On January 23, 2013, the Pentagon indicated that it would lift its ban on allowing women to serve in combat roles. The announcement comes after a long and complex series of legal and professional developments. On November 27, 2012, four female service members — all of whom have served in the Iraq and Afghanistan wars — filed suit against the Department of Defense, challenging the 1994 Direct Ground Combat Definition and Assignment Rule, which restricts women from serving in ground combat units. Represented by the ACLU, the women — a Marine Corps captain, a major in the U.S. Air National Guard, and two Reservists — argued that the restriction was unconstitutional under the Fifth Amendment because it violated their rights to equal protection under the law. This action comes only a few months after another lawsuit was filed against the Pentagon on the same grounds.

The military has been taking gradual steps towards gender equality. In the early 1990s, Congress lifted bans on women flying in combat and serving on combat ships. In 2010, the Navy changed its policy prohibiting women from serving on submarines. This year, the Pentagon began implementing changes that allow female service members to take on a wider range of roles. These changes include allowing for more than 1,000 exceptions to the combat-exclusion policy to enable women to gain increased combat experience.

Already, among the nearly 2 million service members who have been deployed during combat operations in Iraq and Afghanistan, more than 280,000 have been women – and more than 800 have been wounded.

Many argue that due to the nature of modern warfare, women already serve in combat roles, if not in a formal capacity, and the fact that their service is not officially recognized hampers their professional development and access to certain benefits. A recent draft of the National Defense Authorization Act of 2013 passed by the Senate Armed Services Committee includes the following language: “The committee remains concerned that assignment policies restricting service by women may continue to result in inaccurate characterizations of their service in combat, denying them earned benefits and in some cases needed care and services.”

Some recent articles address these issues from a variety of perspectives: “Women in Combat: U.S. Military On Verge of Making it Official” from Christian Science Monitor; “In a New Elite Army Unit, Women Serve Alongside Special Forces, But First They Must Make the Cut” from The Washington Post; “Get Over It! We Are Not All Created Equal” from the Marine Corps Gazette; and “G.I. Janes” from The New York Times.

Below are several of the latest reports and studies that examine some of the challenges female service members and veterans continue to face:

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“Women in Combat: Issues for Congress”
Burrelli, David F. Congressional Research Service, April 5, 2012.

Summary: “In approximately 10 years of combat operations in Iraq and Afghanistan, over 283,000 female members have been deployed, over 800 have been wounded and over 130 have died. According to the Department of Defense (DOD), as of February 29, 2012, over 20,000 female members have or are serving in Afghanistan and Iraq. (U.S. forces were out of Iraq as of Dec. 2011.) On numerous occasions women have been recognized for their heroism, two earning Silver Star medals. This outcome has resulted in a renewed interest in Congress, the Administration, and beyond in reviewing and possibly refining or redefining the role of women in the military.”

 

“America’s Women Veterans”
Department of Veterans Affairs, National Center for Veterans Analysis and Statistics, November 23, 2011.

Executive Summary: “Over the past 30 years, women have entered the military in ever-increasing numbers. Ultimately, these women will make the transition from Servicemember to Veteran. In 2009, women comprised 8% of the total Veteran population in the United States. By 2035, they are projected to make up 15% of all living Veterans. This comprehensive report chronicles the history of women in the military and as Veterans, profiles the characteristics of women Veterans in 2009, illustrates how women Veterans in 2009 utilized some of the major benefits and services offered by the Department of Veterans Affairs (VA), and discusses the future of women Veterans in relation to VA. The goal of this report is to gain an understanding of who our women Veterans are, how their military service affects their post-military lives, and how they can be better served based on these insights.”

 

“From Representation to Inclusion: Diversity Leadership for the 21st-Century Military”
Military Leadership Diversity Commission, March 15, 2011.

Excerpt: “[A]s long as the combat exclusion policies bar women from entering tactical/operational fields and units, women will be at a disadvantage compared with men in terms of career advancement potential…. Therefore, the Commission recommends that DoD and the Services take steps to open all career fields and units to qualified women.”

 

“A Systematic Literature Review of PTSD Among Female Veterans From 1990 to 2010”
Middleton, Katherine; Carlton, David C. Social Work in Mental Health, 2012, Vol. 10, No. 3. doi: 10.1080/15332985.2011.639929.

