Deploying Women's Health Critical to Mission Success in Peace, War
By Rudi Williams
American Forces Press Service
ARLINGTON, Va., March 8, 2000 "We live in a world where we're not just dealing with bombs and bullets, we're dealing with 'the next deep breath could kill you,'" Dr. Sue Bailey recently told an audience here.
Bailey, assistant secretary of defense for health affairs, was the first speaker in a series of monthly "brown bag lunch" lectures on women's health issues at the Women in Military Service for America Memorial at Arlington National Cemetery. Her March 1 talk on health issues of deploying women coincided with the start of National Women's History Month.
"Women are an integral part of the group that goes to war, either as part of our medical team or in any way we ask them to do so," Bailey said. "We're the HMO (health maintenance organization) that goes to war."
DoD's top doctor said safeguarding military women's health is an essential part of her responsibilities. A Naval Reserve officer, Bailey emphasized that women's health is important to the military's success in peace and war because women today serve in more military occupational specialties than ever before.
"They're generally kept out of the so-called combat areas, but today, there's no safe area to the rear," she said. "Injuries are part of what happens when people go on deployment. In thinking about force health protection, it's important that we think about how people get injured in a deployment, sometimes unrelated to combat."
Heat injuries are a major health problem, Bailey said. Troops who wear chemical and biological protective clothing improperly can suffer dehydration, heat stroke, heat cramps or heat exhaustion. But, she said, there are many ways to combat heat injuries.
Solving health problems for women also helps men who are exposed to the same kinds of injuries, Bailey said. "Orthopedic injuries are of real importance to us because women have a higher incidence of stress fractures than men," she noted. DoD scientists' research in bone density, bone geometry and gene mutation may help protect women -- and men -- against orthopedic injuries, Bailey said.
Equipment often isn't designed with women in mind -- or some men, so research geared toward improving equipment, weapons and clothing benefits both genders she noted. Pilot seats, helmets and flak jackets are just a few examples of force protection essentials that need to be designed so both genders can use them She said.
"Motor vehicle accidents are one of the main causes of injuries to troops on deployment worldwide," Bailey said. "These are non-battle injuries" -- and women are just as at risk as men.
"We need to do everything we can to make deployment as safe and healthy as possible," she said. "Even though we have some special hygiene, privacy and specific medical problems that relate to women, that doesn't keep us from serving fully." Bailey expressed concern about urinary tract and gynecological infections in women because "they go hand-in- hand with lack of privacy and need for good hygiene."
Sometimes it's difficult to maintain good hygiene on deployment, but more than a woman's or man's personal responsibility is involved -- unit commanders and other leaders bear responsibility for providing the best conditions for good hygiene possible under their particular circumstances, she said.
For example, she said, commanders should ensure men and women have clean bath facilities during long hauls like Kosovo and Bosnia. Women should also have adequate supplies for personal hygiene and increased fluid intake, particularly in high-heat situations, she added.
"Most of the times, women have been ingenious in finding ways around problems that people thought would keep them out of the foxholes in the past," Bailey noted. She talked about a firsthand experience "rocking and rolling" in a transport flying from Albania to Kosovo. She and her senior enlisted adviser, Navy Master Chief Karen Sayers, learned the only toilet on board was a can in the back of the plane, she said with a hearty laugh. The audience roared with laughter, too.
"But it gets worse. The can was set up down inside some boxes!" she said. "We accomplished it. But that was better than another time when we were going into Haiti." The facility that time was a relief tube -- a funnel on a pipe sticking out a hole in the fuselage.
Pregnancy tops the list of health issues relating specifically to women, Bailey said. Prior to deployment, women should receive an adequate supply of birth control pills or whatever contraceptive method they choose. Unplanned pregnancy is a major issue for women, particularly in the military, she noted.
Bailey said the Army has a working group that focuses on predeployment pregnancy screening. It's important, she said, because 70 percent of the women found to be pregnant during the Bosnia operation were pregnant before they deployed.
Knowing whether a woman is pregnant before a deployment is extremely important because service members are required to take vaccines and other medications to protect themselves in the field, Bailey noted.
"People wonder sometimes why we're so focused on anthrax, because there are a lot of other agents people could use against us -- plague, smallpox," Bailey said. "But anthrax is the No. 1 leading biological agent that could be encountered during a deployment. The No. 2, 3, 4 and down the list of other agents are far less likely to be used -- they're very difficult to stabilize and weaponize."
She said America's enemies are more likely to use anthrax because it's cheap and easy to use. "We have a very safe vaccine," Bailey emphasized. "It has fewer side effects that you usually see with other vaccines." The doctor noted that vaccines have been used for over a century and have shown no ill affects in the reproductive arena.
"To be absolutely certain, any woman who is pregnant may defer the anthrax immunization even though we don't feel that the antibody is harmful to the woman or to a fetus," Bailey said.
She said if she were a nursing mother, she wouldn't take the anthrax vaccine, "and would be very careful about smoking, drinking and probably eating spicy foods." The services are willing to deal with this special situation, she said.
Family separation is another potential major health problem for deploying women, she said. Domestic problems like caring for young children, and sometimes elderly parents, often fall to the woman of the household. Therefore, Bailey said, reducing separation difficulties prior to deployment is essential to having a physically, emotionally and mentally fit and healthy force.
Modern technology, such as cell phones and e-mail, makes it easier and faster to keep in contact with families, she noted.
After deployment, isolation is sometimes a problem for military women because the peer group is small, Bailey noted. But the problem is less than it used to be, she said, because women are now 14 percent of the armed forces and growing.
"The Navy found that a critical mass of women is necessary aboard ships to provide the kind of camaraderie and acceptance that reduce isolation," Bailey noted. She said a women's network and support system forms if 15 to 20 percent of the crew are women.
Sexual harassment and assaults against women are other major problems, and health affairs is studying ways to minimize them, Bailey noted.
"These incidents are probably lower during deployment because of the reduced availability of alcohol," she speculated. However, she added, "when a woman steps into a predominantly male situation, it's more likely there will be sexual harassment and sometimes even assault. Tailhook and Aberdeen brought high-level attention to this problem. We're aware that we need to educate both men and women about this problem if we're going to correct it."
Medical problems always arise after deployments, Bailey said, so carefully diagnosing and treating troops when they return home helps health care providers deliver better protection on future deployments.
Bailey said women understand that they need to maintain their health so they can have a reproductive future. "That means taking good care of yourself today, preventing sexually transmitted diseases and protection against pregnancy," she said.