WASHINGTON, D.C. (August 26, 2021) — A new supplement to the peer-reviewed journal Women’s Health Issues provides overviews of existing research on topics important to military women's health—ranging from sleep to sexual and reproductive health concerns—and identifies places where additional research and policy changes can improve health for this important population.
Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, based in Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University. Amita Vyas, PhD, MHS, an associate professor of prevention and community health at Milken Institute SPH, is the journal’s editor-in-chief; Nancy K. Lowe, CNM, PhD, FACNM, FAAN, of the University of Colorado Anschutz Medical Campus College of Nursing, served as guest editor. The supplement “Military Women’s Health: Research Gaps and Opportunities” was sponsored by the Department of Defense TriService Nursing Research Program and the Military Women's Health Consortium at the Uniformed Services University of the Health Sciences.
The first full-length article in the issue—by Lori L. Trego, PhD, CNM, FAAN of the University of Colorado Anschutz Medical Campus and Candy Wilson, PhD, MHS, APRN, WHNP-BC, FAAN of the Uniformed Services University of the Health Sciences—proposes a framework that informs the other articles: the social ecological model for military women’s health (SEM-MWH). The social ecological model, a mainstay in public health research, describes levels of influence on health: the individual level, involving a person’s beliefs, behaviors, and physiology; the microsystem, where individuals’ tasks and environments matter; the mesosystem, where communities operate; the exosystem, in which organizational practices and policies exert influence; and the macrosystem, where larger cultural forces and policies affect health. Trego and Wilson adapt the social ecological model common in public health research for military women, and describe “leverage points” at each level, where changes can help improve health for military women.
In their article, Trego and Wilson discuss how the levels of the existing social ecological model apply to military women. For instance, they describe the microsystem, which includes deployed settings where gynecologic care may be in short supply; the mesosystem, where military community social groups can provide information and social support; and the exosystem, where Department of Defense policies can ensure that military women are offered specific services, such as contraceptive counseling and maternity care, but the hierarchical nature of the organization can make some servicewomen worry that their health needs will be shared throughout their chain of command. Trego and Wilson also describe the macrosystem, where a “24/7 on-duty” mentality can interfere with meeting health needs and where policies are still adapting to an active duty force that involves far more women than were enlisted when many of the laws governing servicemembers’ health were first adopted. Trego’s accompanying commentary describes the channels involved in setting military health policy, and offers an example of how the supporters of military women’s health can use the supplement’s findings to advance policy changes.
The majority of the issue consists of seven literature reviews that use the SEM-MWH framework to examine the existing publications on military women’s health in the following areas: sleep; adjustment disorders (the most common mental health diagnosis in the U.S. military); sexually transmitted infections; cervical cancer; unintended pregnancy; pregnancy, childbirth, and the postpartum period; and breastfeeding. The scoping reviews identify areas where additional research is needed, as well as potential leverage points at different levels of the SEM-MWH. For instances, the leverage points identified in the scoping review on sleep health include sleep training and education at the individual level, training and work schedules that minimize sleep disruptions (microsystem), training for military health care providers to increase awareness of gender differences in sleep problems (mesosystem), decreasing the frequency of moves that servicemembers must undergo (exosystem), and facilitating a military culture that values sleep (macrosystem).
“We’re delighted that Women’s Health Issues is publishing this supplement, because military women are an important population with unique health needs,” said Vyas. Citing the fact that the U.S. Armed Forces began accepting women into all military occupations, including combat roles, in 2016, she explained: “With combat roles now open to women, it’s never been more important to acknowledge the impact of military service on women’s health and to make sure that women in the military have access to the services they need to stay healthy.”
The supplement “Military Women’s Health: Research Gaps and Opportunities” was published online August 25.