The League of Women Voters of the United States joined comments to the Department of Veterans Affairs (VA) opposing their proposed rule to eliminate comprehensive reproductive care for veterans and their families.
September 3, 2025
Steven L. Lieberman
Acting Under Secretary for Health
Department of Veterans Affairs
810 Vermont Avenue NW
Washington, DC 20420
Submitted Electronically
Attention: Reproductive Health Services, 38 CFR Part 17 (RIN 2900-AR57)
Dear Steven Lieberman, Acting Under Secretary for Health:
As organizations committed to protecting and expanding abortion access for all people, including service members, veterans, and their family members, we strongly oppose the U.S. Department of Veterans Affairs’ (VA) proposed rule on Reproductive Health Services. This proposed rule would eliminate comprehensive pregnancy options counseling, which includes abortion counseling, and severely restrict essential abortion care for veterans and their family members, which is particularly devastating in light of the ongoing reproductive health care crisis. Access to abortion is critical to veterans’ freedom to make decisions about their health and well-being, and this proposed rule takes away veterans’ autonomy and freedom over their bodies, lives, and futures, and jeopardizes their long-term health and well-being.
As a part of this country’s commitment to providing for the needs of veterans after they leave the military, Congress has directed VA to furnish “hospital care and medical services which the Secretary determines to be needed” to veterans who meet a specific list of eligibility criteria. These determinations are called the “medical benefits package.” VA regulations, in turn, provide that care is included in the medical benefits package “if it is determined by appropriate health care professionals that the care is needed to promote, preserve, or restore the health” of the veterans they serve. VA’s responsibility to provide care that promotes, preserves, or restores the health of veterans includes ensuring access to vital comprehensive pregnancy options counseling and abortion services without political interference. Lacking access to abortion and adequate reproductive health services can have profound impacts, including financial insecurity, increased risk of intimate partner violence, and maternal and neonatal deaths. These impacts are disproportionately felt by marginalized communities in the U.S. who have long faced systemic barriers to health care—including Black, Indigenous, and people of color, low-income people, rural populations, LGBTQI+ people, people with disabilities, and immigrants. Those systemic barriers to accessing health care have only been worsened by this administration's withholding of funding from safety net providers, some of whom have had to close health centers as a consequence.
For these reasons, we strongly urge VA to rescind this proposed rule and leave in place the March 2024 Final Rule—which made permanent the September 2022 Interim Final Rule (IFR)— at minimum, which provided for abortion in cases of rape, incest, or where the life or health of the veteran was endangered and abortion counseling to veterans and their loved ones.
I. The proposed rule will only worsen the ongoing abortion crisis, and deepen the barriers veterans and their family members face when trying to access abortion.
Notably, VA provided 88 abortions in the first year the care was offered in the VA medical benefits package, and as VA even references in the proposed rule, an average of 140 beneficiaries obtain abortions through the agency annually. This shows that the September 2022 IFR was effective in its goal to provide coverage for abortion care and counseling for veterans and their loved ones. Alex Ferencz, a veteran, shared how invaluable having access to abortion is for veterans saying:
Because I’m older, if the VA takes away abortion as an option, I’d not even try [to become pregnant]. Abortion care is an essential part of my pregnancy care needs.
My abortion was integral to my plans after the military. It’s given me the ability to go to college and graduate school and pursue a career in social work. All the good I’ve been able to do in this country is because of my abortion. I went to war to protect the rights of my fellow Americans. And when I pledged the oath, I swore to protect freedom.
The proposed rule would take away this access and place the burden back on veterans and family members to obtain and pay for this care. This is especially detrimental, as hostile states continue to strip away abortion access from their residents and create significant and potentially insurmountable barriers to abortion for veterans and their families.
