Despite their presence as nurses in the Revolutionary War and the Civil War, women had no official standing in the military until the establishment of a permanent Army Nurse Corps after the Spanish-American War in 1901. We've come a long way since then. Today, women in the military serve on combat vessels and in planes providing air support to ground troops; they are also part of ground units, driving trucks and working within local communities.
The young woman on our cover is one of over 213,000 women currently on active duty in the U.S. military; and, according to a 2011 Department of Veterans Affairs report, America's Women Veterans: Military Service History and VA Benefit Utilization Statistics, there are another 190,000 women in the reserves and the National Guard.
This past January, in what many saw as the final step in securing gender equality in the military, then defense secretary Leon Panetta lifted the ban on women serving in combat units. Once a contentious issue, it became a no-brainer when the American public realized that the front lines are not as clearly delineated as in prior wars and that even women in support roles are often in the line of fire from insurgents and snipers. The VA report states that 156 women have been killed as a result of action in the Persian Gulf War and the recent wars in Afghanistan and Iraq. And we can expect to see even higher numbers in years to come as women take their place alongside men in combat missions.
Certainly the increasing numbers of women on the front lines will mean new health concerns for women veterans. In this issue, Barbara S. Johnson and colleagues address the unique health needs of veterans of recent wars in “Enhancing Veteran-Centered Care: A Guide for Nurses in Non-VA Settings.” Since the VA reports that only about 25% of veterans receive care at VA facilities—including 19% of women veterans—it's important that nurses in all clinical settings are aware of the special health issues that can arise from being deployed to combat areas.
I wonder what we'll learn about the long-term effects of combat and combat-related injuries on women. The VA report tells us that the primary service-connected complaints for which women veterans seek care are posttraumatic stress disorder (PTSD), low back pain, and migraine. Another hazard discussed by Johnson and colleagues—one that may not be readily apparent, or even apparent for many years—is exposure to hazardous chemicals. (Remember Agent Orange, the defoliant widely used in Vietnam that was eventually linked to illnesses ranging from diabetes to cancer?) What may we later learn about the effects of chemical agents on women's fertility or breast cancer rates?
And if a woman goes through repeated deployments, as is often the case with men, or returns with injuries that include PTSD or depression, what will be the long-term effects on her family? There have been studies on male soldiers but none that I could find on women. Research on children who have a deployed parent indicates that it can be stressful for children of all ages (see “Caring for Families with Deployment Stress,” November 2010). Are the effects exacerbated if the deployed or depressed parent is the mother? Are the effects worse if the child is very young? And should we be putting any soldier who's a single parent of young children in harm's way? According to a 2011 Pew Research Center report, Women in the U.S. Military: Growing Share, Distinctive Profile, 12% of military women are single parents, compared with only 4% of men.
Finally, not all threats to female troops come from the enemy without. In May, the Department of Defense released figures from its 2012 annual report on sexual assaults in the military and the news was bad: a total of 3,374 sexual assaults had occurred, up from 3,192 in 2011, and the vast majority of victims were women. Two highly publicized cases of recruiting officers charged with sexual misconduct have heightened public awareness of the problem, and this has prompted Congress to demand changes in how the military handles sexual assault charges.
While women are eager to serve their country, it's clear to me that the military has a long way to go to make sure that women's service doesn't cost them, or their families, their futures.