[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]


                                     
 
                         [H.A.S.C. No. 117-97]

           SERVICE MEMBERS' REPRODUCTIVE HEALTH AND READINESS

                               __________

                                HEARING

                               BEFORE THE

                   SUBCOMMITTEE ON MILITARY PERSONNEL

                                 OF THE

                      COMMITTEE ON ARMED SERVICES

                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             SECOND SESSION

                               __________

                              HEARING HELD

                             JULY 29, 2022


                                     
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] 







                             ______

             U.S. GOVERNMENT PUBLISHING OFFICE 
 51-197          WASHINGTON : 2023

                                     
  


                   SUBCOMMITTEE ON MILITARY PERSONNEL

                 JACKIE SPEIER, California, Chairwoman

ANDY KIM, New Jersey                 MIKE GALLAGHER, Wisconsin
CHRISSY HOULAHAN, Pennsylvania       STEPHANIE I. BICE, Oklahoma
VERONICA ESCOBAR, Texas, Vice Chair  LISA C. McCLAIN, Michigan
SARA JACOBS, California              RONNY JACKSON, Texas
MARILYN STRICKLAND, Washington       JERRY L. CARL, Alabama
MARC A. VEASEY, Texas                PAT FALLON, Texas

                 Ilka Regino, Professional Staff Member
                 Glen Diehl, Professional Staff Member
                           Sidney Faix, Clerk
                            C O N T E N T S

                              ----------                              
                                                                   Page

              STATEMENTS PRESENTED BY MEMBERS OF CONGRESS

Gallagher, Hon. Mike, a Representative from Wisconsin, Ranking 
  Member, Subcommittee on Military Personnel.....................     3
Speier, Hon. Jackie, a Representative from California, 
  Chairwoman, Subcommittee on Military Personnel.................     1

                               WITNESSES

Arana, Sharon, Active Duty Service Member........................     5
Cisneros, Gilbert R., Jr., Under Secretary of Defense for 
  Personnel and Readiness, Department of Defense; and Seileen 
  Mullen, Acting Assistant Secretary of Defense for Health 
  Affairs, Department of Defense.................................    32
Lamme, Dr. Jacqueline, OB/GYN, Naval Medical Officer.............     9
Moayedi, Dr. Ghazaleh, OB/GYN, Texas-Based Civilian..............    10
Mozillo, Theresa, Active Duty Service Member.....................     7

                                APPENDIX

Prepared Statements:

    Arana, Sharon................................................    49
    Cisneros, Gilbert R., Jr., joint with Seileen Mullen.........    85
    Lamme, Dr. Jacqueline........................................    70
    Moayedi, Dr. Ghazaleh........................................    76
    Mozillo, Theresa A...........................................    59
    Speier, Hon. Jackie..........................................    47

Documents Submitted for the Record:

    Map Displayed by Ms. Speier..................................    93
    Service Member Statements for the Record.....................    94

Witness Responses to Questions Asked During the Hearing:

    [There were no Questions submitted during the hearing.]

Questions Submitted by Members Post Hearing:

    Ms. Houlahan.................................................   107
    Ms. Strickland...............................................   107
           SERVICE MEMBERS' REPRODUCTIVE HEALTH AND READINESS

                              ----------                              

                  House of Representatives,
                       Committee on Armed Services,
                        Subcommittee on Military Personnel,
                             Washington, DC, Friday, July 29, 2022.
    The subcommittee met, pursuant to call, at 8:32 a.m., in 
room 2118, Rayburn House Office Building, Hon. Jackie Speier 
(chairwoman of the subcommittee) presiding.

OPENING STATEMENT OF HON. JACKIE SPEIER, A REPRESENTATIVE FROM 
   CALIFORNIA, CHAIRWOMAN, SUBCOMMITTEE ON MILITARY PERSONNEL

    Ms. Speier. Good morning. The Military Personnel 
Subcommittee of the Armed Services Committee will come to 
order. I want to welcome everyone to our hearing today to 
discuss the challenges of service members that are facing 
accessing reproductive healthcare.
    The Supreme Court decision in Dobbs v. Jackson Women's 
Health Organization overturned 50 years of precedent and took 
away the established constitutional right to an abortion. The 
Court stated that their opinion merely returned the issue of 
abortion to the States and that women can vote for whom they 
wish to represent their values.
    But service members do not get to choose where they live. 
This leaves 230,000 servicewomen who could be ordered to a 
State that restricts bodily autonomy, jeopardizing our 
recruitment and retention efforts.
    There is a map that I want to show you. This map shows the 
States that restrict abortion in red, along with the number of 
military installations within those States. As you can see, 
many bases are in States where abortion is or likely will be 
restricted. In fact, look at Texas where we have 19 
installations and Florida where we have 17 installations. And 
in both those States right now you can't get an abortion under 
virtually any circumstance.
    [The map referred to can be found in the Appendix on page 
93.]
    One-quarter of the women will have an abortion before the 
end of their childbearing years. Of the servicewomen currently 
serving in the military, we would expect that more than 50,000 
of them would have an abortion during their lifetime, and for 
many of them it will be during their years of military service. 
Even before the Dobbs decision, abortion access has long been a 
struggle in the military especially for those overseas and 
junior enlisted with lower incomes.
    Under current law, DOD [U.S. Department of Defense] is 
prohibited from providing abortions except in cases of rape, 
incest, or threat to the life of the mother. These exceptions 
are so narrow that DOD has confirmed to me that only between 11 
and 21 service members have undergone an abortion at a military 
facility each year over the past 5 years. Think about that.
    That means the vast majority of service members are forced 
to pay out-of-pocket not only for the care they need, but also 
for other expenses including lodging, gas, or airfare, and 
childcare. The Dobbs decision will no doubt exacerbate these 
challenges, forcing service members to travel longer distances 
and shoulder greater financial burdens; that is, if they are 
granted leave in the first place.
    Let me be clear, it is inhumane to force women to remain 
pregnant against their will. It is arrogant to think that we 
know better than a woman or her doctor about what is best for 
her body. It is wrong to create government-mandated 
pregnancies. And I feel so strongly that this is going to 
discourage women to enlist, to serve, and to remain in the 
military. It will become, if it not--if it hasn't already 
become both a recruitment and a retention issue.
    Access to abortion care is essential to a woman's health 
and central to their economic and social well-being. The 
ability to access an abortion should not depend on how much 
money you have, where you live, or where you are stationed. 
That is why I have introduced the March for Service Members 
Act, to enable DOD to provide abortion care once and for all.
    My office has been inundated with outreach from former and 
current service members anxious and despondent about being 
stationed in States where they can't control their bodies.
    One Army psychiatrist said to me, and I quote, ``Even I and 
some of my female physician peers in the military, with the 
relative privilege of being officers and physicians, fear 
someday receiving orders to a State which has banned abortion. 
Because of this increased maternal mortality in areas without 
access to safe and legal abortion, I would not feel safe 
attempting to become pregnant in such a State,'' unquote. That 
is a comment by a physician in the military. At a time when the 
military is struggling with recruitment and retention, these 
bans will certainly make matters worse.
    In the aftermath of the Dobbs  ruling, I am asking the 
Department of Defense how they are going to ensure service 
members and their dependents who can access the medical care 
they need and deserve.
    We don't know how many service members of reproductive age 
are living in States with abortion bans.
    We don't know if service members can be denied leave or 
retaliated against for needing an abortion.
    We don't know what guidance medical providers are getting 
so they can continue performing permissible abortions.
    We don't know what updated guidance leaders and commanders 
are being provided when approached by service members seeking 
leave for medical procedures not covered by TRICARE or offered 
in their State.
    We don't know if military treatment facilities will 
continue carrying all safe and FDA [U.S. Food and Drug 
Administration]-approved contraceptive methods.
    With so many unanswered questions it is no surprise we 
needed to have this hearing and give service members and 
medical providers an opportunity to be heard.
    DOD must act now to provide the right resources at the 
right time at the right place so that service members and their 
families--who have no choice about where they live--continue to 
have access to the reproductive care they need, want, and 
deserve.
    As our military members defend our freedoms, we must defend 
theirs.
    I want to say to our first panelists how grateful we are 
that you have come forward, that you have shown the courage 
that you have, that you are speaking for tens of thousands of 
women in the military who serve around the world who are 
finding themselves in the difficult position of having to make 
these decisions.
    The Panel 1 includes two service members stationed at home 
and abroad who will share their personal experiences. Ms. 
Sharon Arana and Ms. Theresa Mozillo both will share their 
deeply compelling stories of how impactful access to timely 
abortion care has been for them.
    Also on Panel 1 is Dr. Jackie Lamme, an OB/GYN 
[obstetrician/gynecologist] currently stationed in Washington 
State and working in a military hospital; and Dr. Ghazaleh 
Moayedi, who will tell us how she is supporting service members 
stationed in Texas seeking reproductive medical care.
    The second panel will include the Honorable Gil Cisneros, 
the Under Secretary for Personnel and Readiness, as well as Ms. 
Seileen Mullen, Acting Assistant Secretary of Defense for 
Health Affairs.
    Before hearing from our first panel let me offer Ranking 
Member Gallagher an opportunity to make an opening statement.
    [The prepared statement of Ms. Speier can be found in the 
Appendix on page 47.]

    STATEMENT OF HON. MIKE GALLAGHER, A REPRESENTATIVE FROM 
 WISCONSIN, RANKING MEMBER, SUBCOMMITTEE ON MILITARY PERSONNEL

    Mr. Gallagher. I thank the chairwoman.
    I want to thank all of our witnesses on both panels for 
being with us today.
    The mission of the Department of Defense is to provide the 
military forces needed to deter war and ensure our Nation's 
security. This is a critical mission. On that we all agree. It 
is enabled by the readiness of the Armed Forces, which is the 
ability of the military forces to fight and meet the demands of 
assigned missions. And the glue that binds mission and 
readiness together is good order and discipline. As George 
Washington once wrote, ``Discipline is the soul of an army and 
makes small numbers formidable, procures success to the weak, 
and esteem to all.''
    I start with mission, readiness, and the need for good 
order and discipline because our military is predicated on men 
and women following orders. At times that includes going into 
harm's way if necessary. The Department of Defense and the 
services therefore should not consider a State's laws when 
making decisions regarding service member assignments, nor 
should service members be empowered to make assignment 
decisions based on whether they agree with a State's laws.
    I personally believe that every human life has innate 
value, but that shouldn't make any difference in the orders I 
am given. Similarly, I should not be able to tell my chain of 
command where to send me based on whether I agree or disagree 
with States' laws.
    With regard to the Supreme Court's decision in Dobbs v. 
Jackson and its direct effect on the Department of Defense, my 
understanding is there was no change to the Federal law that 
covers medical services available to service members, nor are 
we suggesting it is necessary. We cannot both maintain a 
functioning military, however, and allow individuals to choose, 
as some in Congress have suggested, what installation or 
assignment they can receive on the basis of a Pentagon 
bureaucrat's perception of State law.
    This very issue was debated during our full committee 
markup and one of our majority counterparts joined us on that 
vote. The Senate Armed Services Committee voted 18 to 8, a 
strong bipartisan vote, to prohibit the Pentagon from using the 
agreement or disagreement of a member of the Armed Forces with 
the States' laws and regulations applicable to any duty station 
when determining the duty assignment of the member. Following 
the markup Senator Sullivan, the amendment's sponsor, stated, 
quote, ``Allowing our service members to veto the needs of the 
service because they disagree with State or local laws could 
lead to a sorting of the military along ideological lines that 
would devastate readiness, unit cohesion, and the American 
people's respect for their military.''
    Senator Tim Kaine, a Democrat from Virginia, who voted for 
the amendment, said that while family considerations are 
important in assignment decisions, quote, ``ultimately military 
personnel officials make the decision best for the defense 
mission.'' That is as it should be. I agree with Senator 
Sullivan and I agree with Senator Kaine.
    The bottom line here is that allowing State law to become a 
factor when making personnel assignments is a very dangerous 
and unworkable proposition. An apolitical professional military 
is the hallmark of our American democracy.
    For our hearing today I would like to understand how the 
Department of Defense will implement the June 28, 2022, policy 
memorandum from Secretary Austin on ensuring access to 
essential women's healthcare services for service members, 
dependents, beneficiaries, and Department of Defense civilian 
employees.
    Thank you and I yield back.
    Ms. Speier. I thank the gentleman for his comments.
    I want to just state for the record this is not a hearing 
on whether or not service members should be able to choose 
where they serve. It is a hearing to determine what we should 
do to make sure they serve where they are ordered to serve and 
still can receive reproductive healthcare.
    Before we proceed with questions for the witnesses I want 
to add that several service members approached my office about 
wanting to share their stories. Several have submitted 
statements. I now ask unanimous consent to add those statements 
to the record of this hearing.
    Without objection, so ordered.
    [The information referred to can be found in the Appendix 
beginning on page 94.]
    Ms. Speier. I ask unanimous consent that members from the 
full committee or other committees who are inclined to 
participate in this hearing are invited to sit on the dais and 
participate in the hearing.
    Without objection, so ordered.
    To the witnesses, we respectfully ask that you summarize 
your testimony in 5 minutes or less. Your written comments and 
statements will be made part of the hearing record. Each member 
will have an opportunity to question the witnesses for 5 
minutes.
    With that, we welcome Ms. Arana. You may make your opening 
statement. And you need to push that button to----

     STATEMENT OF SHARON ARANA, ACTIVE DUTY SERVICE MEMBER

    Ms. Arana. Good morning, Chairman Speier, Ranking Member 
Gallagher, and distinguished committee members. Thank you for 
the opportunity to testify before you today about service 
members' reproductive health and readiness.
    The views expressed in this testimony are my own and do not 
necessarily reflect the official policy or position of the 
United States Air Force, the Department of Defense, or the 
United States Government.
    I am Sharon Arana, a major and intelligence officer in the 
United States Air Force. I'm a prior enlisted--enlisted officer 
with 24\1/2\ years of Active Duty service.
    In the summer of 2009, a week before graduating Officer 
Training School, I discovered that my birth control had failed. 
At the time I was a single mother of two, recently divorced, 
and a week from commissioning.
    When I realized I had missed my period, I asked my partner 
to take me to buy a home pregnancy test. I didn't want to go to 
the base clinic to get tested there because it would prompt a 
profile and my chain of command would instantly be notified of 
my pregnancy. I also knew the clinic couldn't help me find 
access to safe abortion. I didn't feel comfortable testing in 
the dorms where I was living while I was in training, so I 
ended up taking the pregnancy test alone in a gas station 
bathroom.
    My then-boyfriend/now-husband and I had agreed that 
continuing with the pregnancy was not the right decision for 
us. We were stationed in Alabama and access to abortion was 
restricted. So the weekend before we graduated training we 
drove 3\1/2\ hours to Atlanta. The morning of my appointment I 
learned that Georgia had a 3-day cooling-off period, which 
meant that the first day was only to confirm the pregnancy with 
both a urine test and an ultrasound that I was forced to watch. 
I was expected to return to the clinic in 3 days for the 
abortion. But since I was in training, I needed to return to 
Alabama to finish my course in order to commission later that 
week.
    By chance, I had already planned a trip to my hometown of 
Brooklyn, New York, after my graduation. In New York I had the 
access to the healthcare that I needed and had an abortion. I 
paid $400 out of pocket and I recovered at home for a few days 
while on personal leave before heading for follow-on training 
in Texas with my two children in tow.
    About 3 weeks after arriving in Texas, I sought further 
medical care after experiencing bleeding. At the clinic on 
base, I informed the nurse that I had had an abortion a few 
weeks prior. While my bleeding was a natural part of my healing 
process and not harmful to me, my nurse said she would keep my 
abortion a secret and not add it to my medical records just in 
case.
    I was confused and I felt stigmatized for having an 
abortion, like I was being judged for the decision that my 
partner and I had carefully made together. I was never offered 
any support or follow-on care at the clinic. Rather, I was sent 
on my way back to training without my pregnancy termination 
ever documented in my medical records.
    Choosing to have an abortion was not an easy one and it was 
the decision my partner and I made together. My husband and I 
will be celebrating our 11-year anniversary this year and we 
have never doubted that choosing to wait to start our family 
was the right decision for us. We went on to have two more 
children together when it was right for us and our careers. Our 
four beautiful babies are a testament to the importance of 
having access to critical healthcare, including abortion.
    We are a dual-military family that combined has over 40 
years serving in Active Duty, multiple deployments, years 
stationed apart, missed birthdays and anniversaries, and 
countless weekends and holidays working missions, and we 
wouldn't change a thing.
    I know that if I didn't have an abortion I would not have 
been able to continue my training as a single mother and brand 
new lieutenant going through officer intel school. I also know 
that it didn't have to be that difficult. I was fortunate 
enough to come from a State that honors a woman's right to make 
her own decisions and I wasn't forced to carry through with a 
pregnancy against my will.
    I have put my uniform on for the past 24\1/2\ years with 
pride and I am honored to be able to continue wearing it. My 
family and I continue to make sacrifices because we believe in 
what this Nation stands for. I believe that for everyone in 
this chamber the health and well-being of my fellow service 
members and their families should be a top priority. My husband 
and I would not have been able to continue our military careers 
had we been forced to carry that pregnancy, and as an unwed 
mother of two geographically separated from my partner and 
family I would not be where I am today. Our family, the one at 
home and in uniform, has benefitted because I was able to 
travel to a State that recognized that family-building 
decisions were ours alone to make.
    I thank you for the opportunity to share my story.
    [The prepared statement of Ms. Arana can be found in the 
Appendix on page 49.]
    Ms. Speier. Thank you, Ms. Arana. Your testimony is 
extraordinary and you are precisely who we want to serve in the 
military. And to have anyone snuff out that opportunity for 
just a lack of providing services to our service members is 
repelling to me. So thank you again for your testimony.
    Ms. Theresa Mozillo, who is an Active Duty service member, 
is joining us via Zoom.

  STATEMENT OF THERESA A. MOZILLO, ACTIVE DUTY SERVICE MEMBER

    Ms. Mozillo. Good morning, Chairwoman Speier, Ranking 
Member Gallagher, and distinguished members of the 
subcommittee. It's an honor to appear before you today to share 
my personal experience.
    My name is Theresa Ann Mozillo and I am a major in the 
United States Air Force. My comments today are my personal 
story and do not reflect the views of the Department of 
Defense, Department of the Air Force, United States Government, 
or my current assigned unit, United States European Command.
    I entered the Air Force as an Active Duty enlisted member 
in 2002. Two weeks ago I reached 20 years of military service 
and I was recently selected for promotion to lieutenant 
colonel. I'm extremely proud of my military service. I am 
thankful for all the opportunities it has provided me 
throughout my career.
    Growing up in a lower-income family in rural Pennsylvania, 
the military represented an economic step up and a career path. 
I joined the United States Air Force to see the world, serve my 
country, and complete my college education. I'm grateful I have 
accomplished these goals and so much more.
    When I heard the news that Roe v. Wade had been overturned, 
my heart sank. It was then I decided to share my abortion story 
with others for the very first time.
    Nineteen years ago I discovered I was pregnant at age 21. I 
was terrified. At the time, I was newly stationed at Whiteman 
Air Force Base in Missouri as an airman first class, E-3. I was 
fresh out of technical training as an aerospace ground 
equipment mechanic. I was in my work center for approximately 
90 days. I had no social support system established yet and as 
a first-term airman I lived in a dormitory and did not yet have 
a car. My bimonthly pay was just over $550. As a relatively shy 
person, I only made one friend so far.
    I was a female airman in a male-dominated environment and 
the idea of discussing this personal information with my 
leadership was out of the question. I felt devastated, lost, 
and alone. My dream of a successful military career was falling 
apart before I even had a chance to get started.
    But looking back, I now realize how fortunate I was. At 
that time I was fortunate. I was fortunate I did not have to 
travel far to get an abortion. I was lucky that my only friend 
on base was willing to drive me to an abortion clinic 90 
minutes away along the Missouri and Kansas border.
    I was lucky the clinic was able to schedule my appointment 
on Saturday morning so I bypassed the need to request time off. 
This would have been a critical hurdle.
    It was shop policy that airmen in upgrade training were 
prohibited from taking leave unless it was a compelling reason. 
I could not imagine having to discuss such a personal matter 
with my male leadership. After my abortion I had a whole day to 
recover in my dorm room before returning to work that following 
Monday morning at 7:30.
    I had access to the reproductive care that I needed, but I 
had some financial difficulties to overcome. The abortion cost 
my entire paycheck. I had to wait until my next pay period to 
repay my friend gas money for driving me to my appointment. I 
was grateful for having access to the on-base dining facility 
for meals and I scraped by on a near-empty bank account until 
my next paycheck arrived.
    Without a question, if I had not been able to have an 
abortion as a junior enlisted member, I would not have had my 
career and I would not be in front of you today.
    At the time of my pregnancy I did not have the financial 
ability, support, or personal desire to become a single mother 
serving in the Armed Forces. I know many strong servicewomen 
who have succeeded as single mothers, but deep down I knew that 
abortion was the right personal decision for me.
    Today I'm speaking in support of women in the military who 
will now have a much harder time to access an abortion than I 
did. I'm here today to give Airman First Class Mozillo a chance 
to tell her story in hopes you consider it when developing 
policy for women in the Armed Forces. I'm especially concerned 
for these junior enlisted members like I was on a tight 
financial budget who's now stationed in a State that has banned 
abortion. Many will now need to travel hundreds of miles away 
to find an available clinic in a State that recognizes the 
legal right to abortion.
    Will they be able to afford the transportation and hotel 
costs along with the cost of an abortion? Will they need to ask 
their direct supervisors for leave? Will this knowledge 
compromise their careers or will their privacy be respected or 
will--or will their situation become work center gossip? But 
most importantly, what would their future look like if they 
didn't have an abortion?
    In closing, my heart is heavy after the Supreme Court's 
decision. My story is not unique. I personally know many women 
who have faced much more difficult circumstances accessing an 
abortion while serving. It deeply saddens me to know that as I 
come to the end of my career, my fellow servicewomen must face 
so many additional barriers and challenges to access the 
reproductive care they deserve. They might not have the same 
opportunity to succeed as I did.
    Thank you again for this opportunity to testify here today 
on such a critical issue that involves the health and economic 
well-being of servicewomen and women in general. I look forward 
to any questions.
    [The prepared statement of Ms. Mozillo can be found in the 
Appendix on page 59.]
    Ms. Speier. Thank you, Major Mozillo. And like Major Arana, 
you show extraordinary courage and leadership and we are very 
grateful to you for sharing your story.
    Now we will hear from Dr. Jackie Lamme, OB/GYN at the 
naval--who is a naval medical officer.
    Dr. Lamme.

   STATEMENT OF DR. JACQUELINE LAMME, OB/GYN, NAVAL MEDICAL 
                            OFFICER

    Dr. Lamme. Oh, yes. Sorry. I was having some issues.
    Chairman Speier, Ranking Member Gallagher, and 
distinguished committee members, thank you for this opportunity 
to testify.
    Before I begin, I would like to specify that I'm here today 
in my personal capacity as a physician. The views expressed in 
this statement are those of myself and do not necessarily 
reflect the official policy or position of the Department of 
the Navy, Department of Defense, or United States Government.
    I'm Dr. Jacqueline Lamme. I'm an Active Duty Navy 
gynecologic surgeon and obstetrician and have fellowship 
training in complex family planning. I have been on Active Duty 
for 21 years and prior to specializing I spent 5 years in an 
operational environment as a flight surgeon including deploying 
to Afghanistan with the Marines.
    Both during my time as a flight surgeon and even more so as 
an OB/GYN I have seen how abortion restrictions impact our 
servicewomen and Active Duty families. Active Duty women face 
unique challenges in obtaining full-scope reproductive 
healthcare and witnessing this led me both to change my 
specialty to OB/GYN as well as to pursue additional training in 
complex family planning.
    I'm honored to be here today alongside my fellow panelists 
as they share their personal stories. Abortion care is a part 
of the full spectrum of reproductive healthcare and should be 
available to access no matter one's reason for needing that 
care.
    One of the hardest things I do as a physician is tell a 
family that there is something wrong with their pregnancy. I've 
had to explain to patients that while ending their pregnancy 
early was a medical option, it was not something that I could 
legally provide as a military physician. And I have cried with 
families after their baby was born and pronounced dead soon 
afterwards.
    One person who comes to mind is the wife of an enlisted 
airman, someone who gave me her consent to share her story 
today. This was their second overseas tour far away from 
family. I still remember the look on the maternal fetal 
medicine specialist's face when she walked into my office and 
asked me to join her in talking with the couple about the 
anomaly she'd seen and their options.
    Their daughter Scarlett had severe malformations that meant 
she was unlikely to survive until delivery. My patient asked 
about ending the pregnancy and we talked about the ways this 
could be done. I then had to tell them that legally, since her 
life was not at risk, I was unable to offer her that option in 
a military facility and it would not be covered by her health 
insurance. If she wanted to end the pregnancy she would have to 
return to the States and pay for the procedure with no 
assistance from TRICARE.
    Her care would cost thousands of dollars plus the cost of 
international plane tickets, hotel rooms, and other expenses. 
There was no way this young enlisted family had the means for 
that undertaking. Thankfully she had an amazing friend who set 
up a fundraiser for the family and within a few days they had 
an overwhelming response and enough money to access the care 
she needed.
    When she returned she told me that everyone in the clinic 
was wonderful, but she wished that I had been the one that had 
been there with her throughout this entire process.
    While my patient in this case was able to get the care she 
needed, so many of my patients do not. They should not have to 
share their stories publicly or ask for financial help from 
strangers.
    Time is also a concern. For Active Duty women, they must 
request leave from their commanding officer who may deny it or 
ask for details, forcing them to disclose their personal 
medical information to someone who is not actually involved in 
their medical care.
    I worry about my patients no longer being able to access 
the care based on where they're stationed. As Active Duty 
members we do not get to choose where we live. We have 
volunteered to protect our country and we move every few years 
from State to State and often overseas to fulfill that mission. 
We cannot choose the laws under which we are held depending on 
our duty station. Our healthcare as military members and 
dependents should not be based on the current duty station, but 
on a consistent Federal standard of care for military members 
and their dependents.
    In closing, I want to share how thankful I am for the 
recent memo from Mr. Cisneros reaffirming that we in military 
medicine can and will continue to provide reproductive 
healthcare within the scope of Federal legislation, but more 
needs to be done. I urge you to provide Federal protection to 
both patients and physicians who provide these legal and needed 
services on Federal land.
    I would urge you to go even further. While I truly hope to 
see the Hyde Amendment overturned, at the very least I urge 
Congress to remove the restrictions that do not allow patients 
to self-pay for abortion procedures at military treatment 
facilities as exists for many other procedures covered by 
TRICARE. Preventing the same option for abortion services is 
not only discriminatory; it impacts the readiness of our armed 
services and I fear the impact will worsen with unequal State 
restrictions that force patients to travel long distances and 
take leave to obtain the care they deserve and so desperately 
need. Thank you.
    [The prepared statement of Dr. Lamme can be found in the 
Appendix on page 70.]
    Ms. Speier. Thank you, Dr. Lamme, for your profound 
comments.
    We now welcome Dr. Ghazaleh Moayedi. She is a Texas-based 
civilian OB/GYN who services service members.
    Welcome.