As VA noted in its September 2022 IFR, the onslaught of state bans and restrictions have created “urgent risks to the lives and health of pregnant veterans and the health of pregnant CHAMPVA beneficiaries in [those] States.” According to VA, over 155,000 veterans who may need abortion and rely on VA for health care live in states with abortion bans and restrictions. Women are the fastest growing cohort within the veteran community, and they are projected to make up 18% of all veterans by 2040. Within that group, women of reproductive age between ages 18-44 are the fastest growing subset of new VA users. Further, nearly one in five trans people, many of whom need abortion access, serves in the military or is a veteran. They also serve at almost twice the rate of the general population. Moreover, female veterans are more likely to live in poverty than male veterans, and, similarly, trans veterans are more likely to live in poverty than their cisgender peers. Importantly, the September 2022 IFR, made permanent by the March 2024 Final Rule, extended to CHAMPVA beneficiaries and expanded abortion access and counseling for many veterans’ loved ones and caregivers. According to VA, nearly 50,000 CHAMPVA beneficiaries who may need abortion live in states with abortion bans and restrictions.
The ongoing abortion access crisis makes the VA’s proposed rule especially egregious. Twelve states are enforcing total abortion bans, and four states ban abortion at six weeks. Across the South and Midwest, these bans have decimated abortion access. Without abortion access through VA, many veterans who need this care would be forced to travel to another state to reach a distant clinic. The cost of traveling to obtain care in another state is often prohibitive, especially for people who already face systemic barriers to accessing health care and often do not have financial means. This was the unfortunate reality for many veterans prior to the September 2022 IFR when VA neither provided nor covered abortions—meaning veterans faced unique barriers to care. This crisis will only worsen under the new proposed rule.
II. The proposed rule would deny abortion care and counseling to survivors of sexual assault and those struggling with complex health needs, and does little to protect the lives of veterans and their loved ones.
VA’s proposal to strip away abortion care and counseling from survivors of rape and incest, as well as those beneficiaries whose health would be endangered by continuing a pregnancy, is not only cruel but also completely arbitrary. For example, the proposed rule cites abortion coverage restrictions in Medicaid, the Child Health Insurance Program, TriCare, and the Federal Employee Health Benefits Program as consistent with its terms. Yet the proposed rule fails to acknowledge that each one of these federal programs permits abortion access when the pregnancy is the result of rape or incest, let alone justify removing these exceptions here. These other programs also do not explicitly prohibit comprehensive pregnancy options counseling. VA’s reliance on abortion restrictions in other federal programs therefore does not support its proposal to remove the exceptions for rape and incest at VA.
Additionally, the proposed rule’s preservation of abortion access in a limited circumstance— “when a physician certifies that the life of the mother would be endangered if the fetus were carried to term”—is a narrow exception that is not explicit in the proposed regulatory text. Indeed, the proposed rule seeks only to make that exception explicit in the regulatory text for the CHAMPVA program, but not the VA medical benefits package. The inconsistency between these two regulations will only create confusion for VA patients and providers alike. If VA truly seeks “the avoidance of doubt” as it claims, it must, at a minimum, codify the life endangerment exception under the medical benefits package.
The evidence is clear, however, that even when abortion exceptions are codified, pregnant patients continue to be denied critical, and sometimes lifesaving, medical care. Providers are forced to prioritize consideration of the potential legal ramifications for providing care—rather than the health of their patient—fearing punishment from state-sanctioned abortion bans. As a result, patients have been denied care or have faced delayed care for complications in a range of situations, including when facing miscarriage or ectopic pregnancies, which can cause serious injury or jeopardize the patient’s future reproductive capacity. Hospitals have implemented cumbersome procedures to ensure compliance with vaguely-worded laws, such as requiring multiple providers to sign-off for an emergency abortion and requiring detailed documentation. The American Medical Association has expressed deep concern over the detrimental effects of state abortion bans and the ability of providers to make medically informed decisions for their patients. These barriers are medically unnecessary and can substantially delay care of the pregnant person, putting their life and health and fertility at risk.
The September 2022 IFR made significant progress toward addressing this issue and reinforced the duty of medical professionals to uphold their ethical duty to veterans. Indeed, Dr. Cat Russell, PhD, RN, WHNP-BC, an Army veteran and clinician, emphasized how impactful the expanded coverage from the September 2022 IFR was, noting:
The current policy at VA recognizes that abortion is health care. It's so important to protect because women and pregnant veterans face numerous barriers to abortion care— and are denied their right to bodily autonomy—simply because of what state they reside in. If we trusted these veterans to protect our nation, we should trust them to know what is best for their health and their future.
