A few weeks ago, I wrote about the unintended pregnancy rate among enlisted women in the U.S. Navy, which is higher than that among civilian women. By some estimates, 75 percent of pregