Women Veterans: Is there a difference in treatment? Nanci Swan RN MSN CCRN

Integration of Women in the Military • 1948: Women granted permanent status in the military. • 1975: Public Law 94-106 permits women to enroll in US military academies in 1976. • 1992: Defense Authorization Act allows women to fly combat aircraft. • 1993: Congress opens combat ships to women. • 2011: First women are stationed on a submarine. • Jan, 2013: Barriers are lifted that prevented women from serving in direct combat roles.

History- American Revolution • Not uncommon for wives , mothers and daughters to follow their loved ones into battle • Margaret Corbin and Mary McCauley- heroines in Battle of Monmouth in 1778 • Civil war- at least 400 on both sides • Women acted as spies, saboteurs and couriers as well as cooks, caregivers and nurses • Mary Walker, an army surgeon, was the first and only women to be awarded the Congressional Medal of Honor 3

History- Spanish-American War • Nursing corps established as an auxiliary of the Army by act of Congress • Established women as a formal part of the military

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History- WWI • By the end of WWI, approximately 34,000 women served as nurses in the all of the armed forces • Military women was given no rank or benefits at this point • Turning point in the history of women on the military

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History-WWII • At the end of WWII, almost 280,000 women were serving in the military (14%) • Women were given full military status with the establishment of WAC (Women’s Army Corps) by Congress in 1943. • This lead the way for women in all branches of the Armed Forces • 1948- President Harry Truman signed the Women’s Armed Services Integration Act, making women permanent members of both Regular and Reserve Forces of all Armed Forces. 6

History- Korean Conflict • Women played an active role in engagement • DACOWITS (Defense Department Advisory Committee on Women in the Services) was established by Secretary of Defense George C. Marshall to provide advise and recommendations on matters and policies relating to the recruitment and retention treatment, employment, integration and well-being of the professional women in the Armed Forces. • Overall goal was to mobilize one half-million to one-million women to join. However, the military fell short of it’s goal. 7

History- Vietnam • Military’s next big push to get women in the Armed Services came during this war. • Military opened up many different positions in the Armed Forces due to shortages of men • 1970- Brigadier General Anna Mae Hays, head of Army Nurse Corps became the first woman to attain star rank in nursing • 1972- Rear Admiral Alene B. Duerk, head of Navy Nurse Corps, became the first woman admiral • There were also women who were not nurses making star rank. • 1973- advent of All Volunteer Forces (AVF)

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History- Gulf War • Beginning in 1990, women flew combat aircraft, manned missile placements, served on ships in the Gulf, drove convoys in the desert, and assumed other roles making exposure to combat more likely. • 2001- 12% of women veterans reported having served in combat or war zone • Combat Action Badge- honors any soldier exposed to perilous combat conditions • By 09/2005- the number of women on active duty totaled 202,000, which was close to 14% of the active duty armed forces 9

Population • Female population has increased over the last decade • 1990- 1.2 million women vets • 2007- 1.74 million women vets • Median age for women- 47 • Median age for men-61 10

Scope of the Issue: Women in the Military Women Active Duty

Number

% of Branch

Army

76,694

13.6%

Marine Corps

13,677

6.8%

Navy

53,385

16.4%

Air Force

63,552

19.1%

Coast Guard

6,790

15.7%

Reserves

18,761

19.5%

National Guard

470,851

15.5%

Enduring Freedom & Iraqi Freedom (OEF/OIF) • High utilization by women who served in Operations • Over 102,126 Female OEF/OIF Veterans • • 44.2% of women enroll; of these, 43.8% use from 2-10 visits • • Compares to 15% average utilization by earlier era’s of women

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Statistics • Race – 69% White – 19% Black

• Education – 72%- Some college – 40%- Bachelor’s Degree – 24%- Completed High School

• Martial Status – 52% Married

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VA Benefits • VA Advisory Committee on Women Veterans • Women population is growing • Special needs of women vets

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Top 3 Women Diagnosis at the VA • PTSD • Hypertension • Depression

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Women and Health Care • The Veterans Health Care Act of 1992 • National Women’s Trauma Recovery Program • Women Veterans Health Program Office

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Benefits available • Women’s Veterans Program Manager • Primary Care • Specialty Care • Telephone Care 17

Primary Care • General care includes health evaluation and counseling, disease prevention, nutrition counseling, weight control, smoking cessation, and substance abuse counseling and treatment as well as gender-specific primary care, e.g., cervical cancer screens (Pap smears), breast cancer screens (mammograms), birth control, preconception counseling, Human Papillomavirus (HPV) vaccine, menopausal support (hormone replacement therapy) which is available at greater than 95% of VA facilities.

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Military Sexual Trauma (MST) • Women—and men as well—may experience repeated sexual harassment or sexual assault during their military service. Special services are available to women who have experienced MST. VA provides free, confidential counseling and treatment for mental and physical health conditions related to MST.

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Risk of Sexual Harassment •Fear of harassment => “walking on egg shells” •Varying levels of females’ acclimation to male attitudes/conversations/attention •Becoming “one of the guys” can feel like forfeiting status as a woman •Military’s reverence of male virility => ingrained sense of entitlement •Helplessness on the battlefield => need for power/control over another •Traditional climate can encourage silence and vilification of the victim after an assault

Mental Health Mental health includes evaluation and assistance for issues such as depression, mood, and anxiety disorders; intimate partner and domestic violence; sexual trauma; elder abuse or neglect; parenting and anger management; marital, caregiver, or family-related stress; and postdeployment adjustment or post-traumatic stress disorder (PTSD).

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Specialty care • Management and screening of chronic conditions includes heart disease, diabetes, cancer, glandular disorders, osteoporosis, and fibromyalgia as well as sexually transmitted diseases such as HIV/AIDS and hepatitis. • Reproductive health care includes maternity care, infertility evaluation and limited treatment; sexual problems, tubal ligation, urinary incontinence, and others. VA is prohibited by legislative authority from providing either in-vitro fertilization or abortion services. 22

Specialty Care Rehabilitation, homebound, and long-term care • VA referrals are given to those in need of rehabilitation therapies such as physical therapy, occupational therapy, speech-language therapy, exercise therapy, recreational therapy, and vocational therapy. Homebound and long-term care services are available as well, limited to those meeting specific requirements

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Special programs for women – Homeless women veterans – Victims of domestic violence – Education and training – Employment assistance – Vocational rehabilitation

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Homeless Women • Special programs provide services for homeless women Veterans, victims of domestic violence, and women Veterans interested in education and training, employment assistance, and vocational rehabilitation. • The VA Women Veterans Health Program is committed to helping homeless women Veterans live as independently as possible. Homeless services include emergency shelter, transitional housing programs, and permanent housing. Some services also are available to homeless women Veterans with dependent children.

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Domestic Violence • The Women Veterans Health Strategic Health Care Group, in coordination with the WVPM Communications Workgroup, has created materials to expand awareness of and help prevent domestic abuse against women Veterans and all women. • According to the Centers for Disease Control and Prevention (CDC),* each year women suffer nearly 4.8 million assaults and rapes, while men experience 2.9 million attacks. Teen dating statistics are worse: one in 11 adolescents reports physical dating violence, while one in four reports verbal, physical, emotional or sexual violence every year. Healthy relationships, empowering women, resources for victims, and penalties for abusers are key to prevention. 26

Readjustments • • • •

Transitioning to home and “mom” role Differences for active duty, Guard, Reserve Attachment disruption and parenting issues Social supports network near military bases vs. Guard, Reserve community-based • Transitioning active duty “job” roles to private sector: a step-down for women?

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Latest News…. • April 23, 2013: The Department of Veterans Affairs launched its new Women Veterans hotline: •1-855-VA-WOMEN (1-855-829-6636) •http://www.womenshealth.va.gov/ • See: http://www.womenshealth.va.gov/WOMENSHEA LTH/ culture_change.asp 38

Woman Vet on Oprah

Ms. Duckworth lost both of her legs in a Blackhawk helicopter crash 29

Rear Admiral Joan M. Engel “An Alabama Connection” •

Joan Marie Engel held the position as the 18th Director of the Navy Nurse Corps from September 1994 to August 1998. She concurrently served as deputy commander for personnel management in the Health Sciences, Education and Training Command, and later as assistant chief for Education, Training and Personnel.

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RADM Engel received her nursing diploma from the Mercy Hospital School of Nursing in Buffalo, New York in 1961. She earned a bachelor's degree in public school nursing from Clarion University in Pennsylvania in 1969.[1] In 1980, she earned a Master of Science in nursing from the University of Alabama School of Nursing. She is a Fellow in the American Academy of Nursing, a Wharton Fellow and holds an honorary fellowship in the American Academy of Medical Administrators.

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References • http://www1.va.gov/womenvet/docs/Women Vet_History.pdf • http://www.publichealth.va.gov/womenshealt h/

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More Sources Military/Veteran Statistics: –National Center for Veterans Analysis and Statistics (NCVAS; http://www.va.gov/vetdata/) –Department of Defense, Women’s History Month page (http://www.defense.gov/home/features/2012/0212_wom enshistory/) •Mental Health/PTSD: –National Center for PTSD (NCPTSD; www.ncptsd.com) –Department of Veterans Affairs, Women Veterans (http://www.mentalhealth.va.gov/womenvets.asp)