Battleland

The Nitty-Gritty of Women at War

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Navy Petty Officer 2nd Class Amanda Richeal on patrol in Helman province, Afghanistan, last summer.

What are the experiences of women at war, and what to tell clinicians about how to help? I have been asked to write a textbook on this subject, so have done another canvass of the literature.

What is striking is how little hard data there are about the experiences of female Soldiers and other service members from the wars in Iraq and Afghanistan.

There are lots of articles published by Department of Veterans Affairs authors about the experience of female veterans from earlier conflicts. These normally focus on PTSD and sexual assault. There are some very poignant newspaper articles about the struggles and triumphs of individual female service members and recent veterans.

But the scientific literature is sparse when it comes to the experiences of women who are still serving in the military. The research in the Army has focused on combat teams, who, by definition, are male. A few exceptions: the second Mental Health Advisory Team (MHAT-II) did survey enough women in 2005 to draw some conclusions. Its authors found that the rate of PTSD and related symptoms was very close to, and slightly less than, those of men (12% vs. 13%). MHAT VI had similar findings.

But that’s about it for scientific research, despite the fact that the military has been about 15% female for many years.

The public conversation about women in the military has all been about sexual assault and whether they should be in combat. These are important issues, but the predominant challenges that female service members face are trying to balance deployment with gynecological, reproductive, and family issues. I published on this very topic in 2001 in Military Medicine. Unfortunately not enough has changed.

It makes the men uncomfortable when I say this: how do you change your tampons while driving across the desert in a tank?

If on a convoy, women tend to not drink water, as they have no safe place to pee on the side of the road. This often leads to urinary tract infections.

Often there are only a couple of porta-potties for women. During my time in Somalia, if the “local” female toilet was being cleaned (eg contents of the oil barrel being burned), I had to walk 20 minutes to another female latrine.

Porta-potties have improved over time, as the infrastructure has improved. Except in remote outposts.

More dispiriting is this comment, from Dr. Remington Nevin, a military preventive medicine physician who served for a year at headquarters level in Afghanistan:

My experience in Afghanistan was that pregnant females were disproportionately the targets of punishment from no-sex policies. There were widespread anecdotal reports of medically unsupervised abortifacient use. Plan B was not routinely made available as an Over The Counter medication, and there was a grave reluctance to seek care for sexually transmitted infections (STI) and military sexual trauma (MST). Our Preventive Medicine section was chastised for distributing condoms. It was all very Victorian and quite unhealthful and very disheartening.

For women who have given birth, another major concern is how to maintain breast-feeding in unsanitary places, such as field exercises. The Canadian military allows women a year after birth before deploying. In the U.S. Army, the deployment-free period has gone from four to six months. Not much more has changed in the last eleven years.

Balancing family and work while on exercises or deployment is a huge issue. Of course this includes raising children, but it also involves caring for elderly parents and other family members. Almost all of my female contemporaries in military medicine who had children got out of the service shortly afterwards.

There have been advances. The public conversation is no longer whether women should be in the military at all. There is widespread recognition that women are in combat, whether or not they are in a combat job. For better or worse, when a woman is wounded or killed, there is not a public outcry.

The military could do far more, and it is trying. There is a task force on woman’s health issues. But I have observed many times, both during my time on active duty, and since retirement, that the military changes when the media, the Congress and the American people, push them.

Exhibit A: the recent no-fuss repeal of “Don’t Ask, Don’t Tell.”

So, it’s up to you, Jane and Joe American Public: push the military to be more accommodating for your daughters, wives, sisters and aunts who are heading off to war. After all, just like their brothers in arms, they are willing to make the ultimate sacrifice for the rest of us.

18 comments
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atpcliff
atpcliff

Currently, more than 26 countries allow women in direct combat, including Canada, New Zealand, Britain, Australia, Norway and Germany.

In addition, Israel, Turkey, Norway, Russia, Poland, India, China, Afghanistan, Korea and Britain have females in Special Ops. The U.S. just opened up Task Force 160, an aviation special ops force, to women.

