There are more opportunities for women to serve in military service roles than ever before, and the number of female service members in their reproductive years is increasing. There were approximately 203,000 (or 14.5%) women in the armed forces in 2011, with roughly 74,000 serving in Army, Navy, and Marine Corps. With the increasing role of women in the military, optimization and individualization of medical services are required to ensure that this population is medically ready. 2 The basic components of women’s health care, including contraceptive counseling and provision, and cervical cancer screening, have a high potential impact on individual and organizational readiness.
Providers working in military units or troop-based medical facilities provide first-line care to troops and their families. This includes preventive and routine health services. These providers could be nurse practitioners, physician assistants, specialists, or subspecialty-trained physicians, or general medical officers who have completed an internship or transitional year. These providers are often the only available health care provider for female service members. Their knowledge and skills in female health directly impact this aspect of service member health and medical readiness.
We wanted to assess the knowledge, skills, and practices of some of these first-line healthcare providers about women's health, and reproductive health. The core transitional internship requirements have been standardized across military services by the Accreditation Council for Graduate Medical Education (ACGME). Our study findings can be used to guide and refine future educational opportunities for this population. Our objective was to assess women's reproductive health knowledge, skills, and practice among medical officers in the Army Navy and Air Force whose only postgraduate training was a one-year internship.
The survey provided information about basic medical skills and practices related to women's health, as well as the knowledge and skills of transitional intern-trained medical officers from the Army, Navy, Air Force. Nearly all of the respondents said they provide medical care for reproductive-aged women in their medical settings, but the provision of basic reproductive healthcare (chlamydia, contraceptive counseling, and cervical cancer screening) was not consistent. A fair number of providers stated that they didn't offer contraceptive counseling/services or chlamydia screening in their practices. Respondents felt more comfortable talking about less effective and user-dependent contraceptive methods such as the combined pill patch or ring when they were offered.
We are less comfortable talking about the more effective and longer-lasting methods (copper, LNG-IUDs, contraceptive implants) and emergency contraception. LARC contraceptive methods were not used by more than half of the respondents. Respondents who were trained in LARC methods of contraception were more likely than those who had been taught to use them. LARC methods offer many non-contraceptive benefits, such as high reliability, cost-effectiveness, and are not dependent on the user. Recent cost-analysis models have shown the economic benefits LARC can have on the military's health care system, preventing unintended pregnancies.
Unintended pregnancies are a problem in the United States. Recent studies have shown that unintended pregnancies are up to 50% more common in military women. Unintended pregnancies can occur at any rank, but it is more common in younger and single women who have less education and are in lower ranks. Unintended pregnancy can have many negative consequences for female military personnel, their families, and the military establishment. Contraceptive and reproductive counseling are essential components of every medical visit and medical readiness assessment. At a minimum, routine health assessments should include a review of all pertinent preventative and reproductive health screening (such as cervical and breast cancer and sexually transmitted infection screening, screening for intimate partner violence, and sexual assault), family planning, and contraceptive counseling/provision, and anticipatory and educational guidance.
Recent studies show that women serving in the military have free access to contraception. This includes LARC methods. However, there are some barriers to this access. Predeployment readiness physicals did not include contraception and menstrual suppression counseling for many women. Predeployment counselors may have been confused by past policies that defined acceptable and unacceptable sexual behavior in deployed environments. Others reported obstacles to contraceptive access during deployments, such as limited access or limited supplies. Contraception options must be discussed and documented at routine medical visits.
Certain contraceptive methods may have non-contraceptive advantages that might be especially suitable for female service members. LARC methods are highly effective contraceptives that require minimal monitoring or follow-up. They can also be used to suppress menstrual flow. These non-contraceptive benefits are ideal for female service personnel serving in areas that have limited access to medical care.
The importance of our respondent group is that it provides a sample of first-line medical care for service members. This provider group is crucial in ensuring their medical readiness. Given the increasing number of female military service personnel and their expanding role, reproductive health is crucial. Unintended pregnancy, sexually transmitted diseases, and other reproductive health issues can hurt the mental and physical readiness of both the individual and the organization. To effectively provide first-line medical care for service members, the individuals must have knowledge and skills in the areas of women's health and reproductive health. This will allow them to meet military-strategic readiness goals.
There were many strengths to our study. Our study sought to determine the knowledge and practices of first-line health care providers for service members. Our target population is a great way to understand the first-line service member care and our survey population has all undergone comparable postgraduate medical training in an ACGME-accredited program. We believe the results of our target population offer a valuable insight into the strengths and weaknesses of the reproductive health care offered to female service members. The responses also provide concrete information that can be used to standardize and shape future training to improve the quality of first-line care for female service members. We were able to assess current knowledge and practices in reproductive health care. Based on the training cycles and other obligations, we believe that we have a fair sample of the military's targeted physician pool.
Our study had limitations due to its small sample size and 55% response rate. There is also the possibility of recall bias and non-response bias. Two programs declined to participate or did not respond, which decreased the potential number of subjects and excluded graduates from these programs. There are many types of health care providers that can provide first-line care for female service members. These include primary care providers, transitional year interns, general medical officers, nurse practitioners, and medical officers who have completed full or partial medical specialty training. The study was conducted on medical officers/physicians who had only completed a transitional-year internship. This may have led to our findings not reflecting the standard reproductive health care knowledge and skills of these health care providers. Additional studies will be conducted to assess the reproductive and female health care practices of these doctors.
Although this was a small study, the overall results highlighted areas where providers perform well and areas that could be improved in the training of transitional-year physicians. We recommend standardizing women's health training, which includes contraceptive counseling and provision (to include LARC) and basic reproductive health screening tests knowledge and performance. A better women's health education could directly impact the female service personnel these officers will eventually serve and contribute to unit operational readiness.
The primary provider of medical care for military personnel is the unit, troop, or ship-based provider. Because of the variety of practice settings and access to non-emergent specialty care, as well as the importance of reproductive health for individuals and military readiness, all first-line healthcare providers must be proficient in the basic principles of female reproductive health care. Reproductive health is directly linked to the medical readiness and military organization of female service members. First-line health care providers must be comfortable talking about reproductive health. Individual readiness is directly tied to organizational readiness. This makes it important that first-line health care providers are well trained and comfortable discussing reproductive health issues.
Our study shows that there are opportunities to improve the provision of reproductive health services to female service members at the primary point of care, at least in the subset we studied. This includes providing basic screening services and regular or routine reviews of your reproductive health. Other considerations include standardizing and reviewing the training available for basic reproductive health care services at first-line care sites, as well as improving access to specialist providers via remote consultation or direct
Sources:
https://eurekamag.com/research/065/705/065705711.php
https://www.nychealthandhospitals.org/coneyisland/transitional-year-program/
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