Air Force Women Surveyed Report Health Challenges During Gulf Service

Air Force Reserve Col. Penny Pierce, a flight nurse who served six months in Saudi Arabia during the Gulf War, was one of 30 speakers at a recent Health Issues of Military and Veteran Women symposium at the Military Women's Memorial at Arlington National Cemetery.

During her presentation, "Deployment Considerations of Military Women," Pierce discussed findings from her recently concluded 10-year health surveillance study of 521 Air Force women who had served in the Gulf region during Operations Desert Shield and Desert Storm.

"One of the things we wanted to do was just to document and describe those physical and emotional health effects of women who served during that time," Pierce said, noting little official research was available on how deployments affect military women before her survey.

Pierce said her findings also helped researchers to determine how the women's families fared following deployment, specifically their dependent children.

Although a lot of strides have been made in addressing military women's health issues in the past decade, her survey indicates that more work remains, she said.

An associate professor of nursing at the University of Michigan's School of Nursing, Pierce noted that survey answers and written comments reveal several gender-specific health challenges women faced once they reached the Persian Gulf.

Those concerns, she noted, included inadequate field latrines, a shortage of physicians knowledgeable about women's health concerns, local clothing customs that caused great discomfort among women and, not unexpectedly, concern for children back stateside.

"Even despite some of the reported difficulties women have had, the singular message they want to convey -- that they asked me to convey -- is that they are proud to serve, they want to serve -- despite everything," Pierce emphasized.

The colonel said survey respondents pointed out that most field latrines they encountered offered little or no privacy. Some had barriers to screen users, but respondents noted that most were inadequate. The situation embarrassed many of the women and caused them to endanger their health, she noted.

Women aviators and other aircrew members, she said, were especially peeved. They had to pull down their flight suits while using latrines and that required them to disrobe in plain sight of the men, she said.

Because of the lack of privacy and routine long lines to use latrines, Pierce said many women surveyed reported holding off and waiting for less crowded moments at the latrines. That practice leads to urinary tract infections, which women report often while on field operations, she pointed out,

Pierce noted bottled water was plentiful in the hot Gulf climate, but the Air Force women said they limited their water intake to delay trips to the latrine. Many women became dehydrated as a result, she said.

Health care for women was another hot topic, Pierce said, noting that having "timely gender-specific health care in deployed locations is probably the most important thing" the women cited in the survey. Respondents noted that most health care providers they encountered were not physicians, but male medics who knew little of female health concerns.

As a consequence, Pierce pointed out, many respondents said they simply put off addressing health issues until they could see a doctor -- preferably a woman. The Air Force women, she added, also cited the scarcity of female physicians in the Gulf.

Skin infections caused by continual wearing of full field uniform outside in the hot climate was another issue cited, Pierce said, noting that American service women had to be fully clothed when outside to comply with local cultural concerns.

"In Saudi, women couldn't take their shirts off, like men, to get cool; we (also) had to keep the long sleeves down because of the culture," she explained.

Turning to "home front" issues, Pierce noted that Air Force women deployed to the Gulf who had children back home had more emotional worries than women - and men -- without children.

Pierce noted that differences between women and men should be leveraged rather than magnified in order to make the U.S. military stronger and more efficient. Information provided by long-term studies like the Air Force women's deployment survey, she added, can help to make that so.

"The take-away message, I think, from the subjects in my study the past few years is they are proud to serve their country," Pierce said, noting that military women comprise about 15 percent of the active duty force.

Military women are proud of their service and "don't want to come across as complainers," Pierce said. However, she emphasized that the Gulf War survey of Air Force women illustrates genuine concerns.

"We want to speak to the data," Pierce explained. "The more research that we do where we have quality data, then we can make quality policy decisions that best support women in military service.

"Perhaps that's what we need to listen to," she continued. "How can we help women perform their duties, stay committed to a military career, do their job, without the barriers and hindrances that we currently put in their way?"

Army Dr. (Lt. Col.) Elspeth Cameron Ritchie, the program director for women's health issues within the Office of the Assistant Secretary of Defense for Health Affairs, was a major organizer of the symposium. A military psychiatrist, she agreed that Pierce's work raised significant concerns of deployed women.

"We have been attempting to make headway in this arena," Ritchie said. "There are now a number of pamphlets and other resources of information to teach both women and the chain of command about the importance of personal hygiene, adequate hydration, private latrines, and other methods to reduce infections."

She said important research is now ongoing within DoD regarding the provision of adequate latrine facilities for all deployed troops. She noted that ongoing research efforts outside DoD are examining the development of kits to self-diagnose and treat urinary tract infections.

Still, field hygiene is a leadership issue, Ritchie said. "Women usually will not complain, but they may vote with their feet and get out," she remarked.