DACOWITSDACOWITS 1. A U.S. Army Specialist from 47th Force Support Battalion provides security for fellow Soldiers during an operation in the Al Anbar province of Iraq. 2. U.S. Marines and Navy Sailors receive training in Al Asad, Iraq, during the Lioness Program, on various improvised explosive devices being used to attack coalition and Iraqi forces. 3. A Weapons Director from the 623rd Air Control Flight controls a mission by using a Base Air Defense Ground Environment system at Naha Air Base, Japan. 4. A Minnesota Air National Guard Staff Sergeant from the 148th Fighter Wing is all smiles as she hugs her son and husband after returning from a deployment on an Air Expeditionary Force mission. 5. A U.S. Navy Lieutenant greets his family during the homecoming celebration for the submarine tender USS Frank Cable (AS 40) in Apra Harbor, Guam. 6. A Coast Guard Member gives a tour of the Coast Guard Training Center Yorktown to members of United States Congressional Staff. DEFENSE DEPARTMENT ADVISORY COMMITTEE ON WOMEN IN THE SERVICES (DACOWITS) 2007 REPORT TABLE OF CONTENTS EXECUTIVE SUMMARY ........................................................................................................... i I. INTRODUCTION.................................................................................................................1 A. BACKGROUND ...........................................................................................................3 B. ORGANIZATION OF REPORT.................................................................................13 II. FEMALE-SPECIFIC HEALTH CARE ISSUES OF DEPLOYED FEMALE SERVICE MEMBERS .......................................................................................................14 A. CHARACTERISTICS OF THE FOCUS GROUP SAMPLES...................................15 B. HEALTH CARE EXPERIENCES OF FEMALE SERVICE MEMBERS PRIOR TO DEPLOYMENT .......................................................................................18 C. HEALTH CARE EXPERIENCES OF FEMALE SERVICE MEMBERS DURING DEPLOYMENT..........................................................................................36 D. HEALTH CARE EXPERIENCES POST-DEPLOYMENT.......................................61 E. DIFFERENCES IN THE HEALTH CARE EXPERIENCES OF RESERVE COMPONENT AND ACTIVE COMPONENT FEMALES ......................................73 F. HEALTH CARE PROGRAMS AVAILABLE TO RESERVISTS ............................76 III. MILITARY SPOUSE CAREER AND EMPLOYMENT OPPORTUNITY ................79 A. CHARACTERISTICS OF THE FOCUS GROUP SAMPLE.....................................79 B. CHARACTERISTICS OF THE CAREERS OF MILITARY SPOUSES ..................80 C. EMPLOYMENT OPPORTUNITIES FOR MILITARY SPOUSES ........................110 D. TRAINING AND EDUCATION OPPORTUNITIES FOR MILITARY SPOUSES..............................................................................................120 E. DOD AND SERVICE INITIATIVES AND PROGRAMS FOR ENHANCING SPOUSE EMPLOYMENT OPPORTUNITIES........................................................130 IV. 2007 DACOWITS FINDINGS AND RECOMMENDATIONS: Female-Specific Health Care Issues of Deployed Female Service Members...........................................138 V. 2007 DACOWITS FINDINGS AND RECOMMENDATIONS: Military Spouse Career and Employment Opportunity............................................................................144 VI. APPENDICES...................................................................................................................149 APPENDIX A: DACOWITS CHARTER ......................................................................150 APPENDIX B: BIOGRAPHIES OF DACOWITS MEMBERS..................................153 APPENDIX C: INSTALLATIONS VISITED ...............................................................157 APPENDIX D: FOCUS GROUP PROTOCOLS ..........................................................159 APPENDIX E: MINI-SURVEYS....................................................................................172 APPENDIX F: MINI-SURVEY RESULTS...................................................................179 APPENDIX G: PRE/POST DEPLOYMENT HEALTH ASSESSMENT FORMS ...194 APPENDIX H: BRIEFINGS PRESENTED TO DACOWITS ....................................206 APPENDIX I: ACRONYMS USED IN REPORT .......................................................209 EXECUTIVE SUMMARY The mission of the Defense Department Advisory Committee on Women in the Services (DACOWITS) is to provide the Department with advice and recommendations on matters and policies relating to the recruitment, retention, and advancement of women in the Armed Forces. Further, the Committee is to provide advice and recommendations on family issues related to the recruitment and retention of