Reproductive Health Needs of the Military and Veterans: Part 3

Alicia Y. Christy MD, MHSCR, FACOG

Gilbert L. Mottla, MD

Women comprise nearly 17% of today's active-duty military forces, and 19% of National Guard and Reserves. Currently, there are more than 2 million women veterans in the United States, and women are the fastest growing population in the Veterans Health Administration (VHA).[1] [2] Based on the upward trend of women in all service branches, the number of active-duty women, and women veterans who will need reproductive health care, is expected to dramatically increase. In addition to quality health care, there is also a need for advocacy. In this special issue, we will focus on the unique reproductive healthcare needs of this population, as well as the opportunities to advocate on behalf of all women who have worn the uniform.

Nearly half of all pregnancies in the United States are unintended,[3] and this issue has been reported to be even higher in the military population, especially among single, active-duty women.[4] In the article entitled Contraception and Unintended Pregnancy in the Military Healthcare System, Dr. Heitmann explores both the causes and potential strategies to decrease the high rate of unintended pregnancy among active-duty women.

Determining the impact of pregnancy outcomes for women and their partners while in the military is difficult due to changing exposures over time, difficulty in utilizing appropriate comparison groups, and the lack of prospective investigations. In their review, Obstetric Outcomes in Active Duty Women: Emerging Knowledge, Considerations, and Gaps, authors Mezwa, Adelsheim, and Markenson present a summary of the available research on reproductive health issues, with a focus on obstetrical outcomes among women in the U.S. military.

Military gynecologic oncologists were among the founders of the specialty and have maintained a tradition of leadership and engagement within the field at the national and international level. In the article entitled Gynecologic Oncology in the Department of Defense, Drs. Hamilton, Maxwell, and Casablanca examine gynecologic oncology services in the Department of Defense (DoD) environment, focusing on similarities and differences in the availability of clinical services, as well as the incidence and outcomes of gynecologic cancers among women in the military compared with women in the civilian community.

Lee Woodruff and Gilbert Mottla have been tireless advocates for active-duty men and women as well as veterans. Lee is the New York Times' best-selling author of the book In an Instant, the compelling and humorous chronicle of her family's journey to recovery following her husband Bob's roadside bomb injury in Iraq. They have founded the Bob Woodruff Foundation to assist injured service members and their families. To date, the nonprofit foundation has raised more than $40 million dollars. Gilbert Mottla is a board-certified reproductive endocrinologist practicing in Maryland. He received the prestigious ASRM Humanism in Medicine Award for his work in obtaining Congressional support for infertility services for veterans. In their article entitled Don't We Take Care of our Veterans?” The Critical Need for Veteran's Health Services Infertility Services for Veterans: Policies, Challenges, and Opportunities, they share the compelling stories of military members and Veterans who struggle with infertility. They also describe the need for policy and expansion of services for infertility care in DoD and VHA and the challenges and opportunities that exist.

Active-duty military service and deployment has the potential to compromise fertility through combat-related genitourinary injury, traumatic brain injury, gonadotoxic exposures, and physical separation from a partner. Despite a growing need and interest in fertility preservation, it remains an uncovered benefit for active-duty soldiers. Dr. Martini and her colleagues discuss the importance of fertility preservation in the military, and the need for advocacy to make these services available in their discussion entitled Fertility Preservation before Deployment: Oocyte and Sperm Freezing in Members of the Active Duty.

Current war time fighting environments have changed, and with it the nature of combat-related exposures and injuries that impact fertility has also changed. Dr. Lentscher and her coauthors examine the changing fertility needs of active-duty men and women in their discussion entitled Postdeployment Fertility Challenges and Treatment in the Modern era.

Burnout among physicians is a rapidly increasing problem among practitioners. A systematic review in JAMA reported that the prevalence of burnout is 80%. In their examination of physician burnout, Dr. Jeelani and colleagues answer the question Is Patient Advocacy the Solution to Physician Burnout.

Ltc. Karen Wagner

This issue is dedicated to Lieutenant Colonel Karen Wagner, a Medical Service Corp officer who was killed during the attack on the Pentagon on September 11, 2001. Her legacy remains an inspiration to everyone who knew Karen, and her contributions and sacrifice will long be remembered.

• 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 Centers for Disease Control and Prevention. Unintended Pregnancy 2013 [25 Jul 2013]. Available at: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/ . Accessed June 19, 2020
• 4 Holt K, Grindlay K, Taskier M, Grossman D. Unintended pregnancy and contraceptive use among women in the U.S. military: a systematic literature review. Mil Med 2011; 176 (09) 1056-1064