As studies show service members continue to struggle to access birth control, a group of Senate Democrats is pushing the Defense Department to do more to expand contraception services and counseling.

In a letter Tuesday to Defense Secretary Lloyd Austin, a dozen Democrats on the Senate Armed Services Committee pushed for details on any "barriers preventing the department from implementing provisions mandated by Congress to protect and expand service members' access to contraception and contraceptive counseling."

"Expanding access to contraception is critical to meeting the needs of service members, as well as recruiting^[1] and retaining members of our armed forces^[2]," the senators wrote in the letter, obtained exclusively by Military.com.

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The letter was organized by Sen. Jeanne Shaheen, D-N.H., and co-signed by every committee member aligned with Democrats except for Sen. Joe Manchin of West Virginia, who recently changed his party registration to independent but continues to caucus with Democrats.

The letter comes as Democrats have been focusing on reproductive rights and contraception access amid Monday's two-year anniversary of the Supreme Court's decision in Dobbs v. Jackson Women's Health Organization, which allowed states to ban abortion.

It also comes after the Senate Armed Services Committee for the first time included an amendment in its version of the annual defense policy bill this year that would eliminate copays for contraception for those using military health care.

The letter focuses on a provision that was included in the version of the defense policy bill for fiscal 2016 that was intended to increase service members' access to contraception.

That year's National Defense Authorization Act, or NDAA, required the Pentagon to ensure service members have access to contraception counseling at health exams before and during deployment^[4] and at annual exams. The bill also required the department to craft clinical guidelines for military health care providers on standards of care for contraception counseling and different methods of contraception.

While that provision was technically implemented when the Defense Health Agency issued an instruction on contraception counseling and access^[5] in 2019, the senators expressed concern the law isn't being implemented "to its full effect" since service women are still having trouble accessing their preferred method of birth control.

A Rand Corp. study released in 2022^[6] found that about 18% of active-duty service women said there had been at least one occasion where they could not get their preferred method of birth control from the military health system. Further, only about 18% said they received contraception counseling before deploying, according to Rand.

"This low percentage contradicts Congress' intent to expand access to contraception services and counseling," the senators wrote. "The low rate of service women who received contraceptive counseling is particularly concerning given that, on average, the rate of unintended pregnancy in the military is 6%, higher than the civilian rate of unintended pregnancy."

The senators specifically urged the Pentagon to immediately update pre-deployment forms so service members can indicate whether they want to receive contraception counseling, as well as to include information on all contraceptive methods.

The Defense Department declined to comment on the letter, saying officials would respond directly to the senators "in due course."

While senators are pushing the Pentagon to take action, they are moving to take action themselves. The NDAA under consideration in the Senate right now includes an amendment sponsored by Shaheen that would mandate including information on contraception in pre-deployment service forms and require contraceptive counseling information in periodic health assessments for service members.

Meanwhile, the Senate NDAA's inclusion of an amendment, also sponsored by Shaheen, to end copays on contraception for Tricare^[7] beneficiaries increases the chances that change will become law this year.

While civilians have had access to free birth control since the Affordable Care Act, or Obamacare, became law in 2010, dependents who use Tricare are still subject to a copay for birth control pills. Since July 2022, Tricare has waived copayments for some forms of contraception such as IUDs, but it cannot legally waive copays for prescription pills. As with other prescriptions, active-duty service members can get prescription birth control pills free of charge.

The House for several years has included language in its NDAA to eliminate Tricare copays for all methods of birth control, but the provision has never survived negotiations with the Senate to become law.

With similar language included in both the House and Senate versions of the NDAA this year, a source familiar with the process said they expect the final bill this year to include some action to end copays on birth control. Still, the source added, cost concerns could continue to be a factor in negotiations and result in some changes, such as delaying implementation of the law for a couple of years.

Related: Tricare Should Cover Newly Approved Over-the-Counter Birth Control Pill, Lawmakers Tell Pentagon^[8]