I 

113TH CONGRESS 

2D SESSION H. R. 5524 

To amend title 10, United States Code, to ensure that women members 

of the Armed Forces and their families have access to the contraception 

they need in order to promote the health and readiness of all members 

of the Armed Forces, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 17, 2014 

Ms. SPEIER (for herself, Ms. DEGETTE, Ms. SLAUGHTER, Ms. DELAURO, Ms. 

BROWN of Florida, Mr. RANGEL, Ms. CLARK of Massachusetts, Mr. 

MCGOVERN, Ms. JACKSON LEE, Mr. GRIJALVA, Ms. DELBENE, Mrs. 

NAPOLITANO, Ms. MCCOLLUM, Mr. HASTINGS of Florida, Ms. NORTON, 

Mrs. CAPPS, Ms. CLARKE of New York, Mr. BLUMENAUER, Mr. DEFAZIO, Ms. LOFGREN, Ms. LINDA T. SA ́NCHEZ of California, Mr. LARSEN

of Washington, Ms. MOORE, Ms. HAHN, Mr. CARSON of Indiana, Mr. 

CICILLINE, Ms. LEE of California, Mr. BERA of California, Mr. COHEN, 

Mr. QUIGLEY, Ms. PINGREE of Maine, Mr. ELLISON, Ms. CASTOR of 

Florida, Mr. DELANEY, Ms. TSONGAS, Ms. BONAMICI, Mr. LOEBSACK, 

Ms. MATSUI, Mr. HONDA, Mr. POCAN, Ms. CHU, Mrs. CAROLYN B. 

MALONEY of New York, Mr. HIMES, Mr. LOWENTHAL, Mr. RUIZ, Mr. 

KILMER, Mr. PETERS of California, Ms. KUSTER, Ms. BROWNLEY of 

California, Mr. BISHOP of New York, Ms. ESTY, Ms. SCHAKOWSKY, Mr. 

TAKANO, Mr. JOHNSON of Georgia, Ms. TITUS, Ms. SHEA-PORTER, Ms. 

WASSERMAN SCHULTZ, Ms. FUDGE, Mr. SHERMAN, Mr. BRADY of Pennsylvania, and Mr. THOMPSON of California) introduced the following bill; 

which was referred to the Committee on Armed Services 

A BILL 

To amend title 10, United States Code, to ensure that 

women members of the Armed Forces and their families 

have access to the contraception they need in order to 


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promote the health and readiness of all members of 

the Armed Forces, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Access to Contracep5 tion for Women Servicemembers and Dependents Act of 

6 2014’’. 

7 SEC. 2. FINDINGS. 

8 Congress makes the following findings: 

9 (1) Women are serving in the Armed Forces at 

10 increasing rates, playing a critical role in the na11 tional security of the United States. More than 

12 350,000 women serve on active duty in the Armed 

13 Forces or in the Selected Reserve. 

14 (2) Nearly 10,000,000 members of the Armed 

15 Forces (including members of the National Guard 

16 and Reserves), military retirees, their families, their 

17 survivors, and certain former spouses, including 

18 nearly 5,000,000 female beneficiaries, are eligible for 

19 health care through the Department of Defense. 

20 (3) Contraception is critical for women’s health 

21 and is highly effective at reducing unintended preg22 nancy. The Centers for Disease Control and Preven23 tion describe contraception as one of the 10 greatest 

24 public health achievements of the twentieth century. 


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1 (4) Contraception has played a direct role in 

2 the greater participation of women in education and 

3 employment. Increased wages and increased control 

4 over reproductive decisions provide women with edu5 cational and professional opportunities that have in6 creased gender equality over the decades since con7 traception was introduced. 

8 (5) Studies have shown that when cost barriers 

9 to the full range of methods of contraception are 

10 eliminated, and women receive comprehensive coun11 seling on the various methods of contraception (in12 cluding highly effective Long-Acting Reversible Con13 traceptives (LARCs)), rates of unintended preg14 nancy decline dramatically. 