This perspective demonstrates that the September 2022 IFR meaningfully eliminated some of the longstanding barriers to accessing abortion.
The proposed rule cruelly rolls back this progress and takes away access to essential abortion care and counseling for veterans and loved ones who not only need this care, but have sacrificed their own health and safety to secure our freedoms.
III. Abortion access is essential to maintaining the health of our veterans, and the proposed rule will only harm the health and well-being of veterans and their loved ones.
Abortion care is essential to the health of our veterans and VA is plainly tasked with ensuring veterans receive the health care they need. Childbirth can have severe health consequences. Each year in the United States, about 700 people die during pregnancy or in the year after. This far exceeds the rate of maternal death in other several high-income countries, with the United States having the highest rate of maternal death. Upwards of 60,000 people each year have unexpected outcomes of labor and delivery with serious short- or long-term health consequences. Women denied abortion services report more life threatening complications and chronic health conditions than those who receive abortion care. These complications include chronic migraines, joint pain, gestational hypertension, eclampsia, and postpartum hemorrhage as well as infertility. Pregnancy is especially dangerous for Black and Native women in the United States: Black women are 3.5 times more likely to experience a pregnancy-related death than white women and Native women more than twice as likely. In addition, veterans of reproductive age, in particular, have high rates of service and combat-related and other complex and chronic medical and mental health conditions that may increase the risks associated with pregnancy. Such conditions include chronic post-traumatic stress disorder, severe hypertension, and chronic renal disease. Being denied an abortion also has negative impacts on people’s mental health and is associated with elevated levels of anxiety.
VA’s September 2022 IFR provided necessary relief to veterans who needed this care, and made meaningful headway in tackling the abortion access issues veterans in this country face. With the coverage provided in the September 2022 IFR, veterans could rely on their VA medical benefits package to protect their health and life.
In addition, comprehensive pregnancy options counseling, which includes abortion counseling, allows veterans to make informed decisions about their own body, health, and well-being. Lifting the abortion counseling ban ensured that veterans and their loved ones are provided the opportunity to receive counseling on all of their options, have their questions answered, and receive information relevant to whatever options they might choose, as well as receive any referral they request. As VA noted in the September 2022 IFR, abortion counseling “is a component of comprehensive, patient-centered, high quality reproductive health care both as a responsibility of the provider and a right of the pregnant veteran.” Banning VA providers from comprehensive pregnancy options counseling is cruel and extreme; patients have the right to decide what is best for them.
We firmly oppose the proposed rule which denies veterans the freedom to decide whether to have an abortion, on their own terms, with the information they need.
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As anti-abortion lawmakers continue to decimate abortion access, veterans face significant barriers to care. The significant and well-established evidence, data, and studies included in this comment letter clearly show the hardships veterans and their loved ones continue to face in accessing this care. As mentioned earlier, VA has a core responsibility to provide care if it is medically determined that such care is needed to “promote, preserve, or restore the health” of the veterans it serves. The proposed rule runs counter to this responsibility and dangerously eliminates essential health coverage that veterans and their family members need.
We strongly urge VA to put the health and lives of veterans in this country—including women of color, trans people, and people with disabilities, who face even greater barriers to care—first and foremost, and to work towards fulfilling, rather than undermining, VA’s core mission to care for veterans and their family members. For these reasons, VA should rescind the proposed rule and maintain the 2024 Final Rule, at minimum.
Our comments include numerous citations to supporting research, including direct links to the research, for VA’s benefit in reviewing our comments. We direct VA to each of the studies cited and made available to the agency through active hyperlinks, and we request that the full text of each of the studies cited, along with the full text of our comments, be considered part of the administrative record in this matter for purposes of the Administrative Procedure Act.
Signed,
See Attached for List of Sigantories