Updated at 4:20 p.m. ET
The U.S. military's restrictions on covering abortions can create logistical, emotional, career and health challenges for service members who become pregnant, according to a newly released study.
Previous research shows that women serving in the military have a higher rate of unintended pregnancy than civilian women do. But their access to abortion can be limited by Department of Defense policies, which prohibit military facilities from providing and military insurance from covering abortions, except in cases of rape, incest or danger to a woman's life.
Ibis Reproductive Health, an organization that says it seeks to "improve women's reproductive autonomy, choices, and health," conducted interviews with 21 servicewomen ages 19-34 from the Army, Navy, Air Force and Marine Corps who volunteered to talk about their experiences. The small sample included only women who received abortions while on active duty in the past two years, not those who wanted them and didn't get them.
The results are not "generalizable" to the military as a whole, the researchers note in the study published Wednesday in the journal Perspectives on Sexual and Reproductive Health.
Service members who received abortions from outside providers told researchers that the experience was difficult — and many said they were surprised to discover the military could not or would not help them receive an abortion.
But they say the qualitative survey can help researchers "better understand servicewomen's abortion experiences."
Women in the military are more likely than other American women to have an unplanned pregnancy — as of 2011, they had 72 unintended pregnancies per 1,000 women under 44, as opposed to 45 per 1,000 in the general female population, according to research cited by Ibis.
Those pregnancies have serious implications for women's careers and for the military's staffing, because some jobs in the military are not open to pregnant women.
Several women told the researchers that career interests were a primary reason they sought an abortion. "I can't jump out of a plane ... pregnant and stuff, and that's my job," one enlisted soldier said.
For the most part, the women said they did not find support from supervisors or military medical providers.
"The military makes it easy for you to have kids, but not easy for you to not have kids," one Air Force officer told the researchers.
"Once I told them I wasn't going to keep it, it was like, 'OK, you're on your own.' They couldn't provide me any other help, even if that was something as simple as a reference," an enlisted Navy servicewoman said.
The U.S. military does not permit abortions at military medical facilities or using military insurance.
"For some, the policy led to delayed access to services or feeling stressed or alone in the process when they did not have formal military support," lead author Kate Grindlay wrote in a statement. "Others noted the potential for women receiving substandard care when they are deployed and must seek services on their own."
The costs were substantial, the researchers found. "Servicewomen had to travel to an outside clinic, often located an hour or more away from their base," Ibis wrote in a press release. "Almost all of the women interviewed paid out of pocket for the procedure, which cost an average of $493. In some of the cases with a higher out-of-pocket cost, the procedure cost represented a full paycheck."
There are potentially serious health consequences to this system, the women told researchers.
One woman didn't tell her supervisors about her abortion and said that as a result, she "wasn't able to follow the post-op instructions" as much as she wanted — for instance, she wore a tampon while working and had limited access to a bathroom, while she was continuing to bleed. Another woman noted that since service members have to go off base to seek an abortion, women who are stationed in some parts of the world are "probably not getting the safest medical care" when they seek the procedure.
Furthermore, researchers say many of the women were not even aware of the Department of Defense's current abortion policy, which could cause delays in treatment as they attempted to seek care from facilities that would not provide it or refer them elsewhere.
Those rules have changed over the decades, amid fierce debate in Congress.
The Guttmacher Institute, writing about the issue in 2010, noted that "public funding of abortion at military facilities was available, albeit with some limitations, for military personnel and their dependents during much of the 1970s." But in 1978, Congress decided that Department of Defense funds could not be used to provide abortions.
Then, in the late '80s, DOD decided that women could not even use their own money to acquire abortions at military facilities, except in the case of rape, incest or danger to the life of the woman. That policy was briefly lifted by the Clinton administration, before being reinstated.
More recently, in 2013, the Shaheen Amendment allowed abortions to be covered by military insurance in the case of rape or incest. Only two of the 21 women interviewed were aware of that option.
But the women were divided on whether the overall policy should actually change.
Some believed that servicewomen's abortions should be covered like other forms of health care. Others were wary of using the military health care system for the procedure, over concerns about privacy, confidentiality and the effect on their career if it was known that they had sought an abortion.
The Department of Defense declined to comment to NPR about practices at any individual facility but noted that it is department policy to refer service members "to the civilian sector" for services the military cannot provide.