Women at War
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WOMEN AT WAR WOMEN AT WAR Edited by Elspeth Cameron Ritchie, MD, MPH Chief Medical Officer Department of Behavioral Health Professor of Psychiatry, Uniformed Services University of the Health Sciences Washington, DC Anne L. Naclerio, MD, MPH Deputy Surgeon, United States Army Europe Chair, Women’s Health Task Force, Office of the Army Surgeon General Associate Professor Pediatrics, Uniformed Services University of the Health Sciences Arlington, VA 1 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trademark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016 © Oxford University Press 2015 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-in-Publication Data Women at war (Ritchie) Women at war / [edited by] Elspeth Cameron Ritchie and Anne L. Naclerio. p. ; cm. Includes bibliographical references. ISBN 978–0–19–934453–6 (alk. paper) I. Ritchie, Elspeth Cameron, editor. II. Naclerio, Anne L., editor. III. Title. [DNLM: 1. Military Personnel—United States. 2. Women’s Health—United States. 3. Sex Factors— United States. 4. Veterans Health—United States. 5. War—United States. WA 309 AA1] UB369 362.1086′97—dc23 2014033193 The science of medicine is a rapidly changing field. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy occur. The author and publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is accurate and complete, and in accordance with the standards accepted at the time of publication. However, in light of the possibility of human error or changes in the practice of medicine, neither the author, nor the publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete. Readers are encouraged to confirm the information contained herein with other reliable sources, and are strongly advised to check the product information sheet provided by the pharmaceutical company for each drug they plan to administer. 1 3 5 7 9 8 6 4 2 Printed in the United States of America on acid-free paper Contents Foreword ix Contributors xi Introduction xv PART 1: BACKGROUND AND INTRODUCTION 1. Comparative Morbidity and Mortality of Women Serving in the US Military During a Decade of Warfare 3 Robert F. DeFraites, David W. Niebuhr, Brigilda C. Teneza, Leslie L. Clark, and Sharon L. Ludwig 2. Female Soldiers and Post-Traumatic Stress Disorder 22 Elspeth C. Ritchie, Michael R. Bell, M. Shayne Gallaway, Michael Carino, Jeffrey L. Thomas, Paul Bliese, and Sharon McBride 3. Women and War: Australia 34 Beverley Raphael, Susan Neuhaus, and Samantha Crompvoets PART 2: WOMEN AT WAR 4. Medical Issues for Women Warriors on Deployment 49 Anne L. Naclerio 5. Reproductive Health 78 Cara J. Krulewitch vi Contents 6. Issues in the Prevention of Malaria Among Women at War 93 Remington L. Nevin 7 Women, Ships, Submarines, and the US Navy 120 Heather D. Hellwig and Paulette T. Cazares 8. Female Combat Medics 134 Charles Figley, Barbara L. Pitts, Paula Chapman, and Christine Elnitsky 9. Human Sexuality and Women in the Area of Operations 147 Amy Canuso PART 3: WOMEN HOME FROM WAR 10. Women Home from War 157 Elizabeth C. Henderson 11. Mothers in War 178 Amy Canuso 12. Building the Framework for Successful Deployment Reunions 196 Erin Simmons 13. Traumatic Brain Injury: Implications for Women in the Military 211 Victoria Tepe and Suzanne Garcia PART 4: PSYCHOLOGICAL ISSUES FOR ACTIVE DUTY WOMEN 14. Suicide-Related Ideation and Behaviors in Military Women 243 Marjan Ghahramanlou-Holloway, Brianne George, Jaime T. Carreno-Ponce, and Jacqueline Garrick 15. Intimate Partner Violence, Military Personnel, and Veterans 266 Glenna Tinney and Melissa E. Dichter PART 5: THE FEMALE VETERAN EXPERIENCE 16. The Woman Veteran Experience 301 Isabel D. Ross, Natara D. Garovoy, Susan J. McCutcheon, and Jennifer L. Strauss 17. Mental Health of Women Warriors: The Power of Belonging 311 Kate McGraw Contents vii 18. The Veterans Health Administration Response to Military Sexual Trauma 321 Margret E. Bell and Susan J. McCutcheon 19. Compensation, Pension, and Other Benefits for Women Veterans with Disabilities 329 Jacqueline Garrick Index 351 Foreword Our nation and the military are stronger because we have embraced diversity, whether it be race, color, ethnicity, religion, or gender. This truth is reflected in the vital role that women have played throughout the history of the United