Photo Credit: Liudmila Chernetska

The following is a summary of “Decision and economic evaluation of abortion availability in the United States military,” published in the March 2025 issue of American Journal of Obstetrics & Gynecology by Gill et al. 

Restrictions on federal abortion funding force active-duty service women to seek civilian care, which is increasingly challenged by state bans, despite recent Department of Defense policies aimed at ensuring access.  

Researchers conducted a retrospective study to compare the cost-effectiveness and incidence of adverse maternal and neonatal outcomes in a hypothetical cohort of active-duty service women in abortion-restricted states, evaluating restricted access vs availability with Department of Defense travel support.  

They designed a decision tree model to compare abortion not available and abortion available cohorts among active-duty service women in abortion-restricted states. Cohorts were divided into normal pregnancies and those with a major fetal anomaly. Cost estimates, probabilities, and disability weights for abortion- and pregnancy-related health conditions were sourced from the literature. Effectiveness was measured in disability-adjusted life years, using a willingness-to-pay threshold of $1,00,000 per disability-adjusted life year gained or averted. Probabilistic sensitivity analyses with 10,000 simulations assessed result robustness. Secondary outcomes included stillbirths, neonatal deaths, neonatal intensive care unit admissions, maternal deaths, severe maternal morbidities, and first- and second-trimester abortions.  

The results showed that the abortion not available cohort had a higher annual military cost ($299.1 million, 95% CI 239.2–386.6) than the abortion available cohort ($226.0 million, 95% CI 181.9–288.5) and was associated with 203 more disability-adjusted life years. The incremental cost-effectiveness ratio favored abortion availability. Abortion not available led to an additional 7 stillbirths, 1 neonatal death, 112 neonatal intensive care unit admissions, 0.016 maternal deaths, and 24 severe maternal morbidities annually. It also resulted in 27 fewer second-trimester abortions and 602 fewer first-trimester abortions. Probabilistic sensitivity analysis indicated a greater than 95% likelihood that abortion availability was the more cost-effective strategy.  

Investigators concluded that restricting abortion access for active-duty service women leads to increased military costs and worsened maternal and neonatal outcomes. 

Source: ajog.org/article/S0002-9378(24)00906-2/abstract