Defense Health Primer: Selected Contraceptive Services

Defense Health Primer: Selected Contraceptive Services

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Updated February 17, 2023
Defense Health Primer: Selected Contraceptive Services
The Fiscal Year 2016 National Defense Authorization Act
certain members of the reserve component, may be subject
(P.L. 114-92, §718) requires the Department of Defense
to cost-sharing based on their TRICARE health plan,
(DOD) to make contraceptive services available to all
beneficiary category, and type of medical service received.
female active duty servicemembers. DOD regulations make
Are all contraceptive methods available at every
these services available to all Military Health System
military treatment facility?
(MHS)-eligible beneficiaries. DOD operates the MHS,
Since clinical services and formularies vary by facility,
which delivers certain health entitlements under Chapter 55
MTFs are not required to stock every FDA-approved
of Title 10, U.S. Code, to beneficiaries that include military
contraceptive. If a contraceptive is not readily available at
personnel, retirees, and their families. Health care services
an MTF, a provider is to refer the patient to another MTF or
are available through DOD-operated hospitals and clinics,
TRICARE provider. Prescriptions may be filled at an MTF,
collectively called military treatment facilities (MTFs), or
retail, or mail-order pharmacy.
through civilian health care providers participating in the
TRICARE program.
Are contraceptives available to deployed
What are contraceptive services and which does
servicemembers?
DOD offer?
Deployed military personnel may receive prescribed
The U.S. Centers for Disease Control and Prevention
contraceptives (up to 180-day supply) and related
(CDC) defines contraceptives as medical procedures,
counseling prior to their departure and while in-theater (90-
products, drugs, or services designed to “minimiz[e] the
day supply increments) when subscribed to the Deployed
risk for an unintended pregnancy.” DOD offers counseling
Prescription Program (DPP). In-theater military health care
and contraception methods in accordance with the CDC’s
providers may also issue new or renewal prescriptions that
medical eligibility and selected practice recommendations.
would be filled through the DPP.
MTFs and TRICARE providers only offer methods of
Does the Affordable Care Act’s contraception
contraception that the Food and Drug Administration
coverage requirement apply to DOD?
(FDA) recognizes. These include:
The Patient Protection and Affordable Care Act’s (ACA;
 Short-Acting Reversible Contraceptives (SARCs): oral
P.L. 111-148, §2713) requirement for private and certain
contraceptive, patch, vaginal ring, injection;
employer-based health insurance plans to cover
 Long-Acting Reversible Contraceptives (LARCs):
contraceptive services at no cost, does not apply to DOD.
intrauterine device, implantable rod;

Can DOD provide abortion services?
Barriers: diaphragm, cervical cap, sponge, male/female
Title 10, Section 1093 of the U.S. Code prohibits DOD
condom;

from directly providing or paying for abortion services. In
Sterilization: male/female surgical sterilization,
certain instances, DOD may perform or pay for abortion
permanent implant; and

services if the “life of the mother would be endangered if
Emergency Contraceptives: oral pills (i.e., Plan B One-
the fetus were carried to term or in a case in which the
Step or Ella).
pregnancy is the result of an act of rape or incest.”
Beneficiaries may obtain FDA-approved contraceptives and
Does DOD train its health care providers on the
related counseling through scheduled or walk-in visits, or
methods of contraception offered in MTFs?
through telehealth services (e.g., secure electronic
The Defense Health Agency (DHA) offers training for all
messaging, video teleconferencing, mobile applications)
DOD health care providers on counseling and the methods
with their primary care provider or other appropriate
of contraception offered in MTFs. DOD policy also
clinician. Electronic prescriptions may also be generated
requires health care providers certified as sexual assault
through a telehealth appointment and transmitted to an
forensic examiners to be trained on emergency
MTF or retail pharmacy for dispensing.
contraception counseling and referral procedures for
Figure 1 illustrates contraception use in 2017-2021 among
follow-up care.
female active duty servicemembers of childbearing age
Are all DOD health care providers required to
(i.e., 17 to 49). In 2021, SARCs (23.4%) and LARCs
provide contraceptive services?
(22.4%) were the prevalent methods of contraception
DOD policies allow for a health care provider to opt-out of
among female active duty servicemembers, followed by
delivering specific health care services if those services
surgical sterilization (3.0%), counseling only (2.1%), and
contradict a provider’s own religious or moral beliefs.
emergency contraception (1.1%).
These policies direct health care providers to register their
Patient Costs
objections with their respective MTF leadership, disclose
In general, active duty military personnel incur no out-of-
objections (related to course of treatment) to their patients,
pocket costs for contraceptive services from a DOD or
and transfer patient care to another health care provider.
TRICARE provider. Other DOD beneficiaries, including
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Defense Health Primer: Selected Contraceptive Services
Figure 1. Contraceptive Use Among Female Active-Duty Servicemembers, 2017-2021

