My Mind, My Body, My Journey™ 

Health disparities among women in military has been researched by the Department of Defense (DOD), but progress in improving the health needs of women in the armed services has been limited^1. In 1994, the DOD created a Defense Women’s Health Research Program, it identified that knowledge disparities existed among musculoskeletal injuries, reproductive hazards, and gynecological health field care¹. Although these barriers were identified in 1994, a subsequent report in 2015 revealed that those disparities remained in addition to disparities in mental health care and contraceptive access¹. For example, female recruits had higher risks of developing musculoskeletal injuries during basic training when compared to male recruits¹. Recommendations to reduce musculoskeletal injuries among female recruits included assessing fitness levels during recruitment to assist with preparing female recruits for the fitness requirements during basic training¹. Additional recommendations included improving nutritional health to reduce the likelihood of musculoskeletal injuries¹. It was noted that female recruits had lower levels of Iron, Vitamin D, and Calcium². Other recommendations included having gender specific footwear and better sports bras¹. DOD research on women’s health also recommended methods to improve reproductive health, preconception and postpartum health, and access to fertility treatments¹. Specific recommendations included encouraging breastfeeding and increasing access to contraceptives to avoid unintended pregnancies². It has been estimated that 50% to 65% of pregnancies among women in the military were unintended³.

Members of the Pentagon Advisory Board concluded that the lack of improvement in the health needs of women in the military costs millions and hurts the operational readiness of female recruits². It was noted that when compared to men, women recruits leave the military at rates two times higher than men and experience 57% more limited duty days than men during their first enlistment². The American College of Obstetricians and Gynecologists (ACOG) released a report highlighting the health care needs of women who have served in the military and provided recommendations to OBG-YN providers to improve the care of their female patients with military experience. Due to deployment many women may experience exposure to chemicals and other hazards that can impact reproductive health in addition to increasing the risk of mental health concerns³. Women who served in the military have increased risks of developing anxiety, depression, PTSD, eating disorders, and substance use concerns when compared to civilian women³. Clinicians should assess for the history of intimate partner violence and military sexual trauma when interacting with female veterans³.

In addition to the recommendations above, I believe expansions to healthcare access can improve the health needs of women who have served in the military. Women veterans should have opportunities to obtain healthcare outside of the VA, through increasing the number of providers who accept Tricare insurance and educating providers outside of the VA on the healthcare needs of women who served in the military. Consistent with barriers to mental health care in this country for civilians, the VA had restricted the type of mental health providers who could work with veterans, which limited access to licensed and qualified mental health and substance use providers. Many states continue to restrict the type of mental health providers who can obtain employment with the VA, despite changes in federal recommendations to expand access for those providers. There should also be more support available to address the social determinants of health as many veterans experience homelessness and incarceration. There have been some promising interventions such as special programs that support veteran homeownership and entrepreneurship. Recently the VA announced an expansion of their care coordination services among pregnant and postpartum veterans to include all female veterans, as opposed to those who had high risk pregnancies. The VA making a stance on providing universal perinatal care, is a huge step towards moving the country towards embracing universal interventions among pregnant and postpartum women. Advocating for policy and intervention changes are methods that we can engage in to improve the health needs of women who have served in the military.

Wishing you health and happiness  

References:

1. Healthcare Delivery Subcommittee. Active-Duty Women’s Healthcare Services Report Update. Defense Health Board. Published February 10, 2020.
2. Kime. P. DOD Fails to Address the Health Care Needs of Female Troops, Advisory Board Claims. Military.com. Published November 9, 2020.
3. Committee on Healthcare for Underserved Women. Healthcare for Women in the Military and Women Veterans. American College of Obstetricians and Gynecologists. Published December 2012.