Despite more than three decades of studies and recommendations on military women's health, the Defense Department fails to provide female service members the medical care and equipment needed for their well-being -- a deficiency that costs millions and hurts operational readiness, a Pentagon advisory board has concluded.
In an exhaustive review of the state of health services and support of active-duty women, members of the Defense Health Board found that previous DoD efforts to bolster gender-specific health care across the services have not led to "sustained improvements."
Instead, such inaction causes women to leave the military in their first year of service for disability at twice the rate of men and experience 57% more limited-duty days than their maile counterparts in their first enlistment.
"We're paying for the disability and injuries now, oftentimes for the remainder of the service member's life," said Army National Guard Col. Lee Norman, a Defense Health Board member, at a virtual meeting Wednesday.
In a yearlong effort to dissect the state of health care for female troops, members of the board's Health Care Delivery subcommittee reviewed the health policies of the DoD and each armed service, conducted interviews with experts and personnel, and looked at civilian and foreign militaries.
They concluded that even as women make up 17% of the force, the health initiatives geared toward them lack "sustained leadership commitment" and many have never reached fruition, in part because of a lack of support from commanders and the male-centric culture in the U.S. military.
"All military personnel, not just health professionals, influence or detract from the health care of military women," said board member and retired Air Force Col. Michael Parkinson. "Time and again, in our visits, if we found that the line commander cared about unintended pregnancies, and he happened to be a male, [actions were taken to prevent them] on that base. Line commanders are an essential partner."
Female service members face their toughest health challenges with musculoskeletal injuries, reproductive and genitourinary tract conditions, and mental health, according to the board. As such, the DoD should do more to address these issues to support them, board members said.
Regarding musculoskeletal injuries, the DoD should begin taking care of women before they attend boot camp, focusing on strength and endurance training geared toward women at recruiting stations, the board recommended.
The DoD also should implement two different fitness assessments -- gender-specific physical fitness standards and gender-neutral physical requirements for individual occupational specialties -- and they should be equipped with proper fitting gear, including sports bras and protective equipment tailored specifically to them, members said.
"A 'one-size-fits-all' approach for health fitness contributes to training injuries in a mixed-gender population," they wrote. "Women enter the military with lower fitness levels than men and are more susceptible to overuse and lower limb injuries. Their musculoskeletal injury risk is further increased when they attempt to meet gender-neutral health fitness standards and without access to gender-customized equipment."
In terms of reproductive and genitourinary health, the board recommended that the DoD implement best practices seen in some of the services, including the Navy's promotion of long-acting reversible contraception at basic training and the Air Force's return-to-duty fitness program for postpartum women.
The DoD also should ensure that women have access to devices that give service members the ability to self-test and self-treat bladder or yeast infections and include hygiene devices like the female urinary diversion device in field kits, they said.
Female service members also should have improved access to fertility services and be encouraged to breastfeed when they become mothers, the board recommended.
Given that active-duty women suffer from anxiety, depression and adjustment disorders at higher rates than men and are more likely to experience post-traumatic stress disorder related to sexual assault than their male counterparts, the military should continue to act aggressively to eliminate sexual assault in the ranks and review its screening tools and treatments for these mental health issues to ensure they are addressing service women's needs, they said.
Other recommendations by the board include:
- Standardizing women's health services and availability across the DoD
- Studying whether body appearance standards are appropriate without inadvertently motivating female service members into disordered eating
- Considering whether iron, vitamin D or calcium deficiencies are contributing to injuries among active-duty women, and if so, take steps to improve levels, like not allowing female recruits to give blood at boot camp.
To ensure that women's health services become a priority within the DoD once and for all, the board's top recommendation is for the Pentagon to establish an Office of Women's Health, with oversight and accountability to improve the health, fitness, performance and safety of female service members.
According to retired Navy Adm. Kathleen Martin, the board made establishing that office their No. 1 recommendation because, while much has been done in studying women's health issues in the military, few researchers and advocates "have the authority to act."
"Many times, those recommendations just get lost because they are reporting them up a chain of command that perhaps even isn't listening to them," Martin said. "If we have one central office, reporting directly to the Department of Defense, I truly believe it could really make a difference."
The board approved its report, "Active Duty Women's Health Care Services" on Wednesday and plans to send it to the secretary of defense for action.
"We are forwarding it 'urgently,' meaning that without being time-specific, enough is enough. Let's do it," Parkinson said.