Source: CRS graphic based on analysis of DHA data, July 2022.
Notes: DHA’s data methodology stated that “women who used multiple types of contraceptives during a given calendar year were assigned to
one of four mutual y exclusive groups, with group assignment as follows (in decreasing order of priority): permanent sterilization, LARCs,
SARCs, and contraceptive counseling. Emergency contraception use was measured independently from the other categories of contraceptives.”
DHA did not report prevalence rates for barrier devices.
DOD policies also require MTF and TRICARE to “disclose
contraception education campaign” to enhance
to patients financial arrangements, contractual restrictions,
awareness of available services, expand publicly
ownership of or interest in healthcare facilities, matters of
displayed information, and improve online resources
conscience, or other factors that could influence medical
and assistance for beneficiaries experiencing difficulties
advice or treatment decisions.”
accessing reproductive health care. Oversight
How does DOD collect data on the use of
considerations for Congress could include monitoring
contraceptive services?
DOD implementation of these initiatives and their
effects on access to care and beneficiary satisfaction.
DOD collects administrative and clinical data through its
electronic health record systems, including utilization and
Relevant Statutes and Policies
outcomes data on certain contraceptive services. DOD also
collects contraception-related data on individual and
10 U.S.C. §1074d – Certain Primary and Preventive Health
population health metrics, epidemiological trends, health
Care Services
care utilization, and health care improvement initiatives.
32 C.F.R. §199.4(e)(3) – Family Planning
DOD uses these data to monitor “process and outcome
DHA Procedural Instruction 6200.02 – Comprehensive
metrics that address progress toward the achievement” of
Contraceptive Counseling and Access to the Ful Range of
the Department of Health and Human Services’ Healthy
Methods of Contraception
People 2030 objectives for family planning. DOD also
surveys military personnel on contraception use during the
DHA Administrative Instruction 6025.09 – Walk-in
individual’s yearly Periodic Health Assessment. Similar
Contraception Services at Military Medical Treatment Facilities
questions were included in the 2020 DOD Women’s
TRICARE Policy Manual 6010.60-M, Chapter 7, Section 2.3 –
Reproductive Health Survey and the 2018 DOD Health
Family Planning
Related Behavior Survey of active and reserve

servicemembers.
CRS Products
Selected Issues for Congress
CRS Report R45399, Military Medical Care: Frequently Asked
 Cost-sharing disparities between DOD and health
Questions, by Bryce H. P. Mendez
insurance plans subject to ACA. Some DOD
CRS Report R46785, Federal Support for Reproductive Health
beneficiaries are required to share certain costs of
Services: Frequently Asked Questions, coordinated by Elayne J.
contraceptive services. This contrasts with ACA’s
Heisler and Taylor R. Wyatt
requirement for private and certain employer-based
health insurance plans to provide contraceptive services
Other Resources
at no cost to the patient. Congress could consider
U.S. Centers for Disease Control and Prevention, CDC
legislation to address these beneficiary cost-sharing
Contraceptive Guidance for Health Care Providers, May 20, 2021
disparities.
 DOD’s “Ensuring Access to Reproductive Health
U.S. Army Captain Elena Spielmann contributed research
Care” Initiatives. In October 2022, the Secretary of
and analysis to this product while at CRS.
Defense issued a memorandum that affirmed the
Department’s policy of offering “comprehensive access
Bryce H. P. Mendez, Analyst in Defense Health Care
to contraception and family planning services.” The
Policy
memo also directed DOD to conduct a “comprehensive
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Defense Health Primer: Selected Contraceptive Services

IF11109

Disclaimer
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