Violence Against Women in the Military Martin Donohoe

Outline Definitions History Data Characteristics of abuse victims/perpetrators Consequences of abuse (including PTSD) Recent developments (DOD Review, Iraq/Afghanistan, available programs) Advice for female armed services members Reducing VAW in the military

Violence Against Women Direct: physical, sexual, emotional Global health burden comparable to that of HIV, tuberculosis, and cardiovascular disease Institutional: social, legal, educational, and political marginalization

Rape as a War Crime Common Comfort women (WW II Japan) Sudan Rwanda Bosnia etc. Notions of war/militarism and excessive “masculinity”

Violence Against Women Around Overseas U.S. Bases > 200,000 incidents involving military personnel and Japanese nationals (male and female) since 1952 (> 1000 deaths) > 300 rapes of Japanese citizens committed by U.S. personnel since 1945 Adverse effects on military agreements, support for U.S. troops

Women in the U.S. Military More than 210,000 women are on active US military duty 1.8 million female veterans (out of 23 million total veterans) – 425,000 getting at least some care through VA Almost 60,000 female troops have been deployed in Iraq and Afghanistan 1 in 7 US military personnel in Iraq is female

Victims Active duty troops Army > Marines > Navy > Air Force Female, civilian spouses of active duty personnel

1991 Tailhook Scandal >100 officers at a Navy convention sexually assaulted and harassed dozens of women None convicted Investigation found that Navy brass had tacitly approved such behavior for years

Other Reports of Violence 1996: Sexual assaults at Aberdeen Proving Ground in Maryland led to charges against a dozen Army drill instructors several officers reprimanded 2004: 3 returning veterans who had served in Special Forces in Afghanistan killed their spouses Other homicides, suicides among returning vets since

Violence and Homicides 1997-2001: >10,000 cases of spouse abuse per year occurred in the armed forces 14 homicides Likely a large underestimate (e.g., girlfriends not counted, under-reporting) 1995-2004: 218 domestic murders in the US military

Violence 22% of active duty military women report physical abuse and/or sexual assault while in the service 2004 Pentagon survey of the 3 military academies: 1/7 female cadets had been a victim of sexual abuse during the previous 5 years Only 1/3 of incidents reported

Violence 2004 DOD study: 7.4% of Air Force Academy cadets reported that they were victims of rape or attempted rape

Sexual Assault U.S. Navy Study: Female victims Attempted rape (9%) Completed (36%) rape Male perpetrators Attempted rape (4%) Completed rape (11%)

Violence 2007-2010: 18% increase in alleged sexual assaults committed by U.S. service members Pentagon acknowledges 80% of rapes never reported Child maltreatment more common during deployments Suggests victims becoming perpetrators

Sexual Assault Completed and attempted sexual assaults much more common among female soldiers than among other government employees

Violence National phone survey of 558 Vietnam (and subsequent era) women veterans (response rate 96%) 48% admitted experiencing interpersonal violence during military service, including rape (30%), physical assault (35%), or both (16%) 5% reported repeated rape 5% gang rape

Violence Baltimore VA study (response rate 52%) 68% reported at least 1 form of abuse Sexual abuse (55%) Physical abuse (48%) Rape (41%) All 3 (27%) National sample of women Veterans’ Administration (VA) outpatients 23% reported military-related sexual assault

Violence VA Study (191 inpatients; 411 outpatients) 24% under age 50 report domestic violence in the past year (7% over age 50) 90% under age 50 report a history of sexual harassment (37% over age 50)

Female Perpetrators Female on male violence more common in military than among civilians Moderate aggression: 13% vs. 10% Severe aggression: 4.4% vs. 2% LGBT violence under-reported Lack of provider awareness Don’t ask / don’t tell One study found higher percentages of aggression among female ADM than among male ADM

Common Characteristics of Abuse Victims low self-esteem guilt self-blame denial traditional attitudes regarding women’s roles have children poor financial resources few job skills less education few friends history of childhood abuse

Common Characteristics of Abusers low self-esteem dependency jealousy poor communication skills unemployed/underemployed 21

Common Characteristics of Abusers abuse alcohol/other drugs have witnessed or experienced abuse as children if immigrants, are more likely to have been victims of political violence abuse their own children

Frequent family separations Dangerous work assignments Military families face unique stressors, which increase the risk for family violence Relocations Long work tours Frequent family separations Dangerous work assignments

Combat stress and PTSD increase likelihood of males perpetrating abuse Veterans with combat exposure and PTSD have more marital problems 1/3 of male veterans with PTSD engage in partner violence Rate 2-3X higher than that for non-PTSD veterans and non-PTSD civilians

Health Consequences Victims suffer higher rates of: chronic pelvic pain dysmenorrhea abnormal periods PMS dissatisfaction with sexual relations

Victims More Likely to Report Chronic health problems Lower health-related quality of life Prescription medication use for emotional problems Failure to complete college Annual income < $25,000 Depression (3X higher rate) Alcohol abuse (2X higher rate)

Victims More outpatient visits Poorer self-rated health status History of childhood violence and post-military violence more common

Victims High levels of secondary victimization Feelings of guilt Depression Anxiety Distrust of others Reluctance to seek further help

PTSD Risk of PTSD after sexual assault similar in both female and male veterans to that seen following high levels of combat exposure Female veterans who had suffered sexual assault while in the military 9X more likely to have PTSD

PTSD Patients Males: 6.5% of combat veterans and 16.5% of non-combat veterans reported in-service or post-service sexual assault Females: 69% of combat veterans and 87% of non-combat veterans reported in-service or post-service sexual assault Combat and sexual assault are the 2 most potent predictors of PTSD

