https://crsreports.congress.gov
February 19, 2019
Defense Health Primer: Contraceptive Services
The Department of Defense (DOD) operates a Military
Health System (MHS) that delivers certain health
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
that are recognized by the Food and Drug Administration
(FDA). 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: Plan B/Next Choice, Ella.
Counseling on the methods of contraception is also
available through tele-health. In general, DOD provides
scheduled or just-in-time tele-health services (e.g., secure
electronic messaging, video teleconferencing, mobile
applications) for clinical specialties such as primary care,
family medicine, and obstetrics/gynecology. These services
often provide additional opportunities for patient education
and counseling, as well as increased access for patients and
other health care providers to clinical consultants or
specialists that may be located at another MTF. Electronic
prescriptions may also be generated through a tele-health
appointment and transmitted to an MTF or retail pharmacy
for dispensing.
Figure 1 illustrates contraception use among female active
duty servicemembers from 2012-2016. SARCs remained
the most prevalent method of contraception. LARC use
increased by 4.5% and was most common among those in
the Marine Corps (23.6%) and Navy (22.7%), rather than
the Air Force (19.5%) or the Army (16.5%).
Figure 1. Contraceptive Use Among Female Active
Duty Servicemembers, 2012-2016
Source: Defense Health Agency, Medical Surveillance Monthly
Report, Contraception Among Active Component Service Women, U.S.
Armed Forces, 2012-2016, Vol. 24, No. 11, November 2017.
Notes: DOD did not report prevalence rates for barrier devices or
nonsurgical sterilization.
Patient Costs
Active duty military personnel incur no out-of-pocket costs
for contraceptive services. If a servicemember accesses
contraceptive services that are not directly provided,
referred by a DOD health care provider, or otherwise
covered by DOD, then they may be required to pay for
those services. 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 MTF clinical services vary by facility, they are not
required to stock every FDA-approved contraceptive. If a
contraceptive is not readily available at an MTF, a referral
to another MTF or TRICARE provider is to be provided.
Prescriptions may be filled at an MTF, retail, or mail-order
pharmacy.
Are contraceptives available to deployed
servicemembers?
Deployed military personnel may also receive prescribed
contraceptives (up to 180-day supply) 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 are
authorized to issue new or renewal prescriptions that would
be filled through the DPP.
