UK Armed Forces servicewomen face unique set of hurdles for abortion access/care

UK Armed Forces servicewomen needing an abortion face a unique set of hurdles around access and care, as well as stigma and judgemental attitudes from senior (usually male) colleagues, indicates the first study of its kind, published online in the journal BMJ Sexual & Reproductive Health.

Although based on a relatively low response rate, the findings prompt the researchers to call for more information and policy on abortion provision, both for service personnel and military healthcare professionals.

In the UK around 1 in 3 women will have an abortion by the age of 45. But despite women making up almost 12% of the UK Armed Forces, anecdotal evidence indicates that their gender specific health needs are not being met while on active service, explain the researchers.

In the absence, worldwide, of published research and policy on abortion care in the Armed Forces, the researchers set out to glean the experiences of UK servicewomen to build on the evidence base and inform optimal practice.

They particularly wanted to understand the impact of being in the military on abortion decision-making and uncover any barriers to accessing care.

They circulated an online survey to UK servicewomen between March and April 2024. Respondents were asked whether they had ever had an abortion, what perceived barriers to accessing abortion care they had encountered, and if their abortion(s) were carried out during military service. Space for additional free text comments was provided. 

Those reporting personal experience of abortion were additionally asked about the effect of service on the decision and chosen method, their aftercare, and the involvement of the primary care provider for the UK Armed Forces (Defence Primary Healthcare). 

In all, 427 women from all ranks and all 3 services completed the survey: Royal Navy (134, 31.5%); Army (176, 41.5%); Royal Air Force (115. 21%). Most (60%, 307) were officers or other senior ranks.

In all, the responses represented just over 2.5% of the 16290 women serving in the UK Armed Forces as of October 2023.

Some 124 (29%) respondents said they had had an abortion, most of whom (102, 83%) had done so during military service. Of these, 12% were deployed overseas at the time while around half said that being in the military had affected their decision to have an abortion.

“In these cases, there was a knowledge that pregnancy-related employment restrictions (known as downgrading) may prevent their continued professional development. In many cases, the perception of pregnancy impacting on promotion prospects was cited as a reason for favouring abortion,” explain the researchers.

For all respondents, over half (224, 52.5%) felt there were barriers to accessing abortion care in the UK Armed Forces.

There were 476 free text responses to the open questions, from which 4 key themes emerged: life in the military; trust in information holders; influencers, barriers and access; and systemic lack of awareness.

Respondents said the constant moving about and overseas deployment made it difficult to access services. Others commented on the lack of privacy in shared living quarters and the incompatibility of motherhood with service and deployment needs without family support nearby. 

“Respondents reported the male-dominated environment made it harder to discuss women’s health issues in general and there was a perception that the predominantly male chain of command (CoC) lacked sufficient knowledge,” note the researchers.

Some respondents felt stigmatised and judged and didn’t trust their military healthcare professionals or chain of command to respect confidentiality.

“Several respondents reported experiences of misogyny, which further compounded a lack of trust,” write the researchers.

A systemic and personal lack of information and guidance was mentioned by several respondents, who felt that they didn’t know how to go about accessing abortion care while in service and that there was no aftercare available to deal with such a distressing experience.

“Beyond general ignorance, there was a specific perception that both the [chain of command] and [healthcare professionals] were poorly informed about abortion. Participants commented that when accessing healthcare they received negative comments and judgement from [healthcare professionals], or an uncertainty about local processes for access,” point out the researchers.

“The general lack of awareness about abortion led to increased stress for respondents and it was felt that this worsened the psychological impact of abortion for some people. It was reported that there is minimal formal policy on abortion and aftercare, compared with pregnancy, and this created uncertainty about access, appropriate employment restrictions (duration and type), and future career implications,” they add.

The researchers acknowledge that the response rate was low, with several addressees not distributing the survey due to concerns about the appropriateness of the topic. And abortion can be an emotive topic, meaning that those with strong views might have been more likely to respond, they add.

Further work is required to build on the findings and deepen understanding, they emphasise, but suggest that similar barriers may exist in other uniformed or male dominated  environments, or those with occupational health considerations, such as the police or the aviation industry. 

And they conclude:  “Although military medical services do not provide abortions in the UK, they, and the wider military, should be striving to ensure that they facilitate all aspects of comprehensive abortion care for servicewomen. 

“There is an opportunity for the UK [Armed Forces] to lead the way in breaking the organisational silence around abortion care through creating accessible, robust policies and dissemination of evidence-based information for all stakeholders.” 

Citing previously published research, they insist: “Ultimately, women must not be ‘denied comprehensive reproductive care because they have had the courage to join the military and protect the freedoms afforded others by their service’.”

*Lead researcher Dr Victoria Kincaid comments: ”This study has highlighted a need for greater support and awareness of abortion for all in the UK Armed Forces.”

She adds: "Since our analysis of the survey results, we have worked with a small team of women’s health experts in Defence to create an abortion information leaflet for service personnel and are in the process of creating a similar one for line managers. We have also written best practice guidelines on abortion and have talked to abortion providers to highlight the potential barriers that service personnel may face when accessing abortion care."