Heterotic
Heterotic

Sorry, but if you want to breast feed do not enlist into a position that sees you deployed to an unsanitary place. Even women at some point will have to realize that they cannot have it all.

Whatnow05
Whatnow05

How do women  pilots on 8- 24hr flight ops change a tampon? I'm guessing they wear a diaper like men do. (Even people on the ground wear diapers.)  

Now then this isn't all women, but this is a problem in the military purposely getting pregnant to avoid deployment... And then when the next cycle comes up again getting pregnant once again to avoid that one. It's not common, but not uncommon either. 

Why you ask? Well it screws over other people who then get deployed back to back to back due to manning shortages. I know a few med students that are planning on doing this once they enter the military (Pay off med school, get residency start the family, get out.) Admittedly this is genius on their part, but still thanks for screwing the rest of us over. 

Military as whole favors people with families (More pay, more unofficial time off, and better housing.) What do you hear to this? "You have the same option to make a kid." Which if you ask me is a pretty dumb reason to create a human being. 

Guest
Guest

 As my old brigade commander used to say, that's an 18 year solution to a 1 year problem.

Robyn Roche-Paull
Robyn Roche-Paull

Breastfeeding during field exercises can be done...it's a matter of hand expression to keep one's milk supply up and dumping the milk into the sand/dirt.  Keep hand sanitizer in your pocket and use that to clean your hands.  Women have and are making it work while deployed overseas.  Have you heard of the mom sent to Afghanistan who shipped her breastmilk home every 2 weeks for 4 months?   I wrote a book for military mothers who are breastfeeding, it is full of tips and techniques, military policies, and true stories from moms who have successfully breastfed while serving in the military...all the branches and in all sorts of situations: from piloting a C-17 to boots on the ground in Afghanistan.  http://www.breastfeedingincomb...  

Laura
Laura

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OLimitsQ
OLimitsQ

Interesting piece. I don't mean to sound condescending, rather I am legitimately curious about what you think the solution to the tampon and tank issue is, as well as the issue of operating in austere conditions (sans porta-potties) for women in combat.

atpcliff
atpcliff

@OLimitsQ 

I don't know, but I do know that Germany currently has female tank crewmembers, and the Soviets did in WWII. In addition, most of the more than 26 countries that allow women in direct combat, do not have any restrictions on their combat roles, so I'll bet a lot more countries than Germany now have tank crews.

OLimitsQ
OLimitsQ

Interesting piece. I don't mean to sound condescending, rather I am legitimately curious about what you think the solution to the tampon and tank issue is, as well as the issue of operating in austere conditions (sans porta-potties) for women in combat.

Navy_Wife_757
Navy_Wife_757

The solution is to not have a period at all. There are medications that are prescribed that can put off a period for months (and even years) that is effective and does not harm a woman's reproductive cycle. I know because I have taken them. There are also procedures that can stop a woman's cycle forever such as uterine ablation that destroys the uterine lining. This procedure is for women who do not wish to get pregnant. 

I believe that women should not have children while in the service. It is selfish to have children and then go off to deployment...for either parent. Children deserve to have both parents. At the very least service members should put off having children until their commitment is over.   

BTW: I love children, but do not have any. I have been sterilized and have had the uterine ablation. It was the best decision I have ever made. My life is free from tampons and other "sanitary" protection. I had it done at 30, I would have had it done earlier if I could have. I am also a military spouse. 

Ladies...free yourself!

Guest
Guest

My wife told me that when she was deployed they pushed her to take birth control pills in order to delay menstruation. When she told them she didn't *want* to take them (they make her sick as a dog, and there is a history of breast cancer in her family) and that she could handle what was going on with her body while completing the mission, the nurse humiliated her in front of a group of females. Her gripe is that the more focus there is on this "our bodies, ourselves" stuff then the more reasons males will have to keep her from the fight. As she has said, " I can handle my business. Can you?"

freefallingbomb
freefallingbomb

Why do I always have to disagree with you about everything? What is wrong with YOU ?