Under-reporting by victims and spouses Concern about husbands’ prospects for continued service and promotion Perceived/real lack of confidentiality and privacy Limited victim services

Under-reporting by victims and spouses Fear of retaliation and damage to their careers or being portrayed as disloyal Those who do report are often punished, intimidated, or ostracized Perpetrators of the most vicious crimes often transferred to another base or offered marriage counseling and anger management classes in lieu of more severe punishment

Under-reporting by victims and spouses < 10% of severely-abused Air Force women have reported abuse (2010) 48 % of female active duty military think abuse should be reported to commanding officer 73% of female ADM (vs. 43% of female civilians) think mandatory reporting increases women’s risk of further abuse 82% of ADM think routine screening makes women less likely to disclose abuse to a health care provider

Prosecution and Punishment Rare, Promotion not Uncommon for Perpetrators Since 1992, nearly 5000 accused sex offenders in the Army, including rapists, have avoided prosecution and the possibility of prison time

Prosecution and Punishment Rare, Promotion not Uncommon for Perpetrators 1988-1993: 80% of abusers who left the military received honorable discharges Of those who remained in the military, 54% were promoted (compared with 65% of the overall military population) Over the past 10 years, twice as many accused Army sex offenders were given administrative punishment as were court-martialed

2004 DOD Policy Review Notes Major Problems Incomplete and poorly integrated data systems and records Significant gaps in documentation of victim treatment and case disposition Inconsistent policies and procedures aimed at preventing sexual assault

2004 DOD Policy Review Notes Major Problems Many barriers to reporting, including junior personnel who were not aware of reporting options Only 20% of battered women in the U.S. seek treatment following an injury Victims’ perceived (and in some cases real) lack of privacy and confidentiality. New confidentiality provisions now in place

Iraq and Afghanistan 1/7 female veterans of these conflicts seeking medical care at the VA had suffered sexual trauma (2008 study) A deployed female soldier is more likely to be raped by a fellow soldier than killed by enemy fire

Iraq and Afghanistan Many victims did not receive basic medical care: emergency contraception rape evidence kits testing for sexually transmitted infections prophylactic treatment or testing for HIV rape crisis counseling

Iraq and Afghanistan Prosecution of crimes often delayed indefinitely Many servicewomen continued to serve in the same unit with their assailants

Iraq Disturbing reports of sexual abuse and humiliation at the Abu Ghraib and Guantanamo military prisons Five American soldiers allegedly raped and murdered a young Iraqi woman, burned her body, and killed three members of her family in their home

Recent Developments 1999: VA mandates that all veterans (male and female) be screened for military sexual trauma Compliance still low 2005: Congress establishes Sexual Assault Prevention and Response Office within the Defense Department 2008 – director ordered by DOD superiors not to testify before Congress re problems with office

Recent Developments DOD requires health care provider training on domestic violence Domestic violence advocates program and family support programs in place Utilization still low Civilian perpetrators barred from bases Military police to work with local law enforcement

Victim Assistance U.S. Army’s transitional compensation program provides financial and other benefits to the families of service members discharged for child or spouse maltreatment, including victim assistance and offender rehabilitation

Victim Assistance VA provides lifetime sexual assault victims’ counseling to all military veterans After one leaves the service Most counseled patients are males, who suffer lower rates of sexual assault but make up a large majority of veterans

Recent Developments Military Domestic Violence and Sexual Response Act Would reduce sexual assault and domestic violence involving members of the Armed Forces and their family members and partners through enhanced programs of prevention and deterrence, enhanced programs of victims services, and strengthened provisions for prosecution of assailants In House and Senate subcommittees since mid 2009

Advice for Female Armed Services Members Women on the front lines, who risk capture and being held as a prisoner of war (which puts them at even higher risk for sexual assault), should strongly consider commencing birth control pre-deployment with an intrauterine device or implant

Advice for Female Armed Services Members Victims should report abuse and consider contacting local domestic violence organizations or the Miles Foundation, a Connecticut-based advocacy group for military victims of domestic violence (telephone: 203-270-7861; Web page: http://hometown.aol.com/milesfdn/myhomepage/

Reducing Violence Against Women in the Military Change in the sexist ideologies and practices long associated with militarism and war Improvements in victim services, including enhanced confidentiality Appointment of a central authority within the DOD to investigate and prosecute violent crimes Enhanced curricular offerings to teach trainees and practicing clinicians how to recognize and manage the sequelae of domestic violence

Reducing Violence Against Women in the Military Increased funding of domestic violence shelters Laws to decrease the easy availability of firearms More funding for research, treatment, and prevention Changes in law and policy to protect victims and to improve the status of women

International Vehicles to Decrease Violence Against Women Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW): Calls for equality of the sexes in political, social, cultural, civil, and other fields

International Vehicles to Decrease Violence Against Women UN Security Council Resolution 1325: Mandates protection of, and respect for, human rights of women and girls and calls on all parties to armed conflict to take specific measures to protect women and girls from gender-based violence, particularly rape and sexual violence

International Vehicles to Decrease Violence Against Women International Criminal Court (ICC), established in 2002: Codifies accountability for gender-based crimes against women during military conflict by defining sexual and gender violence of all kinds as war crimes

International Vehicles to Decrease Violence Against Women U.S. has not ratified CEDAW, signed UNSCR 1325, nor signed on to the ICC U.S. should show its commitment to improving women's rights worldwide by taking action on these items The women and men who risk their lives in service to the ideals for which the United States ideally stands deserve no less.

Public Health and Social Justice Website Contact Information, Slide Shows, References, etc. Public Health and Social Justice Website http://www.publichealthandsocialjustice.org http://www.phsj.org martindonohoe@phsj.org