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February 19, 2019
Defense Health Primer: Contraceptive Services
The Department of Defense (DOD) operates a Military
Figure 1. Contraceptive Use Among Female Active
Health System (MHS) that delivers certain health
Duty Servicemembers, 2012-2016
entitlements under Chapter 55 of Title 10, U.S. Code, to
military personnel, retirees, and their families. Basic
medical benefits are offered in military treatment facilities
(MTFs) and through TRICARE, a health insurance-like
program. By law, DOD is required to make contraceptive
services available to all female active duty servicemembers.
Additionally, these services are extended to all beneficiaries
who are eligible for MHS care.
What contraceptive services does DOD provide?
The U.S. Centers for Disease Control and Prevention
(CDC) defines contraceptives as medical procedures,
products, drugs, or services designed to “minimiz[e] the
risk for an unintended pregnancy.” DOD administers
counseling and contraception methods in accordance with
the CDC’s medical eligibility and selected practice
recommendations for contraceptive use. MTFs and
TRICARE providers only offer methods of contraception
Source: Defense Health Agency, Medical Surveillance Monthly
that are recognized by the Food and Drug Administration
Report, Contraception Among Active Component Service Women, U.S.
(FDA). These include:
Armed Forces, 2012-2016, Vol. 24, No. 11, November 2017.
Notes: DOD did not report prevalence rates for barrier devices or
Short-Acting Reversible Contraceptives (SARCs): oral
nonsurgical sterilization.
contraceptive, patch, vaginal ring, injection;
Long-Acting Reversible Contraceptives (LARCs):
Patient Costs
intrauterine device, implantable rod;
Active duty military personnel incur no out-of-pocket costs
Barriers: diaphragm, cervical cap, sponge, male/female
for contraceptive services. If a servicemember accesses
condom;
contraceptive services that are not directly provided,
Sterilization: male/female surgical sterilization,
referred by a DOD health care provider, or otherwise
permanent implant; and
covered by DOD, then they may be required to pay for
Emergency Contraceptives: Plan B/Next Choice, Ella.
those services. Other DOD beneficiaries, including certain
members of the reserve component, may be subject to cost-
Counseling on the methods of contraception is also
sharing based on their TRICARE health plan, beneficiary
available through tele-health. In general, DOD provides
category, and type of medical service received.
scheduled or just-in-time tele-health services (e.g., secure
electronic messaging, video teleconferencing, mobile
Are all contraceptive methods available at every
applications) for clinical specialties such as primary care,
military treatment facility?
family medicine, and obstetrics/gynecology. These services
Since MTF clinical services vary by facility, they are not
often provide additional opportunities for patient education
required to stock every FDA-approved contraceptive. If a
and counseling, as well as increased access for patients and
contraceptive is not readily available at an MTF, a referral
other health care providers to clinical consultants or
to another MTF or TRICARE provider is to be provided.
specialists that may be located at another MTF. Electronic
Prescriptions may be filled at an MTF, retail, or mail-order
prescriptions may also be generated through a tele-health
pharmacy.
appointment and transmitted to an MTF or retail pharmacy
for dispensing.
Are contraceptives available to deployed
servicemembers?
Figure 1 illustrates contraception use among female active
Deployed military personnel may also receive prescribed
duty servicemembers from 2012-2016. SARCs remained
contraceptives (up to 180-day supply) prior to their
the most prevalent method of contraception. LARC use
departure and while in-theater (90-day supply increments)
increased by 4.5% and was most common among those in
when subscribed to the Deployed Prescription Program
the Marine Corps (23.6%) and Navy (22.7%), rather than
(DPP). In-theater military health care providers are
the Air Force (19.5%) or the Army (16.5%).
authorized to issue new or renewal prescriptions that would
be filled through the DPP.
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Defense Health Primer: Contraceptive Services
Does the Affordable Care Act’s contraception
recommendations from various health care quality
coverage requirement apply to DOD?
organizations. In 2017, DOD began surveying military
The Patient Protection and Affordable Care Act’s (ACA;
personnel during annual periodic health assessments on
P.L. 111-148, §2713) requirement for private and certain
methods of contraception used. Similar survey questions are
employer-based health insurance plans to cover
included in the 2018 DOD Health Related Behavior Survey
contraceptive services at no cost, does not apply to DOD.
of Active Duty Military Personnel.
