Before then, even if not technically in “combat positions,” women were still sent to dangerous areas. Ritchie earned three combat patches for providing medical care during her deployments. When in Somalia in the ’90s and Iraq in the ‘00s, “I wasn’t officially fighting, but I was in the middle of it, carrying a weapon,” she says.
Now an advocate of military women’s health, Ritchie, who makes it clear she speaks for herself, not the Veteran’s Association or Department of Defense, is vocal about addressing the logistical and sanitation needs of active service members with periods.
TRICARE, the primary health-care provider for armed-service members, technically offers these contraceptive methods. A 2016 reanalysis of previous research published in Military Medicine, however, found enlistees’ access to menstrual suppressors doesn’t always pan out.
One 2013 study included in the review was published by Daniel Grossman. An obstetrician/gynecologist at the University of California San Francisco, Grossman was at the time working with Ibis Reproductive Health, an organization that promotes the availability of contraceptives worldwide. In a survey he did of 281 service women, 71 percent said they used contraception for menstrual cycle control. While 58 percent thought contraception was easy or somewhat easy to get during deployment, 33 percent of women said they couldn’t access the birth control method they wanted. Of those who used contraceptives, 24 percent brought enough to last their entire deployment. Forty-one percent of those needing refills found them difficult to obtain.
Grossman’s team dug into the reasons why in a smaller set of 22 in-depth interviews published in 2014. The military provides service members with three months worth of medication up-front. The average army deployment is 12 months, so to fill that gap, soldiers are told to use an on-base pharmacy or the TRICARE mail-order service for drug delivery. Grossman’s respondents didn’t always find this advice practical. Remote areas, extensive travel, or trouble transferring civilian prescriptions over to TRICARE sometimes kept them from getting the supplies they needed. Similarly, a study published in 2011 found that 66 percent of soldiers in settings with little privacy and few sanitary disposal options wanted to use birth control pills for menstrual suppression, but only 21 percent were able to use them for their entire deployment.
LARCs were also underused. Some women in Grossman’s 2013 study reported being denied an implant because of an outdated belief the devices were unsafe for young women or those who hadn’t had kids. Though the Centers for Disease Control stated for the first time that the devices were safe for young women in 2010, Grossman says, “practice lags behind.”
Admittedly, for service members, finding the right time for LARC insertion can be tricky, Grossman says. IUDs can cause cramping and discomfort for some people, which enlistees don’t have time for during rigorous basic training. As soon as that phase is over, people are sent to their stations in the U.S. or abroad, which may or may not have medical personnel trained to implant LARCs.