A supplement recently published in Military Medicine seeks to examine how the Defense Department meets the medical needs of its women warriors. Called “Combat: Framing the Issues of Health and Health Research for America’s Servicewomen,” the articles go a long way toward shining a light on an important issue.
Several of the articles in the supplement highlight mental health issues for women in the military. They include the pieces about sexual harassment, the many faces of military families, alcohol use, and the corrosive effects of ostracism.
Dr. Elspeth Cameron Ritchie
One of the articles by Kate McGraw, Ph.D., of the Deployment Health Clinical Center, Silver Spring, Md., focuses on the mental well-being of servicewomen and sexual trauma. Underlying the supplement is the recognition that the most robust mental health research repeatedly conducted in Afghanistan, for example, did not include a single woman because of the sampling methodology. A dedicated group addressing service women’s health and inclusion in health research would have prevented this oversight.
The health of female service members has long been an interest of mine, partly because I was in the Army for 28 years and deployed to a lot of austere environments. They included the rice fields of Camp Edwards, near the DMZ in Korea; Mogadishu and other “cities” in Somalia; and various Forward Operating Bases in Iraq.
Many years ago, I published an article on health concerns of deployed women. That focused on concerns about how to avoid urinary tract infections (UTIs) while in the field – where bathrooms are often scarce and dirty – and other seemingly mundane issues.
Mundane unless you have a UTI, or are trying to figure out how to manage your menses with no tampons or places to wash your hands.
Since then the literature has grown. For example, I published a volume called “Women at War” (Oxford University Press, 2015) last spring. This recent supplement advances those discussions, including articles on avoiding anemia and stress fractures.
But the way forward has been spotty. Many political issues delay an open discussion, especially on reproductive concerns. Further, there is no driving function within the Department of Defense that focuses on funding research in support of service women and reporting back to the department and civilian leadership.
For example: Female service members have a rate of unintended pregnancy twice that of the civilian world. This leads to early attrition from the military, and in turn, to young female veterans with children who are homeless.
Some have said, highlighting these concerns, that females should not be in the military because our presence is a risk to operational readiness. However, this is not an issue without tested solutions.
Taking this one issue further, consider that all service women are included in the Military Health System and have access to a variety of forms of birth control. If female service members can be put on oral contraceptives, that would both suppress their menses and avoid unwanted pregnancies. However, longer lasting methods of birth control would enable service women to enjoy decreased menses, avoid unwanted pregnancies, and avoid access issues during deployment.
The supplement contains numerous health policy and research recommendations as well as a detailed look at the unique health and lifestyle challenges of service women. Other issues include: the reproductive health of women in austere environments, nutritional factors, avoiding musculoskeletal injuries, combat-related injuries, designing military equipment (including uniforms) for optimal performance, and the role of leadership. It concludes with 20 research gaps and accompanying recommendations.
The number of women serving in the military is increasing, while all jobs, particularly those in the ground combat element, are now open to women. The time is now to focus on establishing and tracking health and well-being issues to ensure the success of this population – and the Military Medicine special issue is just a first step.
Dr. Ritchie serves as professor of psychiatry at the Uniformed Services University of the Health Services in Bethesda, Md., and at Georgetown University in Washington. She helped write one of the articles in the supplement with Dr. McGraw and Tracey Perez Koehlmoos, Ph.D., an associate professor with the Uniformed Services University.