However, the Fiscal Year 2016 National Defense
Authorization Act (P.L. 114-92, §718) requires DOD to
Selected Issues for Congress
ensure that contraceptive services are available to female
Congress may consider legislation to address perceived
servicemembers during health care visits.
issues with regard to DOD contraceptive services:
Can DOD provide abortion services?
Lack of standardization in DOD health care provider
DOD is prohibited by 10 U.S.C. §1093 from directly
training plans, requirements, and curricula. DHA and
providing or paying for abortion services. In certain
the military services continue to develop their own
instances, DOD health care providers may perform, or its
training policies and lack a standardized plan to train all
health program may cover, abortion services if the “life of
DOD health care providers on these services.
the mother would be endangered if a fetus were carried to
Cost-sharing disparities between DOD and health
term or in a case in which the pregnancy is the result of an
insurance plans subject to ACA. Certain DOD
act of rape or incest.”
beneficiaries are required to cost-share certain
contraceptive services. This contrasts with ACA’s
Are all DOD health care providers trained on the
requirement for no cost-sharing of contraceptive
methods of contraception?
services offered by private and certain employer based
The Defense Health Agency (DHA) and each military
health insurance plans.
service medical department administers its own health care
Inconsistent access and delivery models of contraceptive
provider training on counseling and the methods of
services across the MHS. Clinic hours, delivery methods
contraception. That training is offered to all DOD health
(e.g., walk-in clinics, appointment-based clinics,
care providers, however, primary care, women’s health, and
outreach in nonmedical settings), and access policies
emergency medicine providers are often the most
vary by military service, potentially serving as a barrier
knowledgeable about contraceptive services. Health care
to care for DOD beneficiaries.
providers certified as sexual assault forensic examiners are
required to be trained on emergency contraception
Relevant Statutes and Policies
counseling and referral procedures for follow-up care.
10 U.S.C. §1074d – Certain Primary and Preventive Health
Care Services
Are all DOD health care providers required to
10 U.S.C. §1093 – Performance of Abortions: Restrictions
provide contraceptive services?
Defense Health Agency Interim Procedures Memorandum 16-
DOD policies allow for health care providers to opt-out of
003 – Clinical Practice Guidelines for Access to Methods of
delivering specific health care services if the health care
Contraception and Contraceptive Counseling
services contradict providers’ own religious or moral
beliefs. DOD and military service-specific policies
TRICARE Policy Manual 6010.60-M, Chapter 7, Section 2.3 –
encourage health care providers to register their objections
Family Planning
with their respective MTF leadership, disclose objections
(related to course of treatment) to their patients, and require
CRS Products
a transfer of patient care to another health care provider.
CRS Report R45399, Military Medical Care: Frequently Asked
MTF and TRICARE providers are also required to
Questions, by Bryce H. P. Mendez
“disclose to patients financial arrangements, contractual
restrictions, ownership of or interest in healthcare facilities,
CRS Report R44130, Federal Support for Reproductive Health
matters of conscience, or other factors that could influence
Services: Frequently Asked Questions, coordinated by Elayne J.
medical advice or treatment decisions.”
Heisler
How does DOD collect data on the use of
Other Resources
contraceptive services?
U.S. Centers for Disease Control and Prevention, CDC
DOD collects a wide range of administrative and clinical
Contraceptive Guidance for Health Care Providers, September 18,
data through its electronic health record systems, including
2017, https://go.usa.gov/xEaZ3
utilization and outcomes data on certain contraceptive
services. The MHS reviews individual and population
health metrics, monitors epidemiological trends, tracks
health care utilization, and implements health care
Bryce H. P. Mendez, Analyst in Defense Health Care
improvement initiatives. Collected data are used to monitor
Policy
approximately 90 quality measures relating to women’s
health, which are selected by MHS leaders based on
IF11109
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Defense Health Primer: Contraceptive Services
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