15 (6) Research has also shown that investments 

16 in effective contraception save public and private 

17 dollars. 

18 (7) The 2011 recommendations of the Institute 

19 of Medicine on women’s preventive health services 

20 include recommendations that health insurance plans 

21 cover all methods of contraception approved by the 

22 Food and Drug Administration, sterilization proce23 dures, and patient education and counseling for all 

24 women with reproductive capacity without any cost25 sharing requirements. 


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1 (8) The recommendations described in para2 graph (7) are reflected in provisions of the Patient 

3 Protection and Affordable Care Act (Public Law 

4 111–148), and thus group and individual health in5 surance plans must provide such coverage. The rec6 ommendations have also been adopted by the Office 

7 of Personnel Management, and thus all health insur8 ance plans that are part of the Federal Employees 

9 Health Benefits Program must provide such cov10 erage. 

11 (9) Under the TRICARE program, service12 women on active duty have full coverage of all pre13 scription drugs, including contraception, without 

14 cost-sharing requirements. However, servicewomen 

15 not on active duty, and female dependents of mem16 bers of the Armed Forces, who receive health care 

17 through the TRICARE program do not have similar 

18 coverage of all prescription methods of contraception 

19 approved by the Food and Drug Administration 

20 without cost-sharing. 

21 (10) Studies indicate that servicewomen need 

22 comprehensive counseling for pregnancy prevention, 

23 particularly in their predeployment preparations, 

24 and the lack thereof is contributing to unintended 

25 pregnancies among servicewomen. 


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1 (11) An analysis by Ibis Reproductive Health of 

2 the 2008 Survey of Health Related Behaviors among 

3 Active Duty Military Personnel found a high unin4 tended pregnancy rate among servicewomen. Adjust5 ing for the difference between age distribution in the 

6 Armed Forces and the general population, the rate 

7 of unintended pregnancy among servicewomen is 

8 higher than for the general population. 

9 (12) With the integrated use of electronic med10 ical records throughout the Department of Defense, 

11 the technological infrastructure exists to develop 

12 clinical decision support tools. These tools, which are 

13 incorporated into the electronic medical record, allow 

14 for a point-of-care feedback loop that can be used to 

15 enhance patient decisionmaking, case and patient 

16 management, and care coordination. Benefits of clin17 ical decision support tools include increased quality 

18 of care and enhanced health outcomes, improved ef19 ficiency, and provider and patient satisfaction. 

20 (13) The Defense Advisory Committee on 

21 Women in the Services (DACOWITS) has rec22 ommended that all the Armed Forces, to the extent 

23 that they have not already, implement initiatives 

24 that inform servicemembers of the importance of 

25 family planning, educate them on methods of contraVerDate Sep 11 2014 04:15 Sep 24, 2014 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5524.IH H5524

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1 ception, and make various methods of contraception 

2 available, based on the finding that family planning 

3 can increase the overall readiness and quality of life 

4 of all members of the military. 

5 (14) Health care, including family planning for 

6 survivors of sexual assault in the Armed Forces is 

7 a critical issue. Servicewomen on active duty report 

8 rates of unwanted sexual contact at approximately 

9 16 times those of the comparable general population 

10 of women in the United States. Through regulations, 

11 the Department of Defense already supports a policy 

12 of ensuring that servicewomen who are sexually as13 saulted have access to emergency contraception. 

14 SEC. 3. CONTRACEPTION COVERAGE PARITY UNDER THE 

15 TRICARE PROGRAM. 

16 (a) IN GENERAL.—Section 1074d of title 10, United 

17 States Code, is amended— 

18 (1) in subsection (a), by inserting ‘‘FOR MEM19 BERS AND FORMER MEMBERS’’ after ‘‘SERVICES

20 AVAILABLE’’; 

21 (2) by redesignating subsection (b) as sub22 section (d); and 

23 (3) by inserting after subsection (a) the fol24 lowing new subsections: 


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1 ‘‘(b) CARE RELATED TO PREVENTION OF PREG2 NANCY.—Female covered beneficiaries shall be entitled to 

3 care related to the prevention of pregnancy described by 

4 subsection (d)(3). 

