U.S. Diplomats Abroad ‘Routinely Denied Access’ to Reproductive Care

More than 200 U.S. diplomatic and aid officials signed a letter accusing the U.S. State Department of blocking medically necessary and lifesaving reproductive health services to its employees stationed abroad.

The letter, signed by 206 State Department and U.S. Agency for International Development (USAID) employees, warned that diplomats and aid officers, most often women, are “routinely denied access to full reproductive health care,” including family planning services, “inconsistent availability of rape kits,” being blocked from returning to the United States for emergency health care procedures, and inconsistent access to trained health care professionals.

The letter was sent to senior management officers at both the State Department and USAID in December 2021. The State Department’s Bureau of Medical Services responded in April, according to several current and former diplomats familiar with the matter.

The letter listed examples of the State Department failing to provide assistance for employees facing medical emergencies, from a case of someone “suffering a nearly fatal ectopic pregnancy” to a case of “suffering a miscarriage at one of the most polluted posts in the world” to a case of “serving in a country where abortion was illegal and was referred by the Medical Unit to illegal local providers.”

A link to the letter was published in an opinion piece by a USAID officer released this month for the Foreign Service Journal, a magazine of the American Foreign Service Association that represents foreign service officers. “This is the story of a group of women who have decided not to stay silent any longer, despite the shame, sadness, fear, anxiety and trauma we still feel in the aftermath of the experiences we share in the following,” wrote Andrea Capellán, the USAID officer.

“Diplomats representing America in countries across the world are denied access to the same services that are legal and readily available in the country we represent and are told, You are on your own. We will no longer stand for this,” she wrote.

Capellán wrote that the State Department’s Bureau of Medical Services, commonly called “MED” by the U.S. diplomatic and aid community, “actively and repeatedly forced patients into impossible decisions and significant financial burden, and put them in life-threatening situations.”

A State Department spokesperson said in response that the State Department “takes our responsibility to provide care to our employees extremely seriously, and this includes providing reproductive health care at post.”

After receiving the letter, the spokesperson said the State Department began investigating complaints outlined in the letter. MED began instituting changes to provide direct communication between patients to MED leadership and implemented a plan to begin supplying “Plan B” emergency contraceptive pills to U.S. diplomatic outposts around the world after responding to the initial letter in April.

The State Department spokesperson said the department “has policies in place” already to ensure there are emergency contraceptives and rape kits available at every medical office and that it “maintains a regularly updated list” of local medical providers. The spokesperson also stressed that the department must comply with the Hyde Amendment, a federal law that prohibits the use of federal funds to pay for abortions unless the mother’s life is in danger or the pregnancy arises from rape or incest.

USAID did not respond to a request for comment.

Without adequate reform, the allegations outlined in the letter could undercut the Biden administration’s own stated policies on sexual and reproductive health, both domestically and in its foreign-policy agenda, including U.S. funding for global sexual and reproductive health programs in developing countries.

“In the Biden-Harris administration, the empowerment and protection of women and girls, including promoting their sexual and reproductive health and rights, is a central part of U.S. foreign policy and national security,” U.S. Secretary of State Antony Blinken said in a statement during the administration’s first week in office in 2021.

The letter was publicized against the backdrop of a nationwide debate about access to reproductive health care in the United States, after Politico published a leaked draft opinion of the U.S. Supreme Court this month indicating it could overturn federal abortion rights. However, only a fraction of the cases outlined in the letter to the State Department pertained to abortion.

The diplomats and aid officials who signed the letter have called for the State Department to provide better health care and support to its employees, including allowing medical evacuations for access to reproductive health services or abortion services prior to 12 weeks of gestation as well as requiring the State Department to “instate [MED] leadership that is representative of its constituents,” Capellán wrote.

Although the State Department and USAID are separate agencies, the State Department oversees and coordinates some aspects of USAID, including management on budgeting and human resource issues. MED oversees medical issues for both State Department and USAID employees, and it can play an outsized role in overseeing U.S. government personnel’s health issues at embassies in developing countries or conflict zones that lack adequate health care infrastructure.

In recent years, MED has come under fire from U.S. diplomats and even some U.S. lawmakers over claims that it mishandled and cut support to U.S. diplomats who have children with disabilities, though several diplomats familiar with the matter say MED’s response to the needs of those diplomats and their family members has improved in the past year.

The latest debate over how MED treats employees began in late fall of 2021, when a diplomat published a post in a private Facebook group for women in the State Department and USAID asking about their experiences accessing reproductive health or abortion services abroad. The post quickly went viral, four current and former U.S. diplomats told Foreign Policy. All spoke on condition of anonymity because they were not authorized to speak to the press or did not want to publicly share their own reproductive health crises.

In the Facebook group, dozens of people began sharing experiences of MED denying emergency medical procedures or medical evacuations back to the United States. In one case that Capellán recounted in her opinion piece, MED denied medical leave to a woman facing a risky pregnancy who was at a U.S. diplomatic outpost in a country facing civil unrest. Medical facilities in that country were set ablaze during widespread protests. Facing intense abdominal pain, the woman took leave without pay and returned to the United States on her own dime, where she was told by the hospital that “due to a severe cord prolapse, her baby could have died had she waited any longer.”

Foreign Policy could not independently verify these examples, but the four former diplomats who tracked the stories shared in the private Facebook group say the examples fall in line with their own experiences.

Eric Rubin, head of the American Foreign Service Association, told Foreign Policy the State Department “should pay for as much as the law allows to enable people to get access to critically needed health care.”

“It’s an equity issue, and it’s also about how we treat our people serving overseas in difficult conditions,” he said.