Reproductive Health Needs of the Military and Veterans: Part 1

Over the past 30 to 40 years, the number of women in the military has increased exponentially, leading to a dramatic growth in the number of women Veterans.[1] Currently, there are approximately 2.3 million women Veterans in the United States, and women Veterans are the fastest growing group of new U.S. Department of Veterans Affairs (VA) healthcare users.[2] The reproductive health needs of women serving in the military are similar, but differ in important aspects from those of civilians. This issue will focus on the unique challenges that women in uniform and female Veterans face. In their systematic review, Reproductive Health of Women Veterans, Dr. Katon and her colleagues review current literature on women Veteran's reproductive health, and identify knowledge gaps in the areas of sexually transmitted diseases, infertility, and menopause.

Active-duty women and women Veterans mirror the diverse ethnic and cultural backgrounds found in the civilian community, and they share many of the same medical conditions found among reproductive-age women, such as infertility. If the prevalence of infertility is comparable to the general population, an estimated 95,000 to 110,000 service members and his/her beneficiaries may be affected.[3] [4] In their contribution, Assisted Reproductive Technology and the Reproductive Endocrinology and Infertility Specialist in the United States Military, Dr. Pilgrim and his DoD colleagues review the infertility services available in the military healthcare system, and discuss additional reproductive healthcare services which are necessary to address the infertility needs of patients receiving care in DoD.

Infertility prevalence and care needs among women Veterans are understudied topics, and infertility is likely to be underreported. In their review, Infertility Services for Veterans: Policies, Challenges, and Opportunities, Dr. Ryan and Dr. Edmonds describe the state of the science and policy on infertility care in the Veterans Health Administration (VHA), and discuss challenges and opportunities that exist within the VHA system.

Richard Burney, MD, MSc

Alicia Y. Christy, MD, MHSCR, FACOG

Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the United States, and within the U.S. military, the age- and race-adjusted chlamydia infection rates among female service members are six times higher. Young active-duty women, who have a 20% annual acquisition rate, are disproportionately impacted by the sequelae of this disease.[5] [6] [7] Dr. Nadeau and her coauthors examine the gynecologic impact of chlamydia infection on female servicewomen, opportunities for intervention, and critical gaps for research funding in their review entitled The Gynecologic Health Consequences of Chlamydia Trachomatis Infection in Military Servicewomen.

A recent gap study found that multiple areas of research related to military women's health were lacking, particularly in the areas of ante-, intra-, and postpartum health as well as birth and infant health outcomes.[8] The DoD Birth and Infant Health Research (BIHR) program was created to provide ongoing surveillance of adverse infant outcomes (e.g., major birth defects, altered infant sex ratio, and preterm birth) among Military Health System (MHS) beneficiaries (both military members and their dependents.[9] In their article, The Department of Defense Birth and Infant Health Research Program, Dr. Khodr and colleagues summarize the preventive measures, environmental exposures, and occupational hazards in pregnancy which are unique to the military.

Similar to active-duty women, female Veterans are also at greater risk for poor obstetrical outcomes. Understanding the causal relationship between military service exposures and deployment on adverse pregnancy outcomes is important for identifying target risk factors that may ultimately contribute to the high prevalence of chronic medical, psychiatric, and substance abuse conditions among women Veterans.[10] [11] In their review, Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans, Dr. Gawron and her coauthors examine deployment and its impact on the obstetrical outcomes of active-duty women and women Veterans.

• References

• 1 Murdoch M, Bradley A, Mather SH, Klein RE, Turner CL, Yano EM. Women and war. What physicians should know. J Gen Intern Med 2006; 21 (Suppl. 03) S5-S10
• 2 Yano EM, Hayes P, Wright S. , et al. Integration of women veterans into VA quality improvement research efforts: what researchers need to know. J Gen Intern Med 2010; 25 (Suppl. 01) 56-61
• 3 Chandra A, Copen CE, Stephen EH. National Health Statistics Report. Infertility Service Use in the United States: Data from the National Survey of Family Growth, 1982–2010. 2014; 73: 1-21
• 4 “Profile of the Military Community.” Military OneSource, 2016 . Available at: download.militaryonesource.mil/12038/MOS/Reports/2016-Demographics-Report.pdf . Accessed August 7, 2018
• 5 Goyal V, Mattocks KM, Sadler AG. High-risk behavior and sexually transmitted infections among U.S. active duty servicewomen and veterans. J Womens Health (Larchmt) 2012; 21 (11) 1155-1169
• 6 Deiss R, Bower RJ, Co E. , et al. The association between sexually transmitted infections, length of service and other demographic factors in the U.S. Military. PLoS One 2016; 11 (12) e0167892
• 7 Shafer MA, Boyer CB, Pollack LM, Moncada J, Chang YJ, Schachter J. Acquisition of Chlamydia trachomatis by young women during their first year of military service. Sex Transm Dis 2008; 35 (03) 255-259
• 8 Yablonsky AM, Martin RC, Highfill-McRoy RM. , et al. Military women's health: a scoping review and gap analysis, 2000–2015. Silver Spring, MD: Naval Medical Research Center. 2017 . Report no. N15–015
• 9 Bukowinski AT, Conlin AMS, Gumbs GR, Khodr ZG, Chang RN, Faix DJ. Department of Defense Birth and Infant Health Registry: select reproductive health outcomes, 2003-2014. MSMR 2017; 24 (11) 39-49
• 10 Friedman SA, Phibbs CS, Schmitt SK, Hayes PM, Herrera L, Frayne SM. New women veterans in the VHA: a longitudinal profile. Womens Health Issues 2011; 21 (4, Suppl): S103-S111
• 11 Patten E, Parker K. Women in the U.S. Military: Growing Share, Distinctive Profile 2011 . Available at: http://www.pewsocialtrends.org/files/2011/12/womenin-the-military.pdf . Accessed June 4, 2018