STATEMENT OF DR. GHAZALEH MOAYEDI, OB/GYN, TEXAS-BASED CIVILIAN

    Dr. Moayedi. Good morning. My name is Dr. Ghazaleh Moayedi 
and I use she/her pronouns. I'm a board-certified OB/GYN, a 
child of Iranian immigrants, a mom, a Texan, and a proud 
abortion provider. I serve on the Board of Directors for 
Physicians for Reproductive Health and Texas Equal Access Fund.
    Abortion is essential healthcare. Every person in our 
country has the human right to decide for themselves when and 
if to start a family, and that includes members of the Armed 
Forces. As an OB/GYN I know firsthand that safe birth, healthy 
families, and thriving communities require access to abortion 
care.
    Abortion bans disproportionately harm structurally 
oppressed communities and members of the Armed Forces. Service 
members and their families are often far from their homes, 
young, and living on low incomes. Few have the resources needed 
to emergently access time-sensitive abortion care.
    While I can talk at length about the impacts of abortion 
bans on the many communities that I serve, today I will speak 
about my experiences caring for members of the military.
    Before becoming a physician I worked for an abortion 
provider in Austin near Fort Hood. We routinely cared for 
service members and I witnessed the countless obstacles they 
endured to receive abortion care. They struggled to obtain 
leave for procedures, get rides to Austin from base, pay for 
their care, and even get a referral on where to go.
    Because of the culture created by unjust policies like the 
Hyde Amendment, the ability to find our clinic often depended 
on one person on base who was willing to secretly give people 
our brochure. Essential healthcare for our Armed Forces hinged 
on a whisper network. For those who did manage to find us, I 
can't even begin to describe the pain service members expressed 
when we would explain your TRICARE won't cover this; you'll 
have to pay out of pocket.
    After becoming a physician I spent part of my training in 
gynecologic surgery on base at Fort Bliss. From previously 
working near Fort Hood I remembered caring for countless sexual 
assault survivors at our clinic even though they technically 
should have been able to receive that care on base.
    Once at Fort Bliss, I realized the problem: to actually 
access abortion care on base everything must line up perfectly 
for the survivor. I was only able to care for one such person 
at Fort Bliss. Thankfully, her commanding officer was 
supportive, so she was able to obtain the necessary 
authorization for her abortion. As members of this committee 
know, it can be incredibly daunting for a service member to 
report an assault committed by another member of the military. 
I was grateful that everything worked out for this patient to 
get the care she needed, but this is not how healthcare should 
work for members of our military.
    After residency I did fellowship in Hawaii, a State with a 
large military population and a critical healthcare destination 
for service members stationed in Asia. Hawaii has excellent 
abortion access and many residents can receive financial and 
transportation coverage for their care. That is, except those 
members of the military.
    I will never forget weeping after sitting with an enlisted 
service member who needed to count out quarters to afford her 
care. She asked me what parts of pain management she could 
forgo so she could afford her abortion. She assured me she was 
strong enough to not need pain medication. I was changed 
forever bearing witness to that injustice.
    I remember another patient who was raped by a fellow 
service member while stationed in Asia. Feeling unsafe, she 
could not report or seek help from her commanding officer. She 
couldn't find care where she was stationed and it took several 
weeks to be able to fly to Hawaii for care. Because of the 
significant violence she endured, she would have ideally had 
her abortion under deep sedation, which is not a requirement 
for safe abortion but might be necessary for trauma survivors.
    The access to anesthesia makes the cost of care 
considerably higher, sometimes over $10,000. Since she was 
paying out of pocket, she had her abortion with just numbing 
medicine in our clinic. While I provided skilled and 
compassionate care, it was devastating to see someone dedicated 
to serving our country abandoned by it. We wept together after 
her procedure. I was honored to be trusted with her care and 
she should have never been forced to come all the way to me to 
access her right to an abortion.
    I'll end by saying that we should all be incredibly angry 
at the systematic denial of reproductive autonomy that is 
happening to millions of people in our country as we meet 
today. Nobody deserves to suffer the indignity of counting 
quarters to pay for medical care, forgoing medication to 
alleviate pain, traveling thousands of miles for basic 
healthcare, or having whispered conversations about where or 
how to access care. These things happen every day to our 
service members and to civilians in every one of your States.
    I envision a world where everyone has access to culturally 
relevant abortion care in their own communities.
    This committee's jurisdiction is the Armed Forces, so I 
will say, I will implore each of you to at least make this 
world a reality for our service members. Thank you for having 
me today.
    [The prepared statement of Dr. Moayedi can be found in the 
Appendix on page 76.]
    Ms. Speier. Thank you, doctor. Again, extraordinary 
testimony. And it pains me, as I am sure it pains many of us, 
to hear these stories, but they are real stories, paying 
extraordinary sums of money to travel and get an abortion 
because they can't access an abortion at a medical treatment 
facility. And to look at the States again that have basically 
banned all abortions and have criminalized the providers for 
giving women abortions is also compelling as well.
    Let me start with asking the two physicians this: One of 
the letters that I received was from an Army psychiatrist and 
she wrote, ``The risk of postpartum depression can be 
particularly high for unwanted or unplanned pregnancies and for 
women under significant stress. Military women are known to 
have higher rates of unintended pregnancy, oftentimes 125 
percent of the regular population, and they may face unique 
stressors related to an unplanned pregnancy including the 
physical and emotional stress of their work, the effect of 
pregnancy on one's career, and the difficulties obtaining 
adequate childcare for long and unpredictable work hours. 
Military women are therefore understandably concerned about 
access to reproductive healthcare.
    ``Even before Roe was overturned I worked with female 
patients distraught about receiving orders to post in Texas 
after the Texas Heartbeat Act was passed. Some of these women 
are already in a fragile emotional state and have the self-
awareness to realize they are currently unequipped to weather 
the mental and physical stress of pregnancy, much less 
motherhood. Others are prescribed medication contraindicated in 
pregnancy but essential to their mental stability.
    ``Female service members may lack the financial means to 
travel for an abortion, they require permission from their 
chain of command even for weekend travel if it is beyond a 
certain radius, and they may not trust the military to protect 
their privacy should they request such travel to obtain an 
abortion. Even I and some of my female physician peers in the 
military with the relative privilege of being officers and 
physicians, fear someday receiving orders to a State which has 
banned abortion. Because of the increased maternal mortality in 
areas without access to safe and legal abortion, I would not 
feel safe attempting to become pregnant in such a State.''
    So, Dr. Lamme and Dr. Moayedi, that is a pretty 
extraordinary statement from a psychiatrist, a behavioral 
health provider, about the impacts of State restrictions on 
healthcare for servicewomen. As OB/GYNs what are your 
assessments of the impact of Dobbs decision on the ability of 
military and civilian healthcare providers to provide care to 
military personnel?
    Dr. Lamme. I can take this one if you want, Dr. Moayedi.
    Thank you, Congresswoman. While the recent statement from 
the Under Secretary makes it clear that we in military medicine 
can and will continue to provide healthcare under current 
Federal legislations, there are still many questions that 
remain both for patients and for providers in various 
locations. I'm lucky I am currently stationed in Washington 
State, so nothing changes for me. But for some of my colleagues 
who are stationed in Texas or Florida or Georgia or overseas, 
there are--most physicians live out in town, so there are 
questions on if they provide an abortion procedure that is 
legally allowed, but then go home, can they be arrested, can 
they be tried with something, and who's going to help them pay 
for that because that--the cost of that can be devastating?
    The same question exists for many of our patients. If they 
get a legal abortion procedure on base but live in one of these 
more restricted areas and have bleeding or concerns and go to 
the emergency room, are they going to be arrested and 
prosecuted for something that they legally obtained on base? I 
think that that is one of the questions that still exists and 
one of the fears that I have heard both from patients and from 
my colleagues who are in more restricted areas over the--the 
last month or so. Thank you.
    Ms. Speier. Thank you.
    Mr. Moayedi.
    Dr. Moayedi. Thank you. And, you know, I'll--I'll add from 
what you heard in my testimony and what--from the other 
witnesses have testified today, the majority of abortion care 
provided for members of the military does not happen on base. 
It happens off base. So when we're talking about a State like 
Texas, that means that no one right now that is stationed here 
has access to abortion care.
    The nearest States, right, what--what are we talking about? 
Oklahoma doesn't have abortion care anymore. Arkansas doesn't 
have abortion care anymore. Alabama doesn't have abortion care 
anymore. And so we're not just talking about going over to the 
next city now, which was already a huge hurdle for many, many 
members of the military, but we're talking about traveling 
hundreds, thousands of miles to be able to get what is very 
basic, simple, safe, essential healthcare. A first trimester 
abortion takes about 3 to 5 minutes to complete, but someone 
from Texas stationed at Fort Hood might travel for 2 days to be 
able to access that procedure now.
    Ms. Speier. Thank you.
    Major Arana and Major Mozillo, what are some of the 
barriers facing servicewomen who seek an abortion and what have 
you heard from service members about their concerns about being 
stationed in a State that bans abortion?
    Ms. Arana. Thank you for the question. So, ma'am, for non-
TRICARE-covered abortions there is minimal to no support. While 
recent changes in the Air Force instructions remove the need 
for commander's approval for the procedure, members are still 
left with the burden of taking personal time off, paying for 
travel, out-of-pocket expenses for the procedure as well.
    These restrictions also, as mentioned earlier, 
disproportionately affect training bases where members have 
less access to resources and experience additional barriers to 
travel or leave due to their training status.
    Ms. Speier. Major Mozillo.
    Ms. Mozillo. Thank you, ma'am. I would say the challenges 
are extremely worse today. The bimonthly base pay of an E-1 
with less than 2 years of service is a little over $900. Even 
if the service member's ultimately able to reach a clinic, 
they're going to face significantly longer wait times, 
increased costs due to the travel, the lodging, the childcare, 
and more expensive procedures. They could require multiple 
trips to the clinic and this would add more and more costs, not 
to mention more and more time off.
    How many levels of leadership will the leave request need 
to go through? I'm so concerned about their privacy and mental 
health. Can our junior members afford these costs?
    Ms. Speier. Do you think that this is going to discourage 
women from serving in the military?
    Ms. Arana. Absolutely, yes.
    Ms. Mozillo. Ma'am, just yesterday I shared this hearing 
with one of my coworkers, a fellow service member, a man. He 
shared with me that his wife needed an abortion after an 
ectopic pregnancy. He stated without timely access to this 
life-saving procedure his wife could have died. To see this 
strong individual, a friend, stand in a hallway with almost 
having tears in his eyes while he recounted this story, it was 
so impactful. He could have been an Active Duty service member 
with a small child and widow.
    This was prior to the reversal of Roe v. Wade. We further 
discussed the concerns and what if he was stationed in a State 
that now bans all abortions? Access to reproductive care 
matters to the life of fellow military members and our 
families, both male and female, and this Court's decision 
affects us all.
    Ms. Speier. Again. Thank you both for your extraordinary 
participation today.
    I now yield to the ranking member.
    Mr. Gallagher. Thank you.
    I think we all agree that the assignment process--and first 
of all, thank you, all, for--again for being here and sharing 
your stories.
    The assignment process is the means by which the military 
makes sure it has people in the right assignments to meet its 
mission requirements both in the continental United States and 
abroad. So the services write orders to unit X for a service 
member to go into a billet or a job because there is a military 
essential task that requires specific skills and knowledge.
    So looking to the future, let's say you were given the 
choice to be assigned--and I guess I would ask both Ms. Arana 
and Ms. Mozillo and Dr. Lamme this question. If you are given 
the choice to be assigned to an installation based on laws that 
were favorable to your political beliefs, whether it is a pro-
life State or a pro-choice State, or something else--let's say 
a State had a concealed carry law that you didn't agree with or 
there is another issue out there, or maybe there is an office 
in DOD that is creating an assignment matrix of red and blue 
States based on existing policies. I mean, because I have 
articulated I think the potential ramifications for that and 
for DOD and the services trying to manage a system like that 
and for service members that now need to put sort of politics 
in their service assignment equation gets unworkable pretty 
quickly.
    So I guess my question is whether you think that that 
personal preference for an assignment should supersede a 
validated military requirement for your service to assign you 
where they need you, if that makes sense.
    Start with you, Ms. Arana.
    Ms. Arana. Thank you, sir. So again, we're not talking 
about assignment and the assignment process here. And I do 
believe at the end of the day it's the needs of the military 
because that's why I'm here and that's why I serve.
    I do believe though that as a serving member I am also owed 
a standard of care. And we talk about access to healthcare and 
standardized healthcare. That shouldn't change based on the 
State that I am stationed.
    I have four daughters and I would hesitate to take any of 
them to a State where I know that their bodily autonomy is not 
going to be respected.
    I don't believe that this is a political issue, as you 
stated earlier. I believe that a person's healthcare should be 
a discussion between the member and their medical provider. 
Health care shouldn't be politicized.
    I shouldn't have to be here today telling my private story 
in this very public forum, but I am here today in the hopes 
that by telling my story I humanize this issue and--and bring 
to light, highlight that healthcare is not a political issue 
and it's not about political leanings. It is about 
understanding that everyone has the right to comprehensive 
medical care to include abortion access. And I hope that with 
this discussion and with this hearing we can redirect this 
conversation and understand or accept that the welfare, safety 
of our service members and their families that are also 
affected by these policies become the priority. Thank you.
    Mr. Gallagher. Thank you.
    Ms. Mozillo.
    Ms. Mozillo. Thank you for your question. This is a 
question of healthcare, not political views, so I can say 
without a--without a question if I had not access to an 
abortion as a junior enlisted service member, I would have--not 
have served in your military for the last 20 years.
    A servicewoman's access to reproductive care should not 
depend on what State they're stationed to. Texas, Arizona, 
Florida, Georgia, Ohio, South Dakota, Oklahoma, Missouri, 
Arkansas, Mississippi, Alabama, and South Carolina--they're all 
homes of large military installations and now they almost fully 
or almost ban abortions.
    Please think of the story I just told you about that male 
service coworker. This makes me fear for all my fellow service 
members. I'm sharing my story because I care about access to 
safe reproductive care, not political views. And I care about 
my sisters in the Armed Forces. I believe we all deserve this 
right no matter what--what State the military sends us to. As 
service members we defend your freedoms. Please defend mine and 
my access to reproductive care. Thank you.
    Mr. Gallagher. Thank you.
    I only have 30 seconds left, so I apologize to our other 
witnesses.
    Unfortunately I think, I mean, healthcare, the reality is, 
is an intensely political issue insomuch as the political 
process is how we make decisions on how healthcare should be 
provided. And that is what we are working through right now, 
very thorny questions about healthcare should be provided.
    And the reason I focus on this issue of assignments and 
whether service member preference should supersede the law of 
the land is that is what was initially suggested by the 
Pentagon, and that is what occasioned the debate in this 
committee and in the Senate. And that is what we are trying to 
work through in good faith right now.
    So I look forward to the day when there is a--I guess a 
less-politicized discussion on healthcare. But it has been my 
observation in 6 years of being here that it is a very 
difficult topic that requires us to talk about it through the 
political process.
    I am out of time. I apologize.
    Ms. Speier. I thank the gentleman.
    I have a question. Do you think that service members should 
have to take personal leave in order to access the healthcare 
that is not available to them at their military treatment 
facility?
    Mr. Gallagher. That was a question for me?
    Ms. Speier. Yes.
    Mr. Gallagher. Do I think that service members should have 
to take personal leave in order to access--to get--like to go 
get an abortion in a State where it is legal?
    Ms. Speier. Correct.
    Mr. Gallagher. Well, in the current system right now would 
it be illegal for some--for the command to grant them leave to 
get that--to get an abortion in a different State?
    Ms. Speier. Well, we can ask that certainly of the Under 
Secretary. But I think it is--the fact that we don't offer the 
healthcare at the military treatment facility where they are, 
means that they then have to take their--what leave they have 
and use it to get healthcare, which seems like it is once again 
another punitive step.
    And I think you and I are on the same page when you talk 
about there shouldn't be an ability to pick the State in which 
you serve, but we have 102 installations right now on that map, 
102 installations in the United States that will--in which the 
States ban, totally ban access to abortion care. I mean, that 
is an extraordinary number. We have another 29 installations 
where they are about to ban abortions.
    So we have got to take a step back and recognize that you 
can't--on top of forcing these service members to go large 
distances to get an abortion, that we are then going to 
penalize them with the costs associated with the travel and 
lose their vacation time, what little there is. I mean we are 
creating a real incentive for women not to serve and in some 
respects it is almost an insidious effort to encourage women to 
leave the military. And that is the last thing that I want to 
see.
    Mr. Gallagher. I think what we are trying to do here today, 
and obviously we have disagreements on both sides of the aisle 
on this issue, and I am not sort of--I hope you appreciate the 
spirit in which I am engaging this debate--is to work through 
all of these--the issues and understand what the DOD's proposed 
policy is, understand all of the issues associated with a post-
Dobbs role.
    My understanding in that particular instance, I think--and 
Glen, you can correct me--but one issue is that it would run 
into the Hyde Amendment, right? We would then have to fund the 
actual--potentially. Potentially. But again that is what we are 
working through here today I think in good faith.
    Ms. Speier. Okay. All right. I thank you for that 
interchange.
    I now recognize Ms. Houlahan for 5 minutes.
    Ms. Houlahan. Thank you, Madam Chair, and I really do 
appreciate the spirit of the conversation. I was that one 
person who voted on the other side of the aisle that said that 
we shouldn't be able to pick where we are serving. I served in 
the military myself. My dad and my grandfather, more than 30-
year careers each of them as well. And I remember being a young 
girl moving around almost every single year and my father would 
say we don't get to pick where we are going.
