• abortion, induced
• contraception behavior
• general practice
• Health Policy
• Health Services Accessibility
• Patient Safety

The number of women in the United Kingdom (UK) armed forces (AF) is rising each year, with women currently representing 11.7% of the regular military; people who work full-time for the AF.1 The UK Government has set ambitious targets to increase this to 30% by 2030 in the wake of the Atherton Report, which highlighted that the military is “still a man’s world”.2 Servicewomen are a population that are easily overlooked when it comes to women’s health provision and research. They are a minority in a large organisation, and highly mobile, with frequent postings and deployments, which may affect their healthcare delivery. For example, during pregnancy, they must register with a National Health Service (NHS) midwife for care therefore their maternity records are not saved on the military system, making them vulnerable to falling between services.

Around 4.5% of servicewomen become pregnant each year and 98% of UK AF women are of reproductive age, therefore prevention of unintended pregnancy and pregnancy care are issues that servicewomen face.1 Of all pregnancies in the UK, 47% are unintended and, of these, 36% end in an abortion.3 In the United States (US), servicewomen have a disproportionally higher rate of unintended pregnancy but lower abortion rates than the general population.4 Table 1 outlines key themes identified from the US literature on abortion rates, access and factors leading to abortion.

Abortion care provision and legislation varies throughout the UK, and the intricacies are outwith the scope of this letter. Importantly, abortion care is not provided in UK military health facilities, and servicewomen requiring an abortion in the UK need to access this via the NHS in their local area.

In the military, healthcare can be divided into the firm base (when servicepeople are in their home country) and deployed. When in their firm base, the US use Tricare, an insurance provider, which does not cover the cost of an abortion, except in cases of rape, incest or life endangerment. When in the UK firm base, healthcare is provided via the NHS, where abortions are free of charge. When deployed overseas, US servicewomen can access abortions at Role 1 facilities, a place where servicepeople can access primary and emergency care, but only in cases of rape, incest or life endangerment. This results in many US servicewomen paying out of pocket for abortions. UK deployed Role 1 facilities do not provide abortion care, and if someone is pregnant while deployed, they must be medically evacuated back to the UK for ongoing care, regardless of their preference for the pregnancy.

There is a paucity of published data on abortion rates, access to and factors driving the need for abortion care in UK servicewomen. We can extrapolate from the US servicewomen data, as many of the driving factors are likely to be similar for UK servicewomen. However, it is important to acknowledge that there are multiple disparities in the healthcare provision in the US compared with the UK. This paucity of knowledge represents an inattention to UK servicewomen and their access to vital reproductive care. Abortion care must be considered as a component of holistic military medicine. As abortion care is carried out by the NHS, it is imperative that on initial registration we ask if the patient is a serviceperson, to allow us to collect data on rates and access. Analysis of this data will aid us in ensuring that UK servicewomen can access safe, legal and free abortions whenever they require them.