nurse at the clinic.
Virginia is becoming a hub for abortion care as other states with large military populations, including Georgia and Texas, impose strict limits. Abortion remains legal in Virginia through the end of the second trimester, in line with the protections that were allowed under Roe.
On average, women stationed in states with strict limits on abortion are traveling hundreds of extra miles to access care since Roe was struck down. The average travel time for a woman stationed in Texas is more than eight hours by car, according to research published in JAMA.
The maze of laws can be a particular problem for women who have only recently transferred to a base and might not know the area. North Carolina now has a 12 week ban on abortions, but it also requires patients to come for a consultation and then come back for the procedure. A second visit may require another request for leave, Clason said.
“I am not trying to make light of the very real issues that civilian women have, but you do not need your boss's legal permission to travel more than a certain number of miles,” Clason said. “That is the first hurdle that active duty service women deal with. The second is you do not choose where you live.”
One Air Force sergeant who spoke with NPR recalled her experience trying to get an abortion after being transferred from Germany to Minot Air Force Base in North Dakota in 2022, after the Supreme Court’s decision in Dobbs v. Jackson Women's Health Organization striking down Roe. NPR has agreed to withhold her name because she feared the decision could follow her.
“My son was six months at the time,” she said. “I had also suddenly lost my mom unexpectedly, right before I gave birth to my son. So mentally, I just was not there. I could not handle another kid.”
She and her husband drove more than four hours to the only clinic in North Dakota. She said her Air Force provider seemed sympathetic but hands off.
“I did not get any information from him.” The only other resources she got, she said, was from a local health clinic.
But when the state’s near-total abortion ban took effect, the clinic shut down. She received the medication for her abortion just before it closed.
A chilling effect
Current and former service members who spoke with NPR say these types of challenges date as far back to 1977, when the Hyde Amendment first went into effect. Nearly 50 years later, they say, the language continues to have a chilling effect on some providers.
The physician who helped coordinate Navy Lt. Commander Juliette Ruff’s abortion in 2016 with a local clinic in Japan, felt obligated to clock out so she wasn’t being paid by the federal government while she helped her.
“She was doing it on her own personal time,” Ruff said. “She was not doing it as an affiliate of the medical system. We became friends through the process.”
Ruff is also a nurse stationed at Marine Corps Air Station Cherry Point in North Carolina and makes herself available to women to answer questions online — part of the informal network of military women helping one another, she said.
There are private groups set up to help women pay for abortions — including women in the military. The National Network of Abortion Funds does not list any fund geared specifically to very particular needs of women in the military.
“You need somebody who was impacted to start that type of a group. You have to have funding and resources to do that. As women in the military, we're a fairly small percentage of our overall force,” Ruff said.
Few women have used the Pentagon’s travel policy
After Dobbs, the Pentagon created a travel and leave policy that pays for off-base travel and up to three weeks of leave for uncovered reproductive care, which includes abortion or in-vitro fertilization. To increase the level of privacy, the policy also gives women 20 weeks to inform their command that they are pregnant.
Advocates say the program is a good first step, but they also worry that it's not been promoted enough.
The policy has also drawn critics. Republican Senator Tommy Tuberville of Alabama held up confirmation of all top military appointments for months in protest of the policy.
Earlier this year, the Pentagon said the program was used just 12 times from June to December last year. The Defense Department did not release figures for the months prior to that, and declined to provide updated figures beyond the end of last year. It responded to a request for comment by referring NPR to a list of existing Pentagon policies.
Advocates say one potential change that could make the program easier to use would be to have military doctors issue the leave, so women won’t have to ask their commands for time off. Andrea Ward-Wiley, a former nurse at a clinic at Naval Air Station Fallon in Nevada, suggested having a person at each base who is point of contact for non-covered reproductive health options, similar to the advocates for victims of sexual assault that are common on military bases.
There are still deep concerns that having an abortion could follow someone throughout their career, said Jackii Wang, senior legislative analyst with the National Women’s Law Center.
“There's a stigma around abortion in the military,” Wang said. “I talk to women service members and they have left the military, often feeling like that system failed them in so many ways. I think that extends to their experience with reproductive health care in the military.”
Air Force Lt. Col. Sharon Arana is stationed at Joint Base Langley-Eustis, Va. In 2009, she was in officers training school in Alabama. She remembers her and her husband stopping outside the base to take a pregnancy test.
“I was in a gas station bathroom because I didn’t want to do it in the dorms, thinking what if someone finds this in the trash,” she said.
Arana leads Sword Athena, an Air Force group that looks at barriers women face in the Air Force — including access to abortion. After Dobbs, she compiled an anonymous survey of over 1,000 women about their experiences with abortion in the military. One woman sold her car to pay for an abortion. Other women said they were denied leave.
Arana has found no consistency in the information or help women were provided — 93% of women were not offered mental health counseling and 88% didn’t receive convalescent leave, according to her findings. Women encountered providers with moral objections to providing even contraception.
The data helped inform the Pentagon’s travel policy, but the program hasn’t fixed some of the underlying problems, she said.
“What we were seeing was that a lot of the people in the military who are getting abortion are those of our airmen who are still in training or living in the dorms,” she said. “They haven't learned yet how to advocate for themselves. And they are kind of beholden to their leadership to take care of them.”
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