![handle is hein.crs/govekqc0001 and id is 1 raw text is: Congressional Research Service
Inforrning the legislative debate since 1914
Updated February 17, 2023
Defense Health Primer: Selected Contraceptive Services
The Fiscal Year 2016 National Defense Authorization Act
(P.L. 114-92, §718) requires the Department of Defense
(DOD) to make contraceptive services available to all
female active duty servicemembers. DOD regulations make
these services available to all Military Health System
(MHS)-eligible beneficiaries. DOD operates the MHS,
which delivers certain health entitlements under Chapter 55
of Title 10, U.S. Code, to beneficiaries that include military
personnel, retirees, and their families. Health care services
are available through DOD-operated hospitals and clinics,
collectively called military treatment facilities (MTFs), or
through civilian health care providers participating in the
TRICARE program.
What are contraceptive services and which does
DOD offer?
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 offers counseling
and contraception methods in accordance with the CDC's
medical eligibility and selected practice recommendations.
MTFs and TRICARE providers only offer methods of
contraception that the Food and Drug Administration
(FDA) recognizes. These include:
* Short-Acting Reversible Contraceptives (SARCs): oral
contraceptive, patch, vaginal ring, injection;
* Long-Acting Reversible Contraceptives (LARCs):
intrauterine device, implantable rod;
* Barriers: diaphragm, cervical cap, sponge, male/female
condom;
* Sterilization: male/female surgical sterilization,
permanent implant; and
* Emergency Contraceptives: oral pills (i.e., Plan B One-
Step or Ella).
Beneficiaries may obtain FDA-approved contraceptives and
related counseling through scheduled or walk-in visits, or
through telehealth services (e.g., secure electronic
messaging, video teleconferencing, mobile applications)
with their primary care provider or other appropriate
clinician. Electronic prescriptions may also be generated
through a telehealth appointment and transmitted to an
MTF or retail pharmacy for dispensing.
Figure 1 illustrates contraception use in 2017-2021 among
female active duty servicemembers of childbearing age
(i.e., 17 to 49). In 2021, SARCs (23.4%) and LARCs
(22.4%) were the prevalent methods of contraception
among female active duty servicemembers, followed by
surgical sterilization (3.0%), counseling only (2.1%), and
emergency contraception (1.1%).
Patient Costs
In general, active duty military personnel incur no out-of-
pocket costs for contraceptive services from a DOD or
TRICARE provider. Other DOD beneficiaries, including
certain members of the reserve component, may be subject
to cost-sharing based on their TRICARE health plan,
beneficiary category, and type of medical service received.
Are all contraceptive methods available at every
military treatment facility?
Since clinical services and formularies vary by facility,
MTFs are not required to stock every FDA-approved
contraceptive. If a contraceptive is not readily available at
an MTF, a provider is to refer the patient to another MTF or
TRICARE provider. Prescriptions may be filled at an MTF,
retail, or mail-order pharmacy.
Are contraceptives available to deployed
servicemem bers?
Deployed military personnel may receive prescribed
contraceptives (up to 180-day supply) and related
counseling prior to their departure and while in-theater (90-
day supply increments) when subscribed to the Deployed
Prescription Program (DPP). In-theater military health care
providers may also issue new or renewal prescriptions that
would be filled through the DPP.
Does the Affordable Care Act's contraception
coverage requirement apply to DOD
The Patient Protection and Affordable Care Act's (ACA;
P.L. 111-148, §2713) requirement for private and certain
employer-based health insurance plans to cover
contraceptive services at no cost, does not apply to DOD.
Can DOD provide abortion services?
Title 10, Section 1093 of the U.S. Code prohibits DOD
from directly providing or paying for abortion services. In
certain instances, DOD may perform or pay for abortion
services if the life of the mother would be endangered if
the fetus were carried to term or in a case in which the
pregnancy is the result of an act of rape or incest.
Does DOD train its health care providers on the
methods of contraception offered in MTFs?
The Defense Health Agency (DHA) offers training for all
DOD health care providers on counseling and the methods
of contraception offered in MTFs. DOD policy also
requires health care providers certified as sexual assault
forensic examiners to be trained on emergency
contraception counseling and referral procedures for
follow-up care.
Are all DOD health care providers required to
provide contraceptive services?
DOD policies allow for a health care provider to opt-out of
delivering specific health care services if those services
contradict a provider's own religious or moral beliefs.
These policies direct health care providers to register their
objections with their respective MTF leadership, disclose
objections (related to course of treatment) to their patients,
and transfer patient care to another health care provider.](ViewImageLocal?handle=hein.crs/govekqc0001&div=1&collection=&method=preview&ext=.png&size=3)
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