Abstract: “This article reviews literature over the past 20 years concerning female veterans and posttraumatic stress disorder (PTSD). The literature identified sexual trauma, pre-military sexual trauma, combat exposure, substance misuse, and gender difference in the development of PTSD among female veterans from the Gulf War to the current conflicts. Also incorporated in the review are evidence-based and other promising treatment options for female veterans suffering from PTSD. Based on the review, female veterans experience higher rates of military sexual trauma and much of the current research on female veteran related PTSD is focused on sexual trauma that occurs while in the military. As the number of females serving in the military grows, there needs to be a continued effort in understanding the multiple issues they experience before, during, and after their time in the military. Researchers need to continue to address sexual traumas, the disparity in the diagnosis of PTSD, effective treatment options, and further understand the dynamics of comorbidity of other mental health disorders with PTSD. In addition, more research needs to be conducted on how trauma and PTSD impacts family and occupational functioning for female veterans after both their return from operational deployment and completion of military service.”

 

“The Health and Wellbeing of Female Veterans: A Review of the Literature”
Crompvoets, Samantha. Journal of Military & Veterans’ Health, April 2011, Vol. 19, No. 2, 25-31.

Abstract: “This paper examines health and wellbeing issues that emerged in a systematic review of the war, peacekeeping and peacemaking experiences of female veterans. Research questions that informed the search were: firstly, what is known about the experiences of female veterans, and in particular, military nurses; and secondly, what influences the perceptions of a veteran of their health and wellbeing? Components of wellbeing that emerged included the ability to cope, ease of access to services and support, satisfaction with parenting, the effects of sexual harassment, and symptoms of PTSD (Post Traumatic Stress Disorder). Perceptions of wellbeing were both informed and challenged by the women’s individual and collective identities, for example a professional identity, military identity, being a parent and being female. There has been little research into the sense of self and identity for women in the military today. However, what we do know suggests that identity can have an impact on a woman’s health and her access to services.”

 

“Physical-Strength Rationales for De Jure Exclusion of Women from Military Combat Positions”
Goodell, Maia B. Seattle University Law Review, 2010, Vol. 34, No. 17.

Abstract: “Women have been serving in the military in steadily increasing numbers for decades. Nevertheless, the military remains one of the few areas in which the U.S. government decides what roles are open to women based on de jure exclusions. This article examines the law governing de jure classification, noting that a mere normative belief about women’s proper place in society is an insufficient basis to justify a sex-based exclusion. It then probes the most common rationale advanced in support of the continued de jure exclusion of women: physical strength. The article examines four problems with the physical strength rationale: (1) stereotyping — the assumption that no woman can do the job without testing the abilities of the individual woman; (2) differential training — the failure to account for the potential for improvement for women who often have less prior physical activity; (3) trait selection — measuring only tasks that are perceived to be difficult for women, while ignoring equally mission-critical tasks that women may be better at performing; and (4) task definition — not considering if there are other ways to get the job done.”

 

“Mortality in Female War Veterans of Operations Enduring Freedom and Iraqi Freedom”
Cross J.D.; Johnson, A.E.; Wenke, J.C.; Bosse, M.J.; Ficke, J.R. Clinical Orthopaedics and Related Research, July 2011, Vol. 469, No. 7, 1956-61. doi: 10.1007/s11999-011-1840-z.

Abstract: “Combat-wounded service members are surviving battle injuries more than ever. Given different combat roles held by men and women, female service members should survive wounds at an unprecedented rate. We determined whether the casualty rates for females differ from their male counterparts and characterized wounds sustained by female casualties…. In Operation Iraqi Freedom [OIF], the percent death for women was 14.5% (103 deaths) versus 12.0% (4226 deaths) for men. In Operation Enduring Freedom (OEF) OEF, the percent death for women was 35.9% (19 deaths) versus 17.0% (793 deaths) for men. Battle-injured females had a greater proportion of facial and external injuries and more severe extremity injuries compared with those nonbattle-injured. The casualty death rate appears higher for women than men although the mechanisms of fatal injuries are not known and may not be comparable.”

 

“Military Sexual Trauma in Treatment Seeking Women Veterans”
Rowe, Erin L.; Gradus, Jaimie L.; Pineles, S.; Batten, Sonja V.; Davison, Eve H. Military Psychology, 2009, Vol. 21, No. 3, 387-395. doi: 10.1080/08995600902914768.