5 ‘‘(c) PROHIBITION ON COST-SHARING FOR CERTAIN

6 SERVICES.—Notwithstanding section 1074g(a)(6) of this 

7 title or any other provision of law, cost-sharing may not 

8 be imposed or collected for care related to the prevention 

9 of pregnancy provided pursuant to subsection (a) or (b), 

10 including for any method of contraception provided, 

11 whether provided through a facility of the uniformed serv12 ices, the TRICARE retail pharmacy program, or the na13 tional mail-order pharmacy program.’’. 

14 (b) CARE RELATED TO PREVENTION OF PREG15 NANCY.—Subsection (d)(3) of such section, as redesig16 nated by subsection (a)(2) of this section, is further 

17 amended by inserting before the period at the end the fol18 lowing: ‘‘(including all methods of contraception approved 

19 by the Food and Drug Administration, sterilization proce20 dures, and patient education and counseling in connection 

21 therewith)’’. 

22 (c) CONFORMING AMENDMENT.—Section 

23 1077(a)(13) of such title is amended by striking ‘‘section 

24 1074d(b)’’ and inserting ‘‘section 1074d(d)’’. 


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1 SEC. 4. ACCESS TO BROAD RANGE OF METHODS OF CON2 TRACEPTION APPROVED BY THE FOOD AND 

3 DRUG ADMINISTRATION FOR MEMBERS OF 

4 THE ARMED FORCES AND MILITARY DEPEND5 ENTS AT MILITARY TREATMENT FACILITIES. 

6 (a) IN GENERAL.—Commencing not later than 180 

7 days after the date of the enactment of this Act, the Sec8 retary of Defense shall ensure that every military treat9 ment facility has a sufficient stock of a broad range of 

10 methods of contraception approved by the Food and Drug 

11 Administration, as recommended by the Centers for Dis12 ease Control and Prevention and the Office of Population 

13 Affairs of the Department of Health and Human Services, 

14 to be able to dispense at any time any such method of 

15 contraception to any women members of the Armed 

16 Forces and female covered beneficiaries who receive care 

17 through such facility. 

18 (b) COVERED BENEFICIARY DEFINED.—In this sec19 tion, the term ‘‘covered beneficiary’’ has the meaning 

20 given that term in section 1072(5) of title 10, United 

21 States Code. 

22 SEC. 5. COMPREHENSIVE STANDARDS AND ACCESS TO 

23 CONTRACEPTION COUNSELING FOR MEM24 BERS OF THE ARMED FORCES. 

25 (a) PURPOSE.—The purpose of this section is to en26 sure that all health care providers employed by the DeVerDate Sep 11 2014 04:15 Sep 24, 2014 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5524.IH H5524

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1 partment of Defense who provide care for women members 

2 of the Armed Forces, including general practitioners, are 

3 provided, through clinical practice guidelines, the most 

4 current evidence-based and evidence-informed standards 

5 of care with respect to methods of contraception and coun6 seling on methods of contraception. 

7 (b) CLINICAL PRACTICE GUIDELINES.— 

8 (1) IN GENERAL.—Not later than one year 

9 after the date of the enactment of this Act, the Sec10 retary of Defense shall compile clinical practice 

11 guidelines for health care providers described in sub12 section (a) on standards of care with respect to 

13 methods of contraception and counseling on methods 

14 of contraception for women members of the Armed 

15 Forces. 

16 (2) SOURCES.—The Secretary shall compile 

17 clinical practice guidelines under this subsection 

18 from among clinical practice guidelines established 

19 by appropriate health agencies and professional or20 ganizations, including the following: 

21 (A) The United States Preventive Services 

22 Task Force. 

23 (B) The Centers for Disease Control and 

24 Prevention. 


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1 (C) The Office of Population Affairs of the 

2 Department of Health and Human Services. 

3 (D) The American College of Obstetricians 

4 and Gynecologists. 

