1. Violence Against Women in the Military Martin Donohoe

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

3. 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

4. Increased Attention  1991 - Tailhook Scandal: >100 officers at a Navy convention sexually assaulted and harassed dozens of women (none convicted) >100 officers at a Navy convention sexually assaulted and harassed dozens of women (none convicted)  1996: Sexual assaults at Aberdeen Proving Ground in Maryland led to charges against a dozen Army drill instructors several officers reprimanded several officers reprimanded  Homicides by returning vets

5. Women in the U.S. Military  More than 210,000 women are on active duty  1.8 million female veterans (out of 23 million total veterans)  Almost 60,000 female troops have been deployed in Iraq and Afghanistan 1 in 7 US military personnel in Iraq is female 1 in 7 US military personnel in Iraq is female

6. Victims  Active duty troops Army > Marines > Navy > Air Force Army > Marines > Navy > Air Force A deployed female soldier is more likely to be raped by a fellow soldier than killed by enemy fire A deployed female soldier is more likely to be raped by a fellow soldier than killed by enemy fire  Female, civilian spouses of active duty personnel

7. Epidemiology of Abuse  15-35% of active duty women  25-85% of female veterans  Most cases unreported  Female on male violence more common than in general population  Violence against LGBT members Repeal of “Don’t ask, don’t tell” may change this (?) Repeal of “Don’t ask, don’t tell” may change this (?)

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

9. 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 Rate 2-3X higher than that for non- PTSD veterans and non-PTSD civilians

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

11. Victims More Likely to Report  Chronic health problems  Poorer self-rated health status/quality of life  More outpatient visits  Depression (3X higher rate)  Alcohol abuse (2X higher rate)

12. Victims  History of childhood violence and post-military violence more common  High levels of secondary victimization  Risk of PTSD after sexual assault similar in both female and male veterans to that seen following high levels of combat exposure

13. 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

14. 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 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

15. 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 Many received honorable discharges, promotions Many received honorable discharges, promotions

16. Recent Developments  1999: VA mandates that all veterans (male and female) be screened for military sexual trauma Compliance still low 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 2008 – director ordered by DOD superiors not to testify before Congress re problems with office

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

18. Recent Developments  Military Domestic Violence and Sexual Response Act Enhanced prevention, deterrence, and victims’ services programs Enhanced prevention, deterrence, and victims’ services programs Strengthened provisions for prosecution of assailants Strengthened provisions for prosecution of assailants In House and Senate subcommittees since mid 2009 In House and Senate subcommittees since mid 2009

19. 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

20. 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/myhom epage/ http://hometown.aol.com/milesfdn/myhom epage/ http://hometown.aol.com/milesfdn/myhom epage/

21. References  Donohoe MT. Individual and societal forms of violence against women in the United States and the developing world: an overview. Curr Women’s Hlth Reports 2002;2(5):313-319.  Donohoe MT. Violence and human rights abuses against women in the developing world. Medscape Ob/Gyn and Women’s Health 2003;8(2): posted 11/26/03.  Donohoe MT. Violence against women: Partner abuse and sexual assault. Hospital Physician 2004;40(10):24-31.

22. References  Donohoe MT. War, rape and genocide: Never again? Medscape Ob/Gyn and Women’s Health 2004;9(2): posted 10/22/04.  Donohoe MT. Violence against women in the military. Medscape Ob/Gyn and Women’s Health 2005;10(2): posted 9/13/05.

23. Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org