Picture this: You’re an American service member stationed abroad. You’re pregnant. And you just found out that you contracted Zika, the rapidly spreading mosquito-born virus that has left thousands of babies with severe brain abnormalities.
That’s not a hypothetical situation — it’s already happened. According to the Pentagon, at least 41 active-duty American service members have contracted Zika abroad since January, including one pregnant woman, who we’ll call Y. All have been instructed to wear mosquito repellent, and Y has been given the option of relocating out of the Zika-affected country. But Zika has been linked to a number of complications, including microcephaly, a birth defect that can cause serious cognitive disabilities.
That raises an obvious question: What if Y wants an abortion?
That may prove complicated. Under American law, women in the military only have access to insurance coverage for abortion in the cases of rape, incest, and life endangerment. Even if they want to foot the bill themselves, they can’t: They’re prohibited from using their own cash to pay for the procedure at military hospitals.
Those provisions can be particularly burdensome for women on military bases abroad, many of whom are stationed in countries where obtaining a legal abortion is already difficult. And this is all more relevant in lieu of the recent news about Zika’s steady spread to the military, public health experts say.
“It’s just critical that the link be made between the reports of Zika and the barriers that people in the military face,” said Dr. Dan Grossman, an obstetrician-gynecologist who has conducted extensive research on reproductive health and the military. “And obviously it affects not just women in the military but because of the possible sexual transmission it would affect the female partners of the male servicemen when they come back.”
Zika was first reported in Uganda in the late 1940s and reemerged in Brazil last year. The mosquito-borne virus has since spread to other parts of South America, the Caribbean, some Pacific islands, and Cape Verde, and is now finding a foothold in the U.S., where an estimated 23,000 people have contracted the virus in the U.S. and Puerto Rico since 2015.
Since Zika does not cause an imminent threat to the life of the mother, there is currently no exception for the virus within the military abortion ban. That means a woman who is infected with the virus and seeks an abortion abroad can get the procedure locally, or she can ask a commanding officer for permission to travel elsewhere, Donna Crane, the policy director of NARAL Pro-Choice America, explained. Both options can be risky.
“It’s just critical that the link be made between the reports of Zika and the barriers that people in the military face.”
Women stationed in countries where abortion is legally restricted don’t have much of a choice — they can forgo the procedure or foot the bill for a trip to a country with less stringent laws. But that can be expensive, complicated, and professionally disruptive. “She has to go to her commanding officer and ask for leave,” Crane said. “We’re told it’s understood that you explain the reason why. And that is obviously not a conversation you want to have with everyone, especially not your boss. And then she has to take a flight to the next place that she can get care. And in some cases people have told us, can be a bad move for your career, that your boss may disagree, that he or she might make a judgment about how those circumstances arose, why you are pregnant, etc.”
Even those in countries where abortion services are available face logistical, personal, and financial hurdles. According to a 2011 study and survey co-authored by Dr. Grossman, servicewomen reported a number of challenges accessing abortion services abroad. In addition to the obvious barriers women in countries with legal restrictions faced, many expressed concerns over confidentiality, safety in countries where travel was dangerous or outright prohibited, and the impact of the decision to seek care on their professional trajectories. Indeed, a 2002 report by the Government Accountability Office found, “for active duty women, explaining their specific ailment to their commanding officer (usually male) or appearing like they need special treatment may make them reluctant to seek the care they need.”
Those challenges can lead to unsafe outcomes. “With no perceived alternatives, some women considered unsafe methods to terminate the pregnancy themselves,” the study concluded.
The military’s abortion funding ban has a long and complex history, beginning in 1979, when Congress prohibited the use of public funds for abortion services at military hospitals abroad. The ban applied in all cases, except for when a woman’s life was in danger. In 1988, the Department of Defense went a step further, issuing an administrative order that barred women from using their own money to pay for abortion services at military bases overseas. The ban was overturned during the Clinton administration thanks to a 1993 executive order — but reinstated two years later, when Congress expanded the ban on public funding to also include the private fund prohibition. The policy remains in place to this day, despite various attempts to reverse it.
The legislature has been more active on other fronts, however. Last week, Congress finally approved a $1.1 billion funding package to combat the spread of Zika. The long-awaited deal, which is part of a larger bill to fund the government until December 9, comes after months of bitter partisan infighting — a wrenching delay for lawmakers and health experts who have long emphasized the need for speedy action in the face of a public health crisis. To fight the virus’ expansion from Florida, where it is most concentrated, to other states, particularly in the Gulf Coast, the money will be put toward mosquito control and vaccine development.
“We are pleased that Congress has put aside political games and finally provided this urgently needed funding to combat the Zika crisis,” said Dr. Willie Parker, Board Chair of Physicians for Reproductive Health. “However, our work to protect those most at risk is just beginning. Those already living with Zika and those most vulnerable, deserve compassion and access to the care they need without shame or stigma. It is vital that our lawmakers continue to provide the resources necessary for women and families to obtain the highest quality health care and make the decisions that are best for their circumstances.”
Whether or not that will extend to women in the military remains to be seen.