5 (E) The Association of Reproductive 

6 Health Professionals. 

7 (F) The American Academy of Family 

8 Physicians. 

9 (G) The Agency for Healthcare Research 

10 and Quality. 

11 (3) UPDATES.—The Secretary shall from time 

12 to time update the list of clinical practice guidelines 

13 compiled under this subsection to incorporate into 

14 such guidelines new or updated standards of care 

15 with respect to methods of contraception and coun16 seling on methods of contraception. 

17 (4) DISSEMINATION.— 

18 (A) INITIAL DISSEMINATION.—As soon as 

19 practicable after the compilation of clinical 

20 practice guidelines pursuant to paragraph (1), 

21 but commencing not later than one year after 

22 the date of the enactment of this Act, the Sec23 retary shall provide for rapid dissemination of 

24 the clinical practice guidelines to health care 

25 providers described in subsection (a). 


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1 (B) UPDATES.—As soon as practicable 

2 after the adoption under paragraph (3) of any 

3 update to the clinical practice guidelines com4 piled pursuant to this subsection, the Secretary 

5 shall provide for the rapid dissemination of 

6 such clinical practice guidelines, as so updated, 

7 to health care providers described in subsection 

8 (a). 

9 (C) PROTOCOLS.—Clinical practice guide10 lines, and any updates to such guidelines, shall 

11 be disseminated under this paragraph in ac12 cordance with administrative protocols devel13 oped by the Secretary for that purpose. 

14 (c) CLINICAL DECISION SUPPORT TOOLS.— 

15 (1) IN GENERAL.—Not later than one year 

16 after the date of the enactment of this Act, the Sec17 retary shall, in order to assist health care providers 

18 described in subsection (a), develop and implement 

19 clinical decision support tools that reflect, through 

20 the clinical practice guidelines compiled pursuant to 

21 subsection (b), the most current evidence-based and 

22 evidence-informed standards of care with respect to 

23 methods of contraception and counseling on methods 

24 of contraception. 


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1 (2) UPDATES.—The Secretary shall from time 

2 to time update the clinical decision support tools de3 veloped under this subsection to incorporate into 

4 such tools new or updated guidelines on methods of 

5 contraception and counseling on methods of contra6 ception. 

7 (3) DISSEMINATION.—Clinical decision support 

8 tools, and any updates to such tools, shall be dis9 seminated under this subsection in accordance with 

10 administrative protocols developed by the Secretary 

11 for that purpose. Such protocols shall be similar to 

12 the administrative protocols developed under sub13 section (b)(4)(C). 

14 (d) ACCESS TO CONTRACEPTION COUNSELING.—As 

15 soon as practicable after the date of the enactment of this 

16 Act, the Secretary shall ensure that women members of 

17 the Armed Forces have access to counseling on the full 

18 range of methods of contraception provided by health care 

19 providers described in subsection (a) during health care 

20 visits, including, but not limited to, visits as follows: 

21 (1) During predeployment health care visits, 

22 with the counseling to be provided during such visits 

23 emphasizing the interaction between anticipated de24 ployment conditions and various methods of contra25 ception. 


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1 (2) During health care visits during deploy2 ment. 

3 (3) During annual physical examinations. 

4 (e) INCORPORATION INTO SURVEYS OF QUESTIONS

5 ON SERVICEWOMEN EXPERIENCES WITH FAMILY PLAN6 NING SERVICES AND COUNSELING.— 

7 (1) IN GENERAL.—Not later than 90 days after 

8 the date of the enactment of this Act, the Secretary 

9 shall integrate into the Department of Defense sur10 veys specified in paragraph (2) questions designed to 

11 obtain information on the experiences of women 

12 members of the Armed Forces— 

13 (A) in accessing family planning services 

14 and counseling; 

15 (B) in using family planning methods, 

16 which method was preferred and whether de17 ployment conditions affected the decision on 

18 which family planning method or methods to be 

19 used; and 

20 (C) if pregnant, whether the pregnancy 

21 was intended. 