States military. Since the Revolutionary War, more than 2.5 million women have served with honor and self- less dedication to the mission. Most recently, nearly 275,000 women have deployed in support of Operations Iraqi Freedom, New Dawn, and Enduring Freedom. I have seen firsthand the courageous work of these deployed women, and the value they bring to the military each and every day. Given recent policy changes, by January 2016 it is expected that all military occupa- tions, positions, and units will be open to women, thus ensuring that they will play even larger roles in future military operations. This begs the question, what is being done to better understand and address the needs of our Servicewomen in both the garrison and deployed environments? In 2011, Army Medicine leaned forward and established the Women’s Health Task Force (WHTF) to address the unique health concerns of women serving in the military. This critical task force has introduced such initiatives as the Women’s Health Portal and new clinical treatment algorithms, and is shaping education, equipment, and care for the next generation of women in the military. While cutting-edge gender-specific healthcare and research in support of combat forces are ongoing, it is more important than ever for providers in all settings to have a full understanding of women’s medical and psychological needs during and after deployments. This book is perfectly timed to share these key insights. ix x Foreword While covering a wide spectrum of topics, Woman at War thoroughly explores each area in enough detail to reveal the true complexities of these issues. In particular, given our current military-wide focus on behavioral health, the authors provide critical infor- mation that will serve to better target such care to women. This book makes it clear that progress in understanding women’s issues related to war and serving in the military has been made, but that much more research on these vital topics is needed. I applaud the many authors of this book for opening up this dis- cussion, and hope that this inspires others to continue research in these emerging fields of national importance. The more we know about the specific needs of women in the military, the more likely it is that we will be able to ensure these needs are met. This will only strengthen the contributions that women can and will continue to make in defense of our great nation. Serving to Heal . Honored to Serve. Patricia D. Horoho Lieutenant General, US Army The Surgeon General and Commanding General, US Army Medical Command Washington, DC Contributors Margret E. Bell, PhD Amy Canuso, LCDR, MC USN National Military Sexual Trauma Board Certified Psychiatrist Support Team Child and Adult Psychiatrist, Mental Health Services Walter Reed National Military Department of Veterans Affairs Medical Center Boston, MA Bethesda, MD Michael R. Bell, MD, MPH Michael Carino, DMD, MPH Commander, US Army Public Health Senior Health Systems Analyst Command Region–North Office of the Surgeon General US Army Surgeon General Consultant Falls Church, VA for Occupational and Environmental Jaime T. Carreno-Ponce, PhD Medicine Psychologist, Department of Medical Fort George G. Meade, MD and Clinical Psychology, USUHS Paul Bliese, PhD Bethesda, MD Chief, Division of Neuropsychiatry Paulette T. Cazares, MD, MPH Walter Reed Army Institute Staff Psychiatrist of Research Naval Medical Center San Diego Silver Spring, MD San Diego, CA xi xii ContrIbutors Paula Chapman, PhD M. Shayne Gallaway, PhD Tampa VA Research and Education Senior Epidemiologist Foundation Behavioral & Social Health Outcomes Zephyrhills, FL Program Directorate of Epidemiology & Leslie L. Clark, PhD Disease Surveillance Armed Forces Health US Army Public Health Surveillance Center Command (Provisional) Silver Spring, MD Aberdeen Proving Ground, MD Samantha Crompvoets, BSc Suzanne Garcia, PhD Hons, PhD Associate, Booz Allen Hamilton, Inc. Australian National University McLean, VA Research Fellow ANU College of Medicine, Natara D. Garovoy, PhD, MPH Biology and Environment Women’s Counseling Center, VA Palo Canberra, Australia Alto Health Care System Women’s Mental Health, Mental Robert F. DeFraites, MD, MPH Health Services Associate Professor and Chair (Interim) Department of Veterans Affairs Department of Preventive Medicine and Palo Alto, CA Biometrics F.