    And so I really, really appreciate--Ms. Arana, I think you 
and I share that sort of sense of the needs of the military 
drive where it is that we need to be.
    But I am so enormously compelled and appreciative of your 
testimony, both of you, because when I served I was a young 
mother as well and I remember having very limited leave and not 
being able to travel--I cannot remember, it was such a long 
time ago--whether it was 90 miles or 90 minutes without having 
to request leave. And so that would have certainly limited my 
opportunities had I needed to make those kinds of decisions for 
my own healthcare.
    And I am also wondering back to my own mother who was a 
military and Navy mom as well as my grandmother, a Navy mom, 
and they had their children--in my grandmother's case seven 
children, in mom's case two--what the sorts of decisions and 
choices that they may have had to make while they were naval 
moms as well.
    So I thank you very much for your bravery and your 
enormously compassionate and articulate expression of this 
personal journey that you have been on.
    Would you be able to talk a little bit more about the 
privacy issues that you--both of you talked about? I remember 
also struggling with whether or not to share certain issues of 
mental health while I was Active Duty. Would you be able to 
talk a little bit more about why you felt as though you needed 
to hide or not discuss these kinds of things with your chain of 
command?
    Ms. Arana, please.
    Ms. Arana. Thank you, Congresswoman, for the question. I 
believe that in the military there is still a stigma 
surrounding this topic. Just, you know, even coming here and 
before I was able to come here and the statement I have to give 
and make sure that it was understood that these are not the Air 
Force's views and these are mine personally, it--it makes it 
really hard and difficult to talk about this.
    While we say that, you know, I talk--I'm a firm believer we 
shouldn't be politicizing our healthcare issues, when I am at 
work I can talk about my mental healthcare issues because that 
is a thing that's encouraged, you know? Let's be open and let's 
be transparent and--and let's help one another out.
    But when we talk about abortion specifically, this is not a 
topic that is accepted in the office. We don't speak about 
this. We definitely--it's amongst friends only. You don't 
advertise it because you don't know who you work for and you 
don't know what their views are on this. And if you have a 
supervisor who doesn't support your decisions, it could always 
come back to you as well and punitively.
    But yes, it's a very uncomfortable situation to be in. And 
the fact that we have this culture where our policies also 
don't support it, that just enforces that stigma, you know? 
We're not taught to--we're not educated in the military on what 
our rights and our accesses are with regards to accessing 
emergency contraceptives or, you know, whether it's rape, 
incest, or life to the mother that you can have TRICARE. Most 
people don't know this information because we're not told 
either. And unless we go out as service members, both men and 
women, seeking this information ourselves and doing the 
homework, it's--it's not advertised to the rest of us.
    Ms. Houlahan. Thank you. And I am sorry to interrupt 
because I only have one more minute.
    I have one other question for the doctor as well, which is 
would you speak a little bit to miscarriage and to your 
experience in this particular very, very common occurrence and 
how both either Active Duty women or spouses are experiencing 
that with relationship to abortion access and healthcare?
    Dr. Moayedi. So I can speak to miscarriage care in my State 
off of base. Not having--first of all, restricting abortion 
access always impacts all pregnancy care. And so the fact that 
abortion is now illegal in the State of Texas makes pregnancy 
in general more dangerous.
    Over the past year we have been seeing that physicians 
across the State have been delaying life-saving interventions 
for miscarriage care because they are worried about how they 
intersect with the abortion bans in our State. They've also 
been delaying life-saving interventions for ectopic pregnancy 
care, again because they're worried about how abortion bans 
intersect with the care of pregnancy complications.
    So it is--it should be a huge concern for service members, 
service member spouses that are stationed in States with 
abortion bans, how they will be treated, and how their lives 
will be valued throughout their pregnancies.
    Ms. Houlahan. Thank you.
    My time is expired and I yield back.
    Ms. Speier. The gentlelady yields back.
    The gentleman is recognized, Mr. Kim, for 5 minutes.
    Mr. Kim. Thank you, chairwoman.
    Thank you all for----
    Ms. Speier. Excuse me. I apologize. Mr. Fallon has joined 
us, so we will turn to Mr. Fallon for 5 minutes.
    Mr. Fallon. Thank you, Madam Chair. I don't have any 
questions for this panel. Thank you. I yield back.
    Ms. Speier. The gentleman yields back.
    The gentleman from New Jersey is recognized for 5 minutes.
    Mr. Kim. Okay. I am back. I just want to say thank you from 
the outset here for all of you and your testimonies. In the 
3\1/2\ years or so that I have been here in Congress I have had 
a lot of hearings here in this committee room and I have to say 
I believe this one to be just at the top in terms of the most 
powerful ones that I have been a part of, to be able to hear 
your stories firsthand. I want to thank you for your 
willingness to come forward and share that with us. It is 
important for us to hear this.
    For me, I have never served in uniform. I am not woman; I 
am not a mother. For me to be able to understand your 
perspective, what you have gone through, your experience, it is 
invaluable, so I want to say thank you.
    When I hear your stories something that really stands out 
pretty much in every single one is about how some circumstance 
came about that helped you along this path.
    Ms. Arana, you talked about how you just happened to be 
having a trip back to your hometown in Brooklyn. Is that right?
    And I think, Ms. Mozillo mentioned that just happened that 
there was one friend that could bring her forward.
    And I just get really moved by that, that just these 
circumstances just came about. And it just bothers me because 
it shouldn't have to hinge on just that kind of--for your 
circumstance, Ms. Arana, just brute luck that you happened to 
be scheduled.
    I wanted to ask you what do you think would have happened 
had you not had that trip scheduled back home?
    Ms. Arana. Thank you for the question. I know what would 
have happened is--would have been one of two things. If I 
wouldn't have been able--if I would have been forced to carry 
through with the pregnancy because I was on my way to technical 
school, to intel officer school in Texas, my training either 
would have been curtailed or I would have been sent to another 
station. It would have affected the entire path of my career.
    Mr. Kim. And Ms. Mozillo, you told the story about how you 
didn't know very many people there and there was one person 
that was able to drive you. What do you think would have 
happened had you not met that person, had that person not been 
willing to help you out?
    Ms. Mozillo. Thank you for your question. I thought about 
that too many times and many times. I joined the Air Force for 
an economic step up and a career. Where my life would have went 
if I didn't have that abortion, I have no idea. And I truly, 
truly value and credit that abortion provider 19 years ago for 
where I am today. And--and I couldn't tell you where my life 
would be, but I know one thing, I wouldn't be standing here 
before you today telling my story and trying to make an impact 
for my fellow servicewomen. Thank you.
    Mr. Kim. Thank you. Just really hits me because we are here 
on this committee trying to make sure that you have the 
services that you need, the infrastructure you need to be able 
to then serve our Nation. And for this, for your own choices to 
come down to just these circumstances, these happenstance of 
trips and people to able to help out, it just shows and 
reinforces to me just how broken of a system--how we failed you 
in terms of being able to provide you what you needed.
    Ms. Arana, you were saying that this was all happening when 
you were graduating from Officer Training School. Is that 
right?
    Ms. Arana. [Inaudible.]
    Mr. Kim. And I am sure that a part of that Officer Training 
School program was about your physical well-being and training 
and exercise. Is that correct?
    Ms. Arana. [Inaudible.]
    Mr. Kim. So obviously a big part of that was about your 
healthcare, about making sure that you are physically fit to be 
a service member and be able to exercise the duties of that 
position. Is that correct?
    Ms. Arana. Yes, sir.
    Mr. Kim. Would you say that your healthcare when it came to 
having an abortion, that that was something that would have 
affected your well-being, your healthcare, your ability to be 
able to do your duty?
    Ms. Arana. Absolutely. I think that, you know, we--as 
military members we have a responsibility to remain worldwide 
deployable. And I think but yet when it comes to abortion 
specifically, we are completely abandoned by the system and 
left to the luck of where we are stationed, you know?
    I want to also point out that a lot of our bases right now 
do not have sufficient obstetrics care for its military 
members, so even Active Duty and dependents--and I want to 
highlight this--this doesn't just affect me and the women in 
uniform. It affects the family members as well, the dependents. 
So we are beholden to civilian services.
    Out of my four kids only one was born in a military 
hospital and the other three were all in civilian hospitals. So 
it makes this even more prudent, more important to make sure 
that we are creating an access, a standard of access of care 
across the board that is completely lacking right now.
    Mr. Kim. Well, we should have done better for you and I 
hope that this committee can do better for many others that are 
going to experience these types of challenges going forward. 
Thank you.
    Ms. Speier. The gentleman yields back.
    The gentlewoman from Texas, Ms. Escobar, is recognized for 
5 minutes.
    Ms. Escobar. Thank you, Madam Chair, for convening this 
hearing.
    And I want to thank all of our witnesses for coming; for 
attending this hearing, both virtually and in person; for 
sharing such incredible and powerful stories; for your bravery; 
for your advocacy; for your selflessness.
    Dr. Moayedi, it is so good to see you again. Thank you for 
your work in our State.
    I want to share just very briefly before I ask my 
questions. I have the incredible privilege of representing Fort 
Bliss. I represent El Paso, Texas, and Fort Bliss is a critical 
component of our community, as well as a critical military 
installation.
    The day after the Supreme Court draft was leaked, my office 
received a number of calls from female service members 
stationed at Fort Bliss who were concerned and wanted to know 
what would happen to them if they were to need abortion care 
while they were in the State of Texas, while they were in the 
community of El Paso, while they were stationed at Fort Bliss.
    And there is so much uncertainty for women around all of 
this, and there are consequences to these decisions, real-life 
consequences, that are potentially deadly for women. We heard 
about the ectopic pregnancy situation and the impact it has on 
women and families, and the limitations to healthcare for them. 
But there are also direct economic impacts for women. Both 
Major Arana and Major Mozillo shared the impact to their future 
that lack of access to abortion care would create.
    And I want to ask both of you, Major Arana and Major 
Mozillo, ever since the overturning of Wade, ever since the 
Supreme Court decision, starting with you, Major Arana, what 
have you heard from fellow service members, from women--maybe 
even men who care about this issue, who care about women and 
their future, and the future of the military? Have you heard 
anything from your colleagues?
    Ms. Arana. Thank you, ma'am, for the question.
    Yes, I have had friends reach out and say that they are 
worried, one, about their base stations and what is it that is 
going to happen when they get there. But I think, really, 
overall, it is a feeling of understanding that State laws are 
quickly becoming more restrictive than are DOD regulations. And 
so, what is that going to mean for the rest of us writ large?
    We talk about bounty laws and what these bounty laws, the 
effect that that is going to have on our service. When we speak 
about readiness, you know, these bounty laws--the DOD is a 
unique employer, in that so much of our information is not 
afforded the same privacy as it is in the civilian sector. And 
so, if we go to States, for example, like Texas, with these 
bounty laws, where service members can sue themselves, can sue 
one another, it kind of sets us up for this situation that is 
similar to like ``Don't ask, don't tell,'' you know, where 
there was harassment.
    But I think, overall, it degrades morale. It affects 
retention, definitely. And I just think that it doesn't create 
the environment that we are told we are supposed to uphold for 
supporting our service members.
    Thank you.
    Ms. Escobar. Thank you, Major Arana.
    Major Mozillo, have you heard anything from your 
colleagues, from fellow service members?
    Ms. Mozillo. Absolutely. And it is just not the concerns 
that we all have, both male and female. The Dobbs decision 
makes us all scared for the future of the military--the future 
of the military that I have served in for the last 20 years. I 
am worried that these barriers to accessing reproductive care 
are going to discourage new recruits from joining the military. 
I am also worried that current members would leave the 
military, depending on what duty station they are, because that 
would mean that they are going to risk their access to 
reproductive care.
    And I say, you know, it affects the whole family. And it 
affects all of us, male and female, and it affects the military 
at large.
    Thank you.
    Ms. Escobar. Thank you so much.
    And I think that is something so critical for us to 
understand, is the impact on readiness, the impact on the 
military, the impact on recruitment and retention. We want the 
best. We want to have a military that is ready, that is lethal, 
that is focused on what it needs to be focused on. And the 
situation right now for women does not create those conditions.
    Thank you, Madam Chair. I yield back.
    Ms. Speier. The gentlewoman yields back.
    The gentlewoman from California, Ms. Jacobs, is recognized 
for 5 minutes.
    Ms. Jacobs. Well, thank you, Madam Chair, for hosting this 
incredibly important hearing.
    And thank you to our witnesses for sharing your stories. 
You know, as a young woman myself, reproductive healthcare is 
also my healthcare. And I am sorry that you have to share the 
very personal details about your healthcare in order to make a 
change, and I thank you for doing that. And I also think it is 
important that we share our stories because we need to de-
stigmatize these issues. This is just healthcare, like all 
other kinds of healthcare.
    So, I am very proud to represent San Diego, which is a big 
military community. And luckily, being in California, my 
constituents can still get the healthcare that they need. But, 
you know, they have to transfer between bases, as we have 
already discussed. And we have a lot of young people from San 
Diego who join the military as a result. And I have to talk to 
their parents and their loved ones, and they are asking me 
constantly if I am doing everything I can to keep them safe, 
and they don't just mean when they are deployed overseas.
    So, I wanted to ask, Ms. Arana and Ms. Mozillo, if you were 
talking to a young woman right now who was 16 or 17 years old, 
and they were asking you if they should join the military right 
now, if it was a good choice for them, what would you advise 
them?
    Ms. Arana. Thank you for the question.
    I have never regretted my choice of enlisting or 
commissioning. I mean, I [inaudible] two and a half decades in, 
and it has always been the exact right decision for me. So, I 
would never discourage anyone from joining the military.
    I will say that I am sitting here, and Major Mozillo and my 
colleagues, we are all here because we believe that we can be 
better and do better. And one of the ways that we make better 
decisions or better policies is by passing, focusing on 
inclusive policy. I think, right now, what we are working 
towards is policies that purposefully create barriers and 
enforce barriers that are already existing. And I think, 
rather, we should be looking towards policies that identify 
barriers to access and tear those down. And that includes 
access to abortion.
    I would never discourage anyone from joining the military. 
This has been an amazing opportunity for me and my family. And 
again, I believe in what this Nation stands for, which is why I 
wear my uniform with pride.
    Ms. Jacobs. Thank you.
    Ms. Mozillo, what would you advise a young woman today?
    Ms. Mozillo. I also don't regret my military service. But I 
am here today to share my personal and private story because I 
care about servicewomen and the future servicewomen and young 
women. I want to make sure that they don't experience difficult 
challenges and that they have the same opportunities that I 
did, and I want to make sure they have access to abortion care 
because it is so essential to their well-being.
    Thank you.
    Ms. Jacobs. Thank you.
    I wanted to follow up on something, Ms. Arana, you talked 
about earlier, which is that there is not enough OB/GYNs in 
military facilities. So, Dr. Lamme, I wanted to ask you, in 
your opinion, does the Department have enough trained 
gynecologists to meet this moment? What steps could we do to 
further prioritize on-base OB/GYN care and, potentially, on-
base access for abortions that currently would be allowed under 
law?
    Dr. Lamme. Thank you for that question.
    I cannot speak to policies of the DOD and staffing issues 
within the DOD, but I do know that we do not currently have the 
staffing to on-base see every patient of reproductive age, 
whether they are Active Duty or dependents. So, we do rely on 
our local community to help care for those patients, and much 
of the OB/GYN care in many locations throughout the country 
does need to be deferred to the network. So, we are reliant on 
that State and the care that can be provided in that State, and 
that is the reality of the staffing that we have at many 
locations right now.
    Thank you.
    Ms. Jacobs. Dr. Moayedi, do you have anything to add on 
that from your experiences?
    Dr. Moayedi. I do. Having worked as a civilian near Fort 
Bliss and also in Hawaii, providing OB/GYN care, I routinely 
received transfers from military installations in both areas. 
So, I know personally from the transfers that I have received 
that high-risk obstetric care often cannot be cared for on 
base. Very pre-term deliveries cannot be cared for on base. And 
so, many times civilian hospitals are the place where people 
with complications are sent to for care, because there aren't 
enough beds; there isn't enough staffing.
    So, that is definitely a concern. That this is not just 
about military installations and the healthcare that they 
provide, but also about the surrounding healthcare 
infrastructure that supports the military within our 
communities.
    Ms. Jacobs. Well, thank you.
    And can I just say, for many years, my OB/GYN was the only 
doctor that I went to, much like many young women. And the fact 
that we can't see every person of reproductive age who should 
be able to access that care in our military treatment 
facilities is really problematic, and it is something I hope 
our committee focuses on.
    Madam Chair, I yield back.
    Ms. Speier. The gentlewoman yields back.
    The gentleman from California, Mr. Garamendi, is recognized 
for 5 minutes.
    Mr. Garamendi. Thank you, Chairman Speier.
    We are fortunate, and women in the military are very 
fortunate, that you are the chairperson of this committee. 
While many Members of Congress work on and care deeply about 
the role of women and the challenges that women have in the 
military, you are the leader, and we are fortunate that you are 
there. And I thank you for that.
    As chairman of the Readiness Subcommittee, of which you are 
a member, you and I and the members of that committee are well 
aware of the extraordinary challenges that the military has to 
be ready to perform its duties anywhere in the world. We are 
increasingly relying upon women joining the military to serve 
in many different positions, three of which we have now seen 
from the witnesses today.
    I am deeply concerned about the long-term--meaning the 
near-term and long-term--effect that the Dobbs decision is 
going to have on the readiness of the military, because it most 
directly, as shown by the testimony of the witnesses today, 
will have a detrimental effect on the women who are serving in 
the military and families who are going to be affected by the 
Dobbs decision.
    A hundred and 31 facilities, installations, are in States 
that are banning abortions in nearly every circumstance. This 
is going to roll out in a very negative way for the readiness 
of our military.
    I don't have questions. The members of your committee have 
asked profoundly important questions. But I am deeply concerned 
about what's happening and the ability of our military to 