22 (2) COVERED SURVEYS.—The surveys into 

23 which questions shall be integrated as described in 

24 paragraph (1) are the following: 


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1 (A) The Health Related Behavior Survey 

2 of Active Duty Military Personnel. 

3 (B) The Health Care Survey of Depart4 ment of Defense Beneficiaries. 

5 SEC. 6. EDUCATION ON FAMILY PLANNING FOR MEMBERS 

6 OF THE ARMED FORCES. 

7 (a) EDUCATION PROGRAM.— 

8 (1) IN GENERAL.—Not later than one year 

9 after the date of the enactment of this Act, the Sec10 retary of Defense shall establish an education pro11 gram for all members of the Armed Forces, includ12 ing both men and women members, consisting of a 

13 uniform standard curriculum on family planning. 

14 (2) SENSE OF CONGRESS.—It is the sense of 

15 Congress that the standard curriculum should use 

16 the latest technology available to efficiently and ef17 fectively deliver information to members of the 

18 Armed Forces. 

19 (b) ELEMENTS.—The standard curriculum under 

20 subsection (a) shall include the following: 

21 (1) Information on the importance of providing 

22 comprehensive family planning for members of the 

23 Armed Forces, and their commanding officers, and 

24 on the positive impact family planning can have on 

25 the health and readiness of the Armed Forces. 


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1 (2) Current, medically accurate information. 

2 (3) Clear, user-friendly information on the full 

3 range of methods of contraception and where mem4 bers of the Armed Forces can access their chosen 

5 method of contraception. 

6 (4) Information on all applicable laws and poli7 cies so that members are informed of their rights 

8 and obligations. 

9 (5) Information on patients’ rights to confiden10 tiality. 

11 (6) Information on the unique circumstances 

12 encountered by members of the Armed Forces, and 

13 the effects of such circumstances on the use of con14 traception. 

15 SEC. 7. PREGNANCY PREVENTION ASSISTANCE AT MILI16 TARY TREATMENT FACILITIES FOR WOMEN 

17 WHO ARE SEXUAL ASSAULT SURVIVORS. 

18 (a) PURPOSE.—The purpose of this section is to pro19 vide in statute, and to enhance, existing regulations that 

20 require health care providers at military treatment facili21 ties to consult with survivors of sexual assault once clini22 cally stable regarding options for emergency contraception 

23 and any necessary follow-up care, including the provision 

24 of the emergency contraception. 


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1 (b) IN GENERAL.—The assistance specified in sub2 section (c) shall be provided at every military treatment 

3 facility to the following: 

4 (1) Any woman who presents at a military 

5 treatment facility and states to personnel of the fa6 cility that she is a victim of sexual assault or is ac7 companied by another individual who states that the 

8 woman is a victim of sexual assault. 

9 (2) Any woman who presents at a military 

10 treatment facility and is reasonably believed by per11 sonnel of such facility to be a survivor of sexual as12 sault. 

13 (c) ASSISTANCE.— 

14 (1) IN GENERAL.—The assistance specified in 

15 this subsection shall include the following: 

16 (A) The prompt provision by appropriate 

17 staff of the military treatment facility of com18 prehensive, medically and factually accurate, 

19 and unbiased written and oral information 

20 about all methods of emergency contraception 

21 approved by the Food and Drug Administra22 tion. 

23 (B) The prompt provision by such staff of 

24 emergency contraception to a woman upon her 

25 request. 


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1 (C) Notification to the woman of her right 

2 to confidentiality in the receipt of care and 

3 services pursuant to this section. 

4 (2) NATURE OF INFORMATION.—The informa5 tion provided pursuant to paragraph (1)(A) shall be 

6 provided in language that is clear and concise, is 

7 readily comprehensible, and meets such conditions 

8 (including conditions regarding the provision of in9 formation in languages other than English) as the 

10 Secretary may provide in the regulations under this 

11 section. 

Æ 


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