Abstract: “As the number of women serving in the military continues to grow, it is increasingly important to explore the [experience] of military sexual trauma (MST) among female veterans. The current study included 232 female veterans who sought outpatient mental health treatment at an urban Veterans Affairs hospital. The study’s aims were to (a) describe and compare the demographic characteristics, health behaviors, and psychological symptoms of female veterans who have experienced MST to those veterans who do not report this experience; and (b) examine the associations between psychological symptoms and health behaviors in this sample, stratified by MST status. Results indicate that treatment-seeking women veterans who reported experiencing MST endorsed more psychological distress compared to those who did not report experiencing MST. In addition, psychological symptoms were associated with engaging in problematic health behaviors, such as binge eating and infrequent physical exercise among both those women who experienced MST and those who did not.”

 

“Work-Related Quality of Life and Posttraumatic Stress Disorder Symptoms Among Female Veterans”
Schnurr, Paula P.; Lunmey, Carole A. Womens Health Issues, July-August 2011, Vol. 21, No. 4, S169-75. doi: 10.1016/j.whi.2011.04.013.

Abstract: “Although prior studies have shown that PTSD symptom clusters are differentially related to work-related quality of life, no study has assessed these relationships in women specifically. Participants were 253 female veterans with current PTSD. We assessed three components of work-related quality of life (employment status, clinician-rated occupational impairment, and self-rated occupational satisfaction) and performed analyses with and without adjusting for self-reported depression symptoms. None of the PTSD symptom clusters were associated with employment status. All PTSD symptom clusters had significant independent associations with occupational impairment. All PTSD symptom clusters except avoidance were significantly associated with lower occupational satisfaction, but none had independent associations with occupational satisfaction. No single PTSD symptom cluster emerged as most strongly associated with occupational outcomes. Symptoms of depression had substantial associations across all occupational outcomes, independent of PTSD symptoms.”

 

“Impact of Exposure to Combat During Deployment to Iraq and Afghanistan on Mental Health by Gender”
Woodhead, C.; Wessley, S.; Jones, N.; Fear, N.T.; Hatch, S.L. Psychological Medicine, September 2012, Vol. 42, No. 9, pp. 1985-96. doi: 10.1017/S003329171100290X.

Abstract: “The current study used data from a representative sample of U.K. Armed Forces personnel to examine gender differences among those deployed to Iraq and Afghanistan (n=432 women, n=4554 men) in three measures of experience: ‘risk to self,’ ‘trauma to others’ and ‘appraisal of deployment’. We examined the impact of such experiences on post-deployment symptoms of post-traumatic stress disorder (PTSD), symptoms of common mental disorder (CMD) and hazardous alcohol use. After adjustment, men reported more exposure to ‘risk to self’ and ‘trauma to others’ events and more negative appraisals of their deployment. Among both genders, all measures of combat experience were associated with symptoms of PTSD and CMD (except ‘risk to self’ events on symptoms of CMD among women) but not with alcohol misuse. Women reported higher scores on the PTSD Checklist-Civilian Version (PCL-C) among those exposed to lower levels of each experience type but this did not hold in the higher levels. Women reported greater symptoms of CMD and men reported greater hazardous alcohol use across both levels of each experience type. Examining men and women separately suggested similar responses to exposure to adverse combat experiences. The current findings suggest that, although gender differences in mental health exist, the impact of deployment on mental health is similar among men and women.”

 

“Reproductive and Other Health Outcomes in Iraq and Afghanistan Women Veterans Using VA Health Care: Association with Mental Health Diagnoses”
Cohen, Beth. E.; Maguen, Shira; Bertenthal, Daniel.; Shi, Ying; Jacoby, Vanessa; Seal, Karen H. Women’s Health Issues, September-October 2012, Vol. 22, No. 5, e461-71. doi: http://dx.doi.org/10.1016/j.whi.2012.06.005.

Abstract: “Women veterans with any mental health diagnosis had significantly higher prevalences of nearly all categories of reproductive and physical disease diagnoses (p < 0.0001 for adjusted prevalences.) There was a trend of increasing prevalence of disease outcomes in women with PTSD, depression, and comorbid PTSD and depression (p for trend 0<.0001 for all outcomes). Iraq and Afghanistan women veterans with mental health diagnoses had significantly greater prevalences of several important reproductive and physical health diagnoses. These results provide support for VA initiatives to address mental and physical health concerns and improve comprehensive care for women veterans.”

 

Tags: veterans, war, mental health, PTSD, sex crimes, women and work, research roundup