a highly qualified professional military. With the guidance of Dr. Chu and Mr. Dominguez, who expressed a desire for DACOWITS to look at the horizon in order to assist the Department in identifying the developing issues that will define its outlook in the decades to come, members identified two issues that have both immediate and long-term ramifications. First, the Committee decided to assess the adequacy of health care for women serving in support of Operation Iraqi and/or Operation Enduring Freedom. The second topic selected by the Committee is military spouse career and employment opportunities. A. FEMALE-SPECIFIC HEALTH CARE ISSUES OF DEPLOYED FEMALE SERVICE MEMBERS Over the past 15 years, women’s representation in the military has increased significantly. In 1990, women represented 12% of the Total Force, with 11% in the Active Duty force and 13% in Selected Reserve. By the year 2005, the percentage had increased to 15% of the Total Force, or 14.6% of Active Duty force and 17.2% of Selected Reserve. Women currently constitute 10% of all deployed forces. Given the decision to deploy increasing numbers of women in support of military operations in Iraq and Afghanistan and the importance of adequate health care that will ensure continuity of service when and where these Service members are most needed, the Committee recognizes the importance of determining whether or not the health care needs of these Service members are being met. To determine the adequacy of female health care, the Committee studied this question from three different aspects – prior to deployment, during deployment, and post-deployment. Pre-Deployment Health Care In the pre-deployment period, each Service member undergoes a health screening, both to identify and address health issues and to determine deployment readiness. It should be noted that the Pre-Deployment Health Assessment is a screening, not a medical exam. Further, it is self- reporting, not investigatory. Thus, this health assessment presumes that each individual Service member will accurately report their health care needs. It further assumes each individual will take responsibility for obtaining follow-up medical tests and/or care prior to deployment. In this era of rapid deployments, often with short notice and requiring long hours of work in order to be prepared prior to going overseas, medical needs can easily become a low priority as i other priorities take precedence. This rushed atmosphere may lead Service members, their leadership, and medical personnel not to ascribe adequate importance to this aspect of the preparation process. Thus, a Service member may not get the medical appointments necessary; they may have tests for which the results are not available prior to departure; and they may not get adequate supplies of their prescriptions (including contraceptives). Mental health needs are often completely overlooked. Health and hygiene briefings for female Service members, which would prepare them for coping with the difficult climate and situations, tend not to be provided consistently and across the board. Gathering female-specific data on pre-deployment forms, providing good information, and making a commitment to ensuring Service members will have the medical attention they need prior to departure may well be the keys to better health care in the pre-deployment period that will carry over into adequately meeting the health care needs of these female Service members once they are in-theatre. Health Care during Deployment Once in-theatre, Service members experience severe climate conditions, as well as combat- related risks, both of which can wreak havoc with their physical well-being. For women, genitourinary issues are most often the result of these severe conditions. Lack of medical personnel trained to deal with gynecological issues and limited female-specific equipment may result in removing a female Service member from her unit in order to get care outside the theatre of operations or simply ignoring conditions until the Service member redeploys. Mental health care was viewed by some focus group participants as inadequate or not taken seriously; some believe that seeking mental health care would result in negatively impacting female Service members’ evaluations, promotions, and ability to maintain a security clearance. Privacy is an important issue in every aspect of health care for female Service members—before, during, and after deployment – but it is most acute during deployment. Medical practitioners from medics to physicians, as well as unit leaders, have been known to exhibit unprofessional behavior by discussing publicly information that ought to remain private. Although a problem at all levels, most privacy violations occurred by paraprofessional staff.