I'm completely against training women how to kill men. Although I never lifted a finger against a woman in my life, I'm seriously afraid that I might lose all human decency and inhibitions against those unlucky enemy infantrywomen (or guerilla women) which I caught alive, or even barely alive, and I sincerely prefer that that never happened. I know I just wouldn't recognize myself, I would probably even enjoy it (war crime investigators, kiss my). Naah, no thanks. Sometimes I think it's precisely the fact that women are rarely seen and perceived anywhere as armed and dangerous that prevents me(n) subconsciously from seeing and treating them as the easy targets they clearly are. I'm not an ethologist (= a researcher of animal behaviour), but maybe this has even become some instinctive response in us men: After all, in Nature most females are also less robust than the males of their species, but they're still generally spared from intra-species attacks by them. Think of deers, cattle, wolves, lions and chicken for example. And if I'm not the only man who reacts that way, then maybe women should start worrying about keeping this positive male instinct alive and well in us, instead of winding back evolution.

But I would never use arguments like “less-than-5-stars hygienic conditions” in the field or incomprehensible physical particularities of the female anatomy to keep women safe = employed as civilians, or spending our money. Any argument but this one. Think: Why do you even have a country now? Only because ~ 200 years ago the American pioneers decided to travel through a vast, unknown, uncultivated, hostile continent – and their women and little daughters travelled, fought and suffered with them all the way to the Pacific coast, everything without nowadays medicine, hygiene and health information.

So, what's the matter now: Are young, modern, trained, U.S. American “warrior women” less tough outdoors than their grand-grand-grandgrannies?

Guest
Guest

 FFB-you made me laugh. Thanks : )

Yang
Yang

Are you serious? 

I'm not sure whether to point out how misogynistic your comment is ,how insensitive to the needs of women it is or even that you're clearly promoting that bodebard's wife should be forced to take birth control pills and lose control over her own body and health.  What does comparing women of today to pioneers have to do with anything? Do you want everyone to revert back to the 1800s and be miserable?I dont think you would enjoy that so don't say that someone else should.

freefallingbomb
freefallingbomb

I'm the one who wants women as safe and protected during a war as possible, to survive at all costs and to live on afterwards, if necessary even with other men, while we men fight and die (for them), so that makes M-E the misogynist here? Hm... fabulous logic!

Nor did I ever (quote:) “clearly promote” that female soldiers “should take anti-conceptional pills” to reduce their hygienic needs. I find that even TOTALLY ABJECT , more or less the opposite of what every civilized nation should fight for. Pity the Armed Forces that resort to such dehumanized, barbaric details just to increase their Infantry's combat readiness a bit: Did the “terrorists” really drive poor, defeated U.S.A. to such desperation?

You're also daft to claim that “I want everybody to be miserable like 200 years ago”. The simple truth is that life in the Infantry is as trying as surviving in the untamed wilderness, always will be. And true special forces have to survive in Nature with considerably less technology than regular troops, and for much longer periods, too. That why they're also the best infantrymen of all. But are women really as fit as men to survive in Nature, all by themselves? How many ever did, and for how long? Should somebody order them to? Why is it that every new continent (even the empty Antarctic!) was initially only inhabitated by us men, not by women, until we created minimally decent conditions for them?

However, I do stand by my point that even 200 years ago life was still incredibly hard, and not just for most newborns, elderly and sick people. We didn't even have heat insulation, plumbing, toilet paper, deodorants and effective drugs etc. etc. back then, or do you deny that? Still: If women back then could travel in wagons, sleep in tents, carry heavy stuff + children for miles and manage complete farms all by themselves, all year long, while today's babes complain mainly about unsatisfactory bodycare toiletries at the battlefront, then either war is too soft on them or they're too soft for war.

Guest
Guest

 BTW, there are no female tank drivers so I think your tampon question is a "red herring,'" as it were...

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