perform, as a result of the Dobbs decision, as a result of 
States--29, I suppose now--who are restricting abortions.
    So, I look forward to continuing to work with you, Chairman 
Speier. Thank you. Thank you for your leadership on this.
    Ms. Speier. The gentleman yields back. I thank him for his 
comments.
    The gentleman from Texas, Mr. Veasey, is recognized for 5 
minutes.
    Mr. Veasey. Thank you, Madam Chair.
    I know that we have talked a lot about reproductive rights 
today. I wanted to specifically ask a question to Ms. Moayedi 
about contraception and about what is available out there for 
people that are in the military, particularly since she is in 
Texas. I would love to know that on a Texas basis.
    I had a really interesting experience at a townhall that I 
had a few years ago. And there were some people from a local 
Right to Life chapter that showed up, and they were asking me 
questions. I said, ``Look, we're not going to agree on 
abortion, but,'' I said, ``can we at least agree on trying to 
prevent unwanted pregnancies or unplanned pregnancies? That 
would help reduce abortions, if you could prevent those 
particular types of pregnancies.''
    And the guy looked at me and he said, ``Are you a part of 
the hookup culture?'' I was really surprised by that response 
back. I said, ``No, I'm not a part of the hookup culture. I'm 
married.'' And then, he said, ``Well, are you an animal? 
Because if you can't--the only reason why you would need 
contraception is because you're an animal and you can't control 
yourself. That's why people would need contraception.''
    And so, that was really one of the first times that I 
realized that there are people that really do believe that 
contraception should be just as controversial and just as 
debated over. This guy that was part of this Right to Life 
chapter in Tarrant County, in Fort Worth, that he really 
adamantly believed in that.
    And I just wanted to ask, what sort of contraception 
services, particularly in Texas bases, like what is available? 
Is there division over these particular services? Or do people 
from all political stripes that serve in the military use these 
particular services?
    Ms. Moayedi.
    Dr. Moayedi. Thank you, Representative. It is Dr. Moayedi.
    So, I have been proud to provide abortion care for many, 
many, many people in your district. And I thank you for your 
service to our communities.
    I can tell you firsthand that the people of your district 
have always struggled to access not only abortion care, but 
contraception care. While I have only worked on one base 
before--that was Fort Bliss--people on base often had access to 
contraception, and good access to contraception. But like the 
other panelists have mentioned, the base is not the only place 
where people receive healthcare, and specifically, family 
planning healthcare.
    So, even though I have only worked on one base providing 
contraception care, I have provided contraception or attempted 
to provide contraception, to many people who are in the Armed 
Forces, their dependents, their spouses, off base.
    And so, it is very true that abortion is not the only thing 
that anti-abortion extremists are looking to limit; that in our 
State, our State government here in Texas, every single session 
we hear anti-abortion extremists also saying that they want to 
limit or stop access to contraception, that they actually don't 
understand how contraception works. They often conflate 
contraception with abortion care. And quite frankly, it is 
very, very disturbing that many members of our legislature here 
in Texas also believe these same things.
    Yes, I will end there.
    Mr. Veasey. Dr. Moayedi, you know, with that, do you think 
that there is an opportunity? I mean, one of the Right to Life 
people that also accompanied to come and initially protest, but 
I did urge them to sit down and ask me questions as well. I am 
a strong believer in the First Amendment. And one of the ladies 
said that she was a nurse, and she was trying to explain to me 
that IUDs don't actually work.
    Do you think that there is an opportunity for people that 
you have met from different political--you know, whether they 
are right or left--to start having more substantive 
conversations around the topic of contraception, that doesn't 
delve into these sort of black-and-white-style camps?
    Dr. Moayedi. Well, I will say, Representative, that I take 
care of people from every political party and every religious 
belief. And so, this actually, it is not a political issue, in 
that everyone needs abortion. Republicans need abortion; people 
who are pro-life need abortion; and I take care of them, too.
    And so, while I am happy and proud to serve and take care 
of anyone, no matter what their beliefs are, I don't engage in 
arguing with people who fundamentally don't believe in science 
and who fundamentally believe in White supremacy, right? That I 
am not going to argue with those people, but I will provide 
them healthcare when they need it.
    Mr. Veasey. Okay. Thank you very much, Dr. Moayedi.
    Thank you. I yield back to the chair.
    Ms. Speier. The gentleman yields back.
    The gentlewoman from Texas, Ms. Garcia, is recognized for 5 
minutes.
    Ms. Garcia. Thank you, Madam Chair, and thank you for 
allowing me and approving my joining your committee. As my 
compadre over here said, you know, we are not on your 
committee, but we certainly have marveled at your leadership on 
many of these issues on this committee. And this issue is one 
that is very important to me and to so many Texans.
    And as the doctor just noted, we are sort of the epicenter 
for a lot of what has been going on on this issue. So, I thank 
you for bringing forward such great witnesses for this hearing.
    Abortion care is essential to a person's health and is 
central to their economic and social well-being. A group of 
extremists across the country have tirelessly fought for the 
last 50 years to strip women of their rights to have autonomy 
over their bodies. And with the help of the Supreme Court, they 
have finally succeeded.
    Regretfully, women do deserve better, and particularly 
those that serve in our military. My district in Houston is 
about 77 percent Latino. So, it does impact, in my view, 
minority women, vulnerable populations, poor women, more than 
any other group.
    So, it has been interesting for me to listen this morning, 
because, obviously, the additional barriers that are placed on 
women that live on installations, no matter what military 
branch, is very, very concerning to me.
    Statutory bans in different States prohibit the Department 
of Defense from providing or paying for abortions in most 
circumstances. I didn't know that. I am learning. This is 
probably now, Madam Chair, I think maybe my third month on this 
committee.
    But I can tell you that it is really almost frightening to 
even think, as my colleague from Texas has said, that there may 
be restrictions on birth control and IUDs, on the morning-after 
pill, and on many others, because this is what opens the door.
    So, my question is really to the doctors. I have a niece 
that is a pediatrician. She works in Fort Worth at a community 
health center. She shares with me sometimes the frustration 
that she has when she can't do something for her patient, 
whether it is a staffing issue, the lack of a specialist. But, 
for yours, this is like so different; I mean, because it is 
military folks telling you that you can't do something. But I 
am sure both doctors are like my niece; they take their 
Hippocratic Oath very seriously. And it pains her when she has 
got to turn a momma away because she doesn't have the shot 
available that her child needs.
    So, I just wanted to hear from the doctors on how they feel 
when they have to turn someone away because they cannot provide 
a service that they would want to do, and that their medical 
profession would dictate that they do.
    Either one of the doctors. I want to hear from both, but 
whoever wants to start first.
    Dr. Lamme. Do you want me to take this first? I can take 
this first.
    Thank you, Congresswoman. I actually appreciate the 
question.
    That is, honestly, one of the most difficult things for us, 
as physicians in the military, is to have legal restrictions to 
what we can provide.
    I would actually like to share another patient story with 
you, if I may. I was a flight surgeon prior to the passage of 
the Shaheen Amendment. So, at that time, we could only provide 
abortion services if the life of the mother was at risk. We 
could not provide them in cases of rape and incest.
    And I remember one particular case where one of the women 
in my squadron was raped at a squadron party. As her squadron 
doctor, when she found out she was pregnant, she came to me for 
care. And I had to be the one to tell her that, legally, we 
could not provide her abortion at the military hospital that we 
were at, and she would have to pay for it on her own.
    She asked me if I could drive her to the local Planned 
Parenthood after she made an appointment because she was 
absolutely positive that she did not want carry this pregnancy 
to term after a rape. That is not an unusual thing. As a flight 
surgeon, I would take many of my patients who had medical 
appointments out in town with specialists to their appointments 
to help be that liaison. So, it was not an unusual request.
    But when I asked for permission to do that, I was told by 
my legal officer that I could not because I was being paid by 
the Navy. So, me driving her was, essentially, using military 
funds to help her get her abortion care. The legal officer's 
recommendation was that she use the duty driver.
    At this time, there were only a few women within the 
squadron. So, it was most likely that duty driver was going to 
be a male and very possibly somebody that was at that party 
that she had been raped at.
    I can't even express the relief that I had when the Shaheen 
Amendment passed and I no longer had to tell patients who came 
to me with a pregnancy after rape that I could not take care of 
them. It was an amazing relief to be able to do that.
    However, I do realize that many of my patients don't 
actually know that they have that right, and that I can take 
care of them within a military treatment facility. It breaks my 
heart to hear how many women still end up going out in town to 
get the care that they need after rape procedures.
    The patient that Dr. Moayedi discussed who could have used 
general anesthesia if she had felt comfortable telling her 
physician that she had been raped and the pregnancy was a 
result of rape, I or one of my colleagues could have actually 
provided that anesthesia, so that she wasn't paying out of 
pocket. But she didn't know that, and the military medical 
system didn't know that she needed that care. And I think that 
that is one of the big gaps and challenges that we have right 
now, and it breaks my heart.
    Thank you.
    Ms. Speier. The gentlewoman's time has expired.
    The gentleman from California, Mr. Takano, chair of the 
Veterans' Affairs Committee, is recognized for 5 minutes.
    Mr. Takano. I want to thank you, Chairwoman Speier, for 
allowing me to waive onto this morning's hearing.
    And I want to thank the Active Duty service members for 
your courageous testimony.
    Chairwoman Speier, I am just profoundly moved by the 
testimony at the hearing this morning. Just tragic stories.
    As chairman of the House Veterans' Affairs Committee, I am 
committed to ensuring that our Nation and VA [U.S. Department 
of Veterans Affairs] continue to support our service members 
after they no longer are in uniform.
    So, I would like to ask Ms. Arana and Ms. Mozillo, are you 
aware that veterans have even less access to abortion 
counseling and abortion services through VA healthcare than 
Active Duty service members do through the Department of 
Defense?
    Ms. Arana. Thank you, sir, for the question.
    I have not researched, honestly, about VA rates or services 
after I am out of uniform in retirement. I think that, again, 
it is such a disservice that this is the support, or lack of 
support, for members who supposedly are celebrated, right, who 
are thanked for our service, but, yet, it feels very 
performative when those thank-yous aren't followed up with 
actual actionable support.
    Thank you.
    Mr. Takano. Thank you, Ms. Arana.
    Ms. Mozillo.
    Ms. Mozillo. Hello. Thank you for your question, sir.
    Actually, I did know that. I follow the VA healthcare 
system. As a medical service corps officer, I am familiar with 
the Military Health System and with the VA as well.
    And I am proud of my military service, and it saddens me to 
know that soon I will end my military career, and that I will 
have to face these challenges; and the sacrifices that I made 
during my career, those will go unnoticed because I am a woman 
and I won't have access to the same care that I did when I was 
Active Duty.
    Thank you.
    Mr. Takano. Well, it makes me concerned that this is one of 
the reasons why women veterans do not access healthcare at the 
VA. They may need the very specialized services in terms of 
post-traumatic stress and mental health that is very 
specialized to veterans, but the fact that the VA cannot even 
counsel women about their healthcare with regard to abortion is 
very troubling to me.
    VA is not bound by the Hyde Amendment exemptions that DOD 
follows for providing abortions to service members only in the 
case of rape, incest, or the preservation of the life of the 
mother. So, VA doesn't do abortions in those cases, either. 
Nonetheless, VA has made its own policy to avoid providing any 
abortion counseling or services.
    Ms. Arana and Ms. Mozillo, as service members who will one 
day be veterans yourselves, do you believe VA should, at the 
very least, align itself with the Department of Defense and use 
its authority to provide abortion counseling and services in 
those limited circumstances?
    Ms. Arana. I believe that all veterans are deserving of a 
standard of care, and standard of care means comprehensive 
reproductive care as well, to include abortion.
    Ms. Mozillo. Thank you.
    I believe reproductive care is healthcare, and that it 
should make no difference, and it should be included as part of 
our benefits.
    Thank you.
    Mr. Takano. Well, thank you.
    Dr. Lamme, based on your experience as a DOD provider, what 
guidance should VA provide to its medical staff in the wake of 
the Dobbs decision? And what are the dangers of VA continuing 
its policy to avoid providing abortion counseling and care, 
even in cases of rape, incest, and threats to the mother's 
life?
    Dr. Lamme. Thank you, sir.
    While I cannot speak directly to policies within the VA, 
and I have not worked within the VA system, I do believe that 
reproductive healthcare and full-scope care is primary 
healthcare, and we should be allowing our constituents to 
access it in the full measure, whether or not they're at a 
military treatment facility [MTF] or a VA facility. So, I hope 
that both the VA and within military medicine we are able to 
continue to expand the access to that very needed, and often 
life-saving, reproductive healthcare for women.
    Mr. Takano. Does it trouble you that, from your ability to 
counsel women, to just offer them counseling about their 
options, including women whose lives may be endangered, does 
that trouble you that VA can't do that counseling?
    Dr. Lamme. I find that very troubling because that is 
something that I do have to do with my patients very 
frequently. It is heartbreaking to not be able to always 
provide the care that patients need, if it is not within the 
Federal regulations allowed for us in MTFs. But to not even be 
able to counsel them, and to, essentially, have a gag order 
that doesn't let me tell the patient what the full scope of the 
healthcare that is available, or should be available to them, 
is, is very troubling. And I would find that very disturbing, 
if I was in that situation.
    Mr. Takano. Thank you.
    Madam Chair, I am sorry for going over. I yield back.
    Ms. Speier. The gentleman yields back.
    The gentlewoman from California, Ms. Brownley, the chair of 
the Health Committee of the Veterans' Committee, is recognized.
    Ms. Brownley. Thank you very much, Madam Chair.
    And I also want to add my sentiments to Ms. Arana and Ms. 
Mozillo, thanking them for sharing their stories today. Your 
bravery is truly twofold, by serving your country in the 
military, and now, serving our Nation by coming forward to 
publicly tell your stories. So, we are extraordinarily 
grateful.
    And, Chairwoman Speier, thank you for letting me waive onto 
the committee this morning. As you mentioned, I am chair of the 
Veterans' Affairs Health Subcommittee, and I also chair the 
Women's Veterans' Task Force.
    And as the chairman of the VA Committee just said, the VA 
has the most restrictive policy of any Federal agency on 
abortion and abortion counseling. There is a ban on both 
abortion and abortion counseling, and it is the most 
restrictive. Even the Bureau of Prisons allow abortions, 
elective abortions. So, prisoners in our Federal prisons are 
allowed elective abortions. They must pay for it, but it is on 
a sliding scale in terms of what they can afford.
    So, I think I wanted to ask the doctors this question, a 
little bit different than what the chairman of the VA was 
asking. And before we go on to the next panel, because I am 
sure we will ask them the question about what kind of guidance 
has come so far, I am interested to hear from you, at this 
point in our post-Roe world, what guidance and support have you 
received from the Department of Defense thus far in terms of, 
you know, how you can best support your patients?
    Dr. Lamme. Thank you, ma'am.
    There was, actually, a recent statement on the 28th of June 
from the Under Secretary of Defense, Mr. Cisneros, who did 
specify that we in military medicine can and will continue to 
provide full-scope reproductive healthcare within the scope of 
Federal legislation.
    So, in theory, that does mean that we continue to provide 
the care we have always provided. And for physicians such as 
myself who are stationed in Washington or California, or States 
without restriction, it does not make a difference. It means 
that we are continuing to provide the care that we have always 
been able to provide.
    I do think that, for many of my colleagues that are in more 
restrictive States, there is still a concern on whether or not 
they can be prosecuted from the State, even though they are 
legally allowed to provide these services on the Federal land. 
And that is one of the concerns that exists, and I would 
encourage the committee to make legislation that protects both 
the physicians and the patients, regardless of where they are 
stationed.
    Thank you.
    Dr. Moayedi. And I will just add to that, to your point, 
Representative--and actually, to Representative Kim's point 
earlier as well--that the laws that are currently being passed 
across the country are also aiming and targeting at helpers. 
And we heard today how important just one person can be for a 
service member to be able to access an abortion.
    But, right now, for example, what we are seeing in Texas is 
that extremists are saying that they want to come after and 
arrest and prosecute anyone who aids and abets an abortion. So, 
that means anyone that gives you that gas money, anyone that 
gives you that ride, anyone that helps you arrange that care. 
And so, we are not just talking about a cruel and inhumane ban 
on a human right to healthcare, but also we are talking about 
systems that are being put into place to keep neighbors and 
community members from supporting each other. We should all be 
worried about what that will mean for the future of our 
country.
    Ms. Brownley. Thank you for that.
    And to the doctors as well, can you prescribe the abortion 
pill?
    Dr. Moayedi. No, you cannot prescribe the abortion pill, 
technically, yet because there is what is called a risk 
evaluation and mitigation strategy on mifepristone and 
misoprostol. And so, the combination drugs that are used in 
medication abortion must be dispensed through a healthcare 
facility--you can't go to your local pharmacy--or through 
certain types of registered pharmacies. But, for example, in 
Texas, it cannot be accessed through a pharmacy at all.
    Ms. Brownley. Thank you for that.
    And thank you again, Madam Chair. I yield back.
    Ms. Speier. The gentlewoman yields back.
    This brings to a conclusion our first panel. And I must 
say, it is truly a great privilege for us to have heard from 
you, Major Arana, Major Mozillo, Dr. Lamme, Dr. Moayedi.
    I have really done a terrible job on your name. Moayedi, is 
that correct?
    Dr. Moayedi. Dr. Moayedi.
    Ms. Speier. Moayedi.
    You have provided us with great insights into the fractured 
system that exists in the military for women, one that is 
untenable and unacceptable, and one that we must fix.
    So, you have provided great information for us, great 
testimony. Your courage and bravery is to be commended.
    And with that, we are going to recess. We are going to 
recess momentarily to bring the next panel on. And we are going 
to take the testimony from the Under Secretary, and then, we 
will recess after that for the two votes and come back.
    So, again, thank you very much.
    [Recess.]
    Ms. Speier. We now welcome our second panel. And we welcome 
back a friend and former colleague, the Honorable Under 
Secretary in the Department of Defense for Personnel and 
Readiness, and Ms. Seileen Mullen, the Acting Assistant 
Secretary of Defense for Health Affairs.
    So, Under Secretary Cisneros, the floor is yours.

