Melissa Price remembers the exact moment her third child was conceived.
She and her husband, both members of the U.S. Army, were stationed in Iraq and living together when their birth control method failed. “I can actually go to high schools and say, ‘It only takes one time [to get pregnant],” laughs Price, 40, whose name has been changed to protect her privacy.
But she wasn’t laughing then. Getting pregnant in theater — the military term for a war zone — is forbidden and socially taboo. “That’s the one thing you don’t want to do: You don’t want to get pregnant in theater,” says Price, who left her tour two months early due to the pregnancy. “I was mortified.”
While all couples can struggle to balance careers and kids, family planning for women in the military can be more complicated because they’re frequently deployed during their most fertile years.
That can mean becoming pregnant at the wrong time — or missing a fertility window altogether. “There are just some things that maybe [military moms] have to think about and deal with that maybe others don’t,” says Price, who now lives in Virginia and is in the U.S. Army Reserve. “But we put ourselves in that position.”
Deployed and Pregnant
A large majority of servicewomen are in their reproductive primes. Of the 2.2 million active duty members and ready reserve personnel in 2013, 16 percent were women and about 40 percent were under age 26, according to an article published this month in the journal Military Medicine. While birth control pills and some other forms of contraception are covered by the military (women are allowed a 180-day supply prior to deployment), access can be spotty, according to a 2013 study in the journal Contraception that found one-third of the 281 active duty servicewomen surveyed couldn’t get the type of birth control they wanted before deploying, and 41 percent had trouble refilling prescriptions on duty.
“[Contraception] may be a handful of condoms at the front desk,” says Dr. Elspeth Cameron Ritchie, a retired colonel and forensic psychiatrist who specializes in military, veterans and women’s health issues.
In effect, rates of unintended pregnancies among active duty servicewomen range between 50 percent and 62 percent — the same as the civilian population, the Military Medicine article reports. “When you’ve got young men and women together, sex happens,” consensual or not, says Ritchie, who urges the military to take birth control “much more seriously” by better educating service members during basic training and counseling women on long-term birth control options like IUDs. (Terminating the pregnancy isn’t a very accessible option: The military only covers abortion in cases of rape, incest and if the mother’s life is at risk. Women who want to pay for it themselves might have to return to the U.S. anyway to receive treatment safely and legally.)
Being pregnant while on active duty has consequences. For one, military medical personnel may not have the training or tools to treat pregnancy complications or emergencies. Price, for instance, was treated by a pediatrician before returning to the United States.
Pregnancy during deployment can also have a significant impact on women’s careers. If pregnant women are in a war zone, they must be “immediately evacuated,” Price says. In addition to time away, it can also cause “a lot of resentment” on the part of their fellow troops, who may assume the women get pregnant to get out, Ritchie says.
Fortunately for Price, who kept her pregnancy a secret for about one month until she was required to urinate in a cup, most comrades were supportive. “There were lots of people I never would have thought would have been OK [with me being pregnant], and they were writing me cards and saying, ‘Congrats,'” she remembers. “These people came out of the woodwork.”
Infertility After the Military
Dr. Wilma Larsen had been married about a year and a half before she was deployed to Bosnia in 1996 at age 33. Fertility — or the potential loss of it — was the last thing on her mind. “I never even thought about it,” says Larsen, a retired colonel who’s now an OB-GYN and assistant chair of the Department of Obstetrics and Gynecology at Scott & White Memorial Hospital in Temple, Texas.
But it’s a worthwhile consideration for young service members, says Larsen, who got pregnant post-deployment and now has 16-year-old twins. “There isn’t any data that would say you’ll be less fertile after deployment than you would be beforehand,” she says, “but if you think about some of the environmental issues that could occur, it makes sense that there could be an effect on fertility.”
What’s more, women can age out of their most fertile years while serving, and the increasing number in combat roles risk injuries that could compromise their ability to reproduce, says Dr. Gilbert L. Mottla, a reproductive endocrinologist and infertility specialist at Shady Grove Fertility, a fertility clinic with offices in the District of Columbia, Maryland, Virginia and Pennsylvania. “In a perfect world, we would counsel both men and women to consider fertility preservation before deployment,” he says.
But that doesn’t happen, Larsen says, in part because the physicians who work with military members pre-deployment aren’t typically OB-GYNs or infertility experts. The military also doesn’t cover egg freezing under most conditions, although that may changeif recommendationsfrom the Department of Defense’s Force of the Future program — an initiative to attract and keep military talent — are implemented, Larsen says.
“That will really improve women’s mental well-being [if] they don’t have to worry so much about trying to time their pregnancy perfectly,” Larsen says.
In the meantime, veterans who have trouble conceiving are out of luck if they want coverage from the Department of Veterans Affairs for in vitro fertilization — even if their infertility is due to a combat injury — thanks to an over-20-year-old law that Mottla and lawmakers are advocating to change. “IVF is a completely [different] treatment today — it’s highly successful, highly safe, the technology has rapidly increased since way back in the early 90s,” he says. Especially frustrating for veterans, Mottla adds, is the fact that military health care covers IVF for active duty members with certain injuries that compromise fertility, but once they phase into the VA system, that coverage is lost.
Until the VA catches up with the military health care system, Mottla says over 100 fertility clinics, including his, are providing “deeply discounted” care to veterans whose service-related injuries impaired their fertility. The program, offered by some clinics affiliated with the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology, is called Serving Our Veterans. “We have great success helping these young couples start their families,” says Mottla, noting that interested couples can find a participating clinic near them on an online database.
Ellen Smith hopes to become one like them. As a member of the U.S. Army, she always wanted to be a mom, but hadn’t found the right partner to make it a reality. (Dating in the military is a different story, she says.) When she turned 37 and really started to worry about her fertility declining, Operation Iraqi Freedom hit its high point. “It became a steady series of deployments,” says Smith, now a commander of a large Army organization whose name has been changed to protect her privacy. “I blinked my eyes, and then I was 41.”
So Smith froze her eggs — 80 of them — although she had to go outside of the military health care services to do so. She encourages other servicewomen to consider the option before deployment and the military to cover it in order to retain more female talent. “It’s kind of consistent with everything else we do before we deploy — you’re supposed to come up with plans, you’re supposed to work on your will and you’re supposed to talk to your family,” she says. “Cryopreservation is just good insurance.”
Military Motherhood
For Price and her husband, who now have four kids including their 7-year-old “Iraqi-made” son, the biggest challenge wasn’t getting pregnant — but raising kids throughout deployments and relocations. “Because we’re very transient, we don’t have as long an opportunity to build those roots [in the community],” which are even more important for single moms and dads, she says. Some military parents also have to deal with lifelong mental and physical wounds of war.
But often, military service can make moms more resilient, a phenomenon called post-traumatic growth, Ritchie says. “It used to be that you join the military to ‘make a man out of you,’ she says, but women now also reap the “growing and maturing” benefits of serving. “There’s a balance between ‘It’s difficult to be in the military and be a mother’ and overblowing that and providing fodder for ‘This is why women shouldn’t be in the military,'” she adds.
Price, for one, doesn’t regret anything. “I have lost something in terms of my relationship with my two oldest [kids],” because she was deployed at the time, she says. But, she adds, “I wouldn’t change it because I’ve led by example and shown my kids the importance of serving your country.”
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Military Fertility: It’s Complicated originally appeared on usnews.com