   STATEMENT OF GILBERT R. CISNEROS, JR., UNDER SECRETARY OF 
DEFENSE FOR PERSONNEL AND READINESS, DEPARTMENT OF DEFENSE; AND 
   SEILEEN MULLEN, ACTING ASSISTANT SECRETARY OF DEFENSE FOR 
             HEALTH AFFAIRS, DEPARTMENT OF DEFENSE

    Mr. Cisneros. Chairwoman Speier, Ranking Member Gallagher, 
and distinguished members of the subcommittee, thank you for 
the opportunity to discuss the rights and access to 
reproductive healthcare of our service members, Department of 
Defense civilians, and DOD families, in light of the June 24, 
2022, Supreme Court ruling Dobbs. Joining me today is my Acting 
Assistant Secretary of Defense for Health Affairs, Ms. Seileen 
Mullen.
    Secretary Austin has made clear that nothing is more 
important than the health and well-being of our service 
members, civilian workforce, and DOD families. We are committed 
to taking care of our people and ensuring a ready and resilient 
force.
    I want to start by saying that I was deeply moved by the 
witness testimonies in the previous panel and appreciate them 
sharing their experiences and concerns. I want to assure them, 
and this committee, that the Department takes the concerns of 
our military community seriously, and we, including the 
services, are doing all we can to provide the healthcare our 
service members deserve with focus and compassion.
    I was particularly moved by the stories about the 
servicewomen who became pregnant as a result of sexual assault 
experiences during their time in the military. No one should go 
through what these women experienced. This is another 
demonstration of why the Department is urgently implementing 
significant organizational and cultural change to eliminate the 
scourge of sexual assault in our military.
    What these stories very clearly highlighted is that we have 
work to do. We must build a system where our victims feel 
comfortable coming forward, so that they can access all the 
services they need and are legally entitled to, and victims of 
sexual assault do not need to report their assault to the 
leadership to access the care and services, including 
abortions.
    There are many resources to help navigate their options. We 
will continue to publicize this information as widely as 
possible, and continue to professionalize our Sexual Assault 
Response workforce to ensure victims are receiving the care 
they need and deserve.
    Following the Supreme Court's ruling, I sent out a 
Department-wide memo reassuring our service members that the 
Department would continue to provide federally authorized 
abortions, which we call covered abortions. Service members can 
receive the same reproductive healthcare after Dobbs as they 
did before the ruling.
    Consistent with long-existing Federal law, covered 
abortions--those cases that involve rape, incest, or where the 
life of the mother would be endangered--will continue to be 
authorized to use Federal funds and facilities. There is no 
interruption to this care.
    I also affirm that our existing policies have not changed. 
For example, our travel policies related to healthcare remain 
the same. Service members who require travel to obtain a 
covered abortion may travel in official status and are not 
charged leave. Regular leave can be taken for cases involving 
non-covered abortion care. The Office of Personnel Management 
released similar guidance for civilians, reiterating that 
employees may use sick leave and other forms of leave for these 
purposes.
    While our policies have not changed, I did acknowledge that 
complexities and challenges posed by the Court's decision. 
Dobbs does not affect the care we can provide, but service 
members are now having to navigate additional challenges to 
access essential women's healthcare services.
    Service members and their families who were previously able 
to make very personal decisions about when to have a family may 
now face greater burdens depending on where they are stationed. 
They may lead to some wanting to leave the military because 
they don't want to be assigned to a duty station where they 
cannot access their choice of healthcare.
    Other potential impacts include recruitment of women who 
may have concerns about restrictions to access for reproductive 
healthcare and victims of sexual assault who may have added 
fears of maintaining confidentiality, if their only option is 
to obtain covered abortion through the Military Health System.
    These are just some of the complex issues brought on by 
Dobbs. We understand the very personal nature of how the 
Court's decision impacts families. So, we are being very 
deliberate in analyzing Dobbs with both focus and compassion. 
We want to make sure we get this right because it impacts 
access to essential women's healthcare and reproductive care.
    Chairwoman Speier, we know that there is still more work to 
be done, and as we continue to review our policies, I commit to 
working with you and this committee, just as we have always 
done. We have a solemn obligation to support all those who 
volunteer to keep our country secure, including service 
members, civilian employees, and military families. We pledge 
to do everything we can to ensure that individuals in our 
military community are able to access the healthcare they need.
    Thank you, and we look forward to your questions.
    [The joint prepared statement of Mr. Cisneros and Ms. 
Mullen can be found in the Appendix on page 85.]
    Ms. Speier. Thank you, Under Secretary.
    Ms. Mullen, do you have a statement as well?
    Ms. Mullen. No, I do not.
    Ms. Speier. All right. I think, considering we have a vote 
on right now, but there is still about 374 Members who haven't 
voted, we will start the questioning.
    I am going to reserve my questions to the end. So, I am 
going to recognize the gentleman from New Jersey, Mr. Kim, for 
5 minutes.
    Mr. Kim. Thank you so very much.
    I know how tough a position we are in right now in terms of 
how we are trying to figure out to be able to provide care to 
some of the service members. Some of the stories we heard today 
are reflective of what service members are going through right 
now.
    I wanted to just ask you, what do you need from us? What is 
it that we should be thinking about here on the Hill to be able 
to try to open this up? I want to be as crystal-clear to my 
colleagues about what is at stake and the role that we play. I 
know and appreciate what you outlined, the notices that you 
have given to our service members right now, to the providers. 
I know that there is probably more that you want to be able to 
do, but you are going to need to have us and others be able to 
step up, too. So, I wanted to just kind of give you that 
opportunity right now from the outset.
    Mr. Cisneros. Thank you, Congressman Kim, for that 
question.
    It is well known Dobbs created a lot of complexities. As 
Mr. Garamendi had said earlier, this is like--it was 26; now it 
is as many as 29 States that we are having to navigate the 
different laws in each State and to see how it affects our 
service members in each State.
    We are currently reviewing our policies and procedures, and 
we are committed to continue to work with the committee after 
we finish that process. But the complexity of this issue is 
really--we need to take the time to go out just to see how each 
State law affects us, and then, as I have stated, we are 
willing to come and work with the committee to see how you can 
best support us.
    Thank you.
    Mr. Kim. Thank you. I hope you take away from this 
discussion here that there are many of us here eager and 
willing to help. And we would like to have a continued and 
robust conversation, not just today, but going forward, just to 
make sure that we are on the same page in thinking that 
through.
    Another thing that I wanted to ask is, in your statement, 
you also mentioned that families may experience distress 
because of these barriers; that it could inflict emotional harm 
on those seeking care, as well as their families.
    So, I just wanted to make sure that we are being mindful 
about some of the challenges that are being faced in other 
aspects, especially when it comes to mental health. So, I 
wanted to ask if you have been thinking that through and if 
there are any additional resources needed for behavioral health 
services to try to address some of these types of other order 
effects that are coming from these challenges that service 
members are facing.
    Mr. Cisneros. Congressman, you are right, the Dobbs 
decision not only affects our service members, but also their 
families. You know, a service member could have a spouse that 
may need to go seek access to care outside of a State where 
this type of healthcare is not permitted. And so, it does 
affect our families.
    And mental health, behavioral health, is an issue that we 
are very concerned about. The Secretary has said many times 
that mental health is health. And we are continuing to work 
with our service members and their families to ensure that they 
get the mental healthcare that they need.
    If any service member does come and desires and needs help, 
especially around this issue, our medical staff is trained to 
kind of work with them and to kind of ensure that they seek 
that help.
    And with that, I can turn it over to Ms. Mullen, who can 
speak more in detail about that.
    Ms. Mullen. Thank you.
    I would first like to acknowledge the first witness panel. 
Those stories, both from the providers and from the Active Duty 
servicewomen, were compelling, and we thank you for sharing 
their stories with us.
    First, two parts. Regarding providers, this committee has 
been very supportive of increasing behavioral health providers 
in our system. We acknowledge that that is something we are 
working on, and that we have been allowing both additional pay 
and recruitment activities to try to get more behavioral health 
providers into our system, both military and civilian.
    Second, any woman going through counseling for either a 
covered abortion procedure or any contraceptive care is always 
asked, or should always be asked, [if] they would like some 
additional mental health counseling.
    Thank you.
    Mr. Kim. Great. Thank you. Well, look, we will continue to 
work together on this, but I appreciate it.
    With that, I will yield back.
    Ms. Speier. The gentleman yields back.
    The gentlewoman from Texas, Ms. Escobar, is recognized for 
5 minutes.
    Ms. Escobar. Thank you so much, Madam Chair.
    And many thanks to our panelists here today. Mr. Under 
Secretary, it is wonderful to see you again. So proud to see 
you on the other side of the dais and so proud of the work that 
you are doing.
    Thank you for coming to my district last week. I was so 
bummed to not be there with you and to miss the opportunity to 
visit with you. But, again, thanks to both of you.
    And as we heard in the prior panel, the impact is real. The 
impact of the Dobbs decision is profound. And I am not sure if 
you caught my own opening remarks, but the day that the draft 
decision was released--and this was before the final decision 
was released--my office received a number of calls from women 
service members at Fort Bliss, and the uncertainty that the 
draft decision brought about was really challenging for us to 
navigate and it was deeply troubling.
    But I think that, now that that uncertainty has sunken in 
for a lot of women in those dozens of States, it is really 
going to be critical that we provide as much guidance and 
information and clarity as possible, because that uncertainty 
is frightening for women.
    So, I would like to ask you all if you can provide 
specifics on how you will help female service members navigate 
and understand their rights, understand the information about 
where they can access care and help. How do we de-stigmatize 
this, so that women feel like they have the ability to ask 
these questions, and so that they are not seeking help outside 
of their military installations--or not help, but, literally, 
information outside of their military installations. So, really 
would love to know what you are doing specifically, but what 
tools--really kind of piggybacking on what my colleague, Mr. 
Kim, mentioned--what tools do you need from us that could 
really help you with that, while we, hopefully, seek to create 
better conditions in the future?
    Mr. Cisneros. Well, thank you for that question, 
Congresswoman. And it is good to see you again as well, and 
unfortunately, I did miss you. We did miss you in El Paso, but 
it was great to go down to Fort Bliss and visit with the 
soldiers down there that are dedicated to serving our country, 
as well as to visit with the people of the great city of El 
Paso. So, thank you very much for that.
    One of the reasons that we put out that message on June 
28th was to clarify to our service members across the force 
that, despite the Dobbs decision, that we will continue to 
perform the covered abortions, as we are legally able to do, 
which is in the case of incest, rape, or endangers the life of 
the mother.
    And we wanted it to be known that this decision will not 
affect the healthcare that we provide at our MTFs. We also sent 
out a second message to our healthcare providers to let them 
know that they are able, despite this decision, they are able 
to continue to provide the healthcare that they were able to 
provide pre-Dobbs on our MTFs and it will not affect them. As 
long as they are doing their job performing it in a Federal 
status, which they are because they are working for the U.S. 
military in a Federal installation, that will not affect the 
job that they can perform. So, we felt it was important to get 
that out, and we will continue to message with the force.
    As I said earlier, this Dobbs decision is very complex. 
Each State is creating their own laws and policies. And so, we 
are looking how it is affecting each State, is affecting us. 
And we want to make sure that, when we come--as I said, we are 
willing and we want to work with the committee--but we want to 
make sure we are getting it right and taking time to study this 
before we come to you with asks. So, thank you.
    Ms. Escobar. Well, please count on us, especially this 
committee under the leadership of Chairwoman Speier, for what 
you need. We want to make sure that we are as helpful to our 
service members, because we are all very concerned about 
retention and recruitment and readiness.
    Thank you, Madam Chair. I yield back.
    Ms. Speier. The gentlewoman yields back.
    The gentlewoman from California is recognized for 5 
minutes.
    Ms. Jacobs. Thank you, Madam Chair.
    And thank you to our witnesses. Mr. Under Secretary, it is 
great to see you again.
    In our last panel, we heard that there are not currently 
enough OB/GYNs in the military healthcare system to treat every 
person of reproductive age who would need that care. We also 
heard that there was not enough to even do the abortions that 
are currently covered and allowed under law.
    So, I was wondering what you are doing to make sure that 
our service members are getting their healthcare. I mean, I am 
a young woman myself, and for many years, my OB/GYN was the 
only doctor I went to. And if that is not care that is 
available for our service members in military facilities, that 
is deeply problematic. So, what are you doing to make sure that 
we have enough OB/GYNs; that covered abortions at military 
facilities will continue uninterrupted, even in States where 
abortion is being criminalized; and to ensure that those OB/
GYNs and military personnel are trained, so that we can have 
the full range of contraceptive methods, including IUDs?
    Mr. Cisneros. Well, thank you, Congresswoman. It is good to 
see you again as well.
    As the Secretary has stated, Secretary Austin has stated 
many times, taking care of our people is our top priority. And 
part of that, of taking care of our people, is ensuring that 
they have access to essential healthcare; that we are able to 
provide them, and providing it to them, the best quality 
healthcare out there available.
    You know, it is essential that we have our physicians. 
There are, of course, shortages. There is a shortage of doctors 
nationwide. That is no different in the military. But we are 
doing what we can to make sure that we have access; that every 
service member, when they go out and when they come to an MTF, 
that they are seeking healthcare, that they will get the best 
quality healthcare that they can.
    With that, I can turn it over to Ms. Mullen, who can go 
into greater detail.
    Ms. Mullen. Thank you.
    Each of our MTFs are staffed by both military and civilian 
providers who are able to deliver reproductive care to all of 
our men and women. Oftentimes, that specialty care that they 
are seeking may not be available at the MTF. But, as you know, 
the TRICARE network, which is a private sector care integrated 
network across the United States, they will be able to provide 
that care in our network. Every woman will have that ability to 
get the care that they need, either at the MTF or in our 
network.
    But I would also like to say that, this week, under Mr. 
Cisneros' guidance, we have expanded what we have in military 
treatment contraceptive clinics, walk-in clinics. We have had 
that a bit across the United States with 18. We are now 
expanding that to all of our MTFs. So, a woman or a man could 
come up, get counseling, and decide what contraceptives they 
need that day.
    Thank you.
    Ms. Jacobs. And would they be able to access IUDs and other 
contraceptives----
    Ms. Mullen. Absolutely.
    Ms. Jacobs [continuing]. At those clinics?
    Ms. Mullen. Absolutely, yes. Yes.
    Mr. Cisneros. With that, I will also state, around IUDs, is 
we are currently updating our policy, so that service members 
and their families will be able to receive those IUDs through 
the TRICARE healthcare system without having to pay a copay, 
which is currently the thing right now. So, we are changing our 
policy, updating it, so that the copay will be eliminated with 
that.
    And the other thing I will mention, too, around 
contraceptives is, currently, at our boot camps, when women 
come into boot camp, they do receive a woman's health exam, 
where they are asked about contraceptives. Are they currently 
taking them? Do they like their current contraceptive? Would 
they prefer an IUD? So, contraceptives is ensuring--that is 
women's healthcare, and we want to ensure that our service 
members have access to that healthcare.
    Ms. Jacobs. Thank you.
    With that, Madam Chair, I yield back.
    Ms. Speier. The gentlewoman yields back.
    The gentleman from California, Mr. Garamendi, is recognized 
for 5 minutes.
    There are 225 Members not voting.
    Mr. Garamendi. Including us.
    Ms. Speier. Including us, yes.
    Mr. Garamendi. Thank you, Madam Chair.
    I was about to say, ``Gil.'' That would be improper.
    Mr. Cisneros. Not at all, sir. Not at all.
    Mr. Garamendi. I am delighted to see you in your position. 
I am even more delighted to hear your testimony today. You are 
taking strong steps, not only on this specific issue of 
abortion, but on women's healthcare. The testimony you have 
given thus far would indicate that you intend to continue with 
that.
    As chairman of the Readiness Subcommittee, together with 
Ms. Speier, we are deeply concerned about this entire issue of 
women in the military and the issues surrounding their safety. 
And Ms. Speier has led us very adroitly in the years she has 
been chairman of the committee, Personnel Committee, in dealing 
with sexual assault and other issues. We note your desire to 
deal with that issue also, and thank you for that. And now, we 
have the abortion issue, to even further compound that 
situation.
    My concern here is the overall readiness of our military. 
We do rely, increasingly and appropriately, on women in the 
military. I hope that continues. I am concerned that this issue 
of abortion may cause some women to rethink and to think that 
they should not be in the military.
    So, my question to you is, I would like to hear your view 
on, do you anticipate the Dobbs decision to reduce the 
readiness of our military? And if so, how might it and what 
should we do, if that is the case?
    Mr. Cisneros. Well, thank you, Congressman Garamendi. It is 
a pleasure to see you again. I hope you and your family are 
doing well.
    You know, readiness is a big concern of ours. And, of 
course, readiness, you know, the individual healthcare of our 
service members is readiness, as many other things that we take 
into consideration as the readiness of our force. If they are 
not healthy, they won't be able to perform their duties.
    I don't want to say it is going to affect readiness, but it 
is a concern that we have. You know, as you heard in the last 
panel, I think one of the majors had said that, if she wasn't 
able to get the abortion when she was an E-3, she probably 
would not have stayed in the military. You know, retention is 
also a concern that we have.
    As Ms. Escobar stated, she has heard numerous calls from 
servicewomen. We have heard those, too, coming in from service 
members who are concerned about how this decision is going to 
affect them.
    We are working. It is essential for the survivability of 
our force that we become more diverse. Women are a big part of 
that. Having a conversation I recently had with the Secretary 
of Navy, it is that we need more women to join our Navy, and 
that is essential. And they will make us more inclusive. They 
will make us a more lethal and better fighting force. And we 
need them to join our military. And so, we know that this 
decision is going to have some type of impact.
    As the major--who was it?--Major Arana said, and Major 
Mozillo, they speak proudly of their military service. They 
encourage young women to join, and I hope they continue to do 
that. And I know they will because they said they will. But to 
think that some woman may not think twice before joining the 
military because of the Dobbs decision, it is definitely a 
concern, sir.
    Mr. Garamendi. I would ask that you monitor this, provide 
the statistical analysis, and return to us any information that 
you might receive and develop on the impact of the Dobbs 
decision and the 131 installations that are in States that are 
restricting abortions. And with that information, it may 
provide additional motivation for the Congress, and 
particularly our committees, to provide the necessary support 
that women need.
    Thank you so very much. I yield back.
    Ms. Speier. The gentleman yields back.
    The gentlewoman from Texas, Ms. Garcia, is recognized for 5 
minutes.
    Ms. Garcia. Thank you, Madam Chair.
    And welcome, Mr. Secretary. It is really great to see you, 
and I'll always remember you as part of our freshman class. We 
had some good times, and now you are on to greener pastures, as 
they say.
    But thank you for your presentation. And I think, for us, 
it is we know our brave service members have defended our 
freedoms. And as elected Members of Congress, it is now up to 
us to defend theirs. And for the women service members, that 
includes their freedom to decide their own healthcare 
decisions.
    My question is sort of a broader question. I have visited 
some installations, different branches, especially many Air 
Force--Air Force since my family is more Air Force than 
anything else. And it has always struck me that the services 
that are provided to service members at the different 
installations aren't always the same. So, when it comes to 
healthcare, I think it is important that there be as much 
uniformity and as much access as possible at every 
installation.
    So, what are we doing to make sure that the healthcare 
access is comprehensive, but also uniform throughout the 
installations, particularly in the 131 that have been mentioned 
by others as being in States that have bans on abortion or some 
abortion restrictions at some level?
    Mr. Cisneros. Ma'am, as stated earlier, taking care of our 
people in the Department of Defense is our biggest priority. 
Ensuring that they have access to quality healthcare is 
something that we think about, I think about, on a daily basis. 
And we want to ensure that all our service members will have 
access throughout the MTFs all over the country and the world 
that we are legally able to provide. And we will continue to do 
that and ensure that it is granted equally out there.
    I mean, there will always be instances where there may be a 
smaller number of service members in one area compared to like 
an area such as San Antonio, where there is a large number of 
service members. So, the access, what is going to be available, 
is going to be greater in those larger areas than in the 
smaller ones. But, in those situations where a service member 
may be serving remotely, they are provided TRICARE access 
there, to where they can get healthcare through TRICARE to 
ensure that they are still receiving quality healthcare.
    And with that, I will turn it over to Ms. Mullen, if she 
has anything else to add.
    Ms. Mullen. Thank you.
    As you know, we have a statutorily defined benefit which is 
incredibly very comprehensive. So, one, we are very proud of 
that.
    Second, this week, under Mr. Cisneros' direction, we set up 
a dedicated women's health page. As we heard from the witnesses 
ahead of us, clearly, we need to do a better job of 
disseminating information, communicating, and educating both 
our beneficiaries, our providers, and everybody in the Military 
Health System. So, we are really hoping that this women's 
health page will be a one-stop shop where a lot of women can go 
to make sure that they can actually know what their benefits 
are.
    Ms. Garcia. Great.
    And, Mr. Secretary, you mentioned in your opening remarks 
that you were reviewing all your policies, and that one of them 
was to ensure that if people, women have to travel, if service 
members have to travel to another State to get any reproductive 
healthcare, that they would be able to do so on official 
status. Is that what I heard you say, sir?
    Mr. Cisneros. Ma'am, if a service member is covered 
during--for covered abortions, a service member, we will 
provide transportation cost for that service member, if, for 
whatever reason, they can't get that where they are currently 
stationed. We will ensure that they get that care and will 
allow them to travel at cost, as well as provide the procedure 
for covered abortions.
    Ms. Garcia. But will they have to take their time off of 
their own personal time?
    Ms. Speier. Covered abortions is what is critical here. So, 
only for rape, incest, and life of the mother will they cover 
the cost.
    Ms. Garcia. Okay.
    Mr. Cisneros. Yes, for covered abortions, no, they will not 
have to take time off, take leave for that. That will be 
covered through the Department of Defense.
    Ms. Garcia. Okay. Well, thank you again.
    Those are all the questions I have, Madam Chair, and I 
yield back.
    Ms. Speier. The gentlewoman yields back.
    And there are 97 Members who have not yet voted.
    I am going to ask my final questions, and we will then 
close the hearing because Mr. Gallagher has other commitments 
as well.
    So, I want to thank you again, Under Secretary, for being 
here. I remember you also fondly when you served on this 
subcommittee as well.
    There are a couple of things that I think we really need to 
delve into, though. One is a more robust contraception 
education program within the military. So, will you commit to 
building up that contraception education, so that military 
service members know the difference between all the 
contraceptives that are available and the Plan B, which is 
often referred to as morning-after pill, which sometimes--and 
even on this committee--has inappropriately been considered to 
be an abortifacient, which it truly is not?
    Mr. Cisneros. Yes, ma'am, my time here, serving with you 
fondly on this committee, I think of that very fondly, too. So, 
thank you very much for your kind comments.
    But, as I said, ma'am, earlier, currently, in the boot 
camps we are providing that education with the women's wellness 
exams; talking to them about contraceptives, explaining the 
different types of contraceptives; you know, seeing if they 
want to change, if they like their current contraceptive. Would 
they like to do something different?
    As Ms. Mullen has also stated--and I will let her talk more 
about this in a minute--we are moving to allow free 
contraceptives at our MTFs. We currently do it and it was being 
done at 18. We are now expanding that to all our MTFs.
    I think it is essential, as we do that, of course, we need 
to educate our service members as well as to types of 
contraceptives that we can provide. What is the difference 
between an implant, such as an IUD, versus pharmaceutical 
contraceptives, versus emergency contraceptives?
    So, with that, yes, I will commit to you that, as we 
expand, we will also expand our education programs around 
contraceptives.
    And with that, I will turn it over to Ms. Mullen to----
    Ms. Speier. Ms. Mullen, if you would just pause for a 
moment? Mr. Garamendi has a question.
    Mr. Garamendi. Mr. Secretary, in answer to Ms. Garcia's 
question, you indicated that an officer could authorize an 
expenditure to travel to another State for authorized 
abortions. Some of those authorized abortions appear to be 
illegal in some States. Could the officer be held criminally 
liable for assisting in the abortion?
    Mr. Cisneros. Congressman, again, the complexities of this 
Dobbs decision have created very many uncertainties. And that 
is one reason why we are very diligently working with our 
Office of General Counsel to examine how each State law might 
affect what we do within the Department of Defense.
    But, currently, the way that it works in the leave policy--
well, let me take that back. But, you know, the way that we see 
it, as long as they are performing their legal duties--so, a 
medical provider performing their legal duties at an MTF, 
advising a service member to their options for a covered 
abortion, and that they need to go--is that, currently, the way 
that we have look at it is, no, because they are performing 
their duties in a Federal matter, that the State law will not 
trump over the Federal law, sir.
    Mr. Garamendi. I will be interested to hear the legal 
analysis.
    Thank you very much, Madam Chair.
    Ms. Speier. All right. Ms. Mullen, briefly, if you would?
    Ms. Mullen. Thank you.
    As you mentioned earlier, we are very much front and center 
about trying to communicate better with our beneficiaries, in 
particular our women, about what their choices are.
    We are about ready to publish a women's reproductive health 
survey conducted by RAND. It is the first time that has been 
done in 30 years, and it has given us quite a bit of 
information, to include the lack of education about women's 
options around contraceptives, which are free in our--all 
Active Duty service members get free contraceptives in the MTFs 
and in our retail pharmacies. It is a small copay for our 
Active Duty family members, but, with your legislation that you 
are spearheading, we hope to see that change this year. Thank 
you for that effort.
    We also do have an app that is called ``Decide and Be 
Ready,'' that men and women can use to go through their 
contraceptive options and decide what is best for them.
    We also have those walk-in clinics that are newly being 
expanded this year as well.
    But, as you have mentioned, overall, it is sort of 
astonishing how our young men and women really don't fully know 
what their reproductive rights and healthcare consist of, and 
we need to do a better job.
    Ms. Speier. And I would also say, Under Secretary, while 
you are doing that education with women who are in boot camp, 
we really need it for the men as well, because, truly, we keep 
losing sight of the fact that there are two in this process. 
And the burden and responsibilities rest with just one, once 
she is pregnant. And also, for service members who, as men, 
have spouses that should be accessing this. So, it is important 
that we do a much more robust one.
    We have to do something about the leave that women cannot 
access. They TDY [temporary duty travel], I guess is what you 
would refer to it, where they are allowed to go to another 
State to get the abortion and not be docked in terms of leave.
    We are providing unequal access to women in the military 
when we have 109 installations in these red States that are 
banning all abortions--109 installations. And it could be as 
many as 134 because there are court cases pending.
    So, there needs to be a way, one, of not docking them for 
the time that they have to take away, and we have got to deal 
with this travel issue at some point.
    And finally, I would say that my concerns about retaliation 
are real--that needs to be nipped in the bud--and the potential 
for a commanding officer to refuse to grant the leave because 
of a religious concern, or just because they can refuse.
    So, we can continue this conversation. As you point out, it 
is a complex decision. But I think there is no question that 
there is a 14th Amendment violation to women serving at these 
109 installations where they cannot access the abortion care 
nearby, and as we heard from our witnesses earlier today, have 
to spend thousands of dollars, as much as $10,000, because if 
you need to have anesthesia, even if it is a D&C [dilation and 
curettage] or a D&E [dilation and evacuation], you are dealing 
with very expensive costs. And for these enlisted service 
members, as you know, they are making very small incomes.
    So, with that, we will continue this conversation. We thank 
you both for being here and for your commitment to making sure 
that we maximize the benefits to service members, all service 
members, and particularly, women, since the Dobbs case.
    With that, we stand adjourned.
    [Whereupon, at 10:54 a.m., the subcommittee was adjourned.]



      
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                            A P P E N D I X

                             July 29, 2022

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                             July 29, 2022

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              QUESTIONS SUBMITTED BY MEMBERS POST HEARING

                             July 29, 2022

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                  QUESTIONS SUBMITTED BY MS. HOULAHAN

    Ms. Houlahan. The Fiscal Year 2021 National Defense Authorization 
Act, Section 555 required the Department of Defense to develop a policy 
to ensure that the career of a member of the Armed Forces is not unduly 
affected because the member is pregnant, gives birth, or incurs medical 
condition related to pregnancy or childbirth. My office has asked the 
Department for a copy of that policy but has yet to receive it. When 
can this committee expect to receive a copy of that policy?
    Mr. Cisneros. [No answer was available at the time of printing.]
    Ms. Houlahan. Pregnancy is a medical condition which deserves the 
same right to privacy and autonomy over medical decisions as any other 
medical condition. Reviewing witness testimony, and written statements 
submitted by Chairwoman Speier, I am horrified at the utter lack of 
medical privacy servicewomen face when pregnant. In one letter a 
service member states that the results of a urine test completed at a 
military treatment facility to confirm a pregnancy immediately 
``triggered the Public Health office to place me on a physical fitness 
profile and an assignment limitation code . . . I was in a constant 
state of terror that my immediate supervisor and their rater, who both 
have access to the data base that would display those changes, would 
see this information and start asking questions.'' Furthermore, in a 
letter from the Commander of Air Mobility Command, it states that:
    ``Pregnancy is the only condition widely disseminated across 
medical, personnel, and readiness systems. We must better safeguard 
medical information and privacy.''
    The letter goes on to address specific actions units within the Air 
Mobility Command must take to ensure that HIPAA protections are 
provided to service members who are pregnant. Will the Department of 
Defense consider implementing privacy conditions and information 
restrictions across its medical, personnel, and readiness systems to 
ensure the right to medical privacy is applied to pregnancy?
    Mr. Cisneros. [No answer was available at the time of printing.]
    Ms. Houlahan. Would you agree that servicewomen should be able to 
secure leave for an abortion without disclosing the reason to their 
commanding officers, and if so, what steps is the Department taking to 
ensure privacy and confidentiality for servicewomen?
    Mr. Cisneros. [No answer was available at the time of printing.]
    Ms. Houlahan. The Blue Star Families' annual 2021 Military Families 
Lifestyle Survey (aMFLS) found that 64% of active-duty family 
respondents reported having family building challenges while serving in 
the military. Over four in 10 active-duty family respondents report 
that military service created challenges to having children, 
specifically the desired number and/or spacing of their children. 
Furthermore, family building challenges due to military service are 
much higher for female active-duty service members than their male 
peers (57% vs. 28%), given the requirements to balance career goals, 
duty locations, partner co-location and biology. As such, can you 
explain your current understanding of how family building challenges 
affect military readiness?
    Mr. Cisneros. [No answer was available at the time of printing.]
    Ms. Houlahan. Does the Office of the Under Secretary of Defense for 
Personnel and Readiness support a study on the connection between 
active-duty military service and family building challenges to provide 
a full accounting for how many military members struggle with family 
building challenges and how those unsupported burdens could be 
affecting retention and readiness?
    Mr. Cisneros. [No answer was available at the time of printing.]
                                 ______
                                 
                 QUESTIONS SUBMITTED BY MS. STRICKLAND
    Ms. Strickland. TRICARE currently pays for assisted-reproductive 
procedures if a loss in reproductive ability is a result of a service-
connected injury. The services also must be combined with natural 
conception and the servicemember must have a lawful spouse. Non-coital 
reproductive procedures are not covered. Otherwise, servicemembers must 
pay out of pocket.
    Does the Department of Defense believe that all service members 
deserve the right to start a family in a matter commiserate to their 
medical needs? Does the Department of Defense believe that all 
servicemembers and their spouses deserve equitable access to 
infertility care without discrimination?
    Mr. Cisneros. [No answer was available at the time of printing.]
    Ms. Strickland. TRICARE prescribes a diagnosis of infertility as 
the inability to conceive after 12 months or more of regular 
unprotected sexual intercourse. This definition of infertility 
contradicts the operational nature of military service for the majority 
of the work force and is discriminatory in its exclusion of military 
members who choose to parent independently or as a parent in a same sex 
partnership. Moreover, female service members have significantly 
greater rate of infertility than the general population.
    Military life, which requires physical separation by partners, 
exposure to hazardous materials, inherent risk in training and combat 
and the prevalence of comorbid conditions--PTSD, Anxiety, Depression, 
Sexual Dysfunction contributes to the challenges that negatively impact 
fertility for today's servicemen and women.
    Will the Department of Defense consider revising the definition of 
infertility for active-duty servicemembers and their dependents? Will 
the Department of Defense also consider making baseline fertility 
testing available to individuals finding traditional ``watch and wait'' 
techniques inadequate?
    Mr. Cisneros. [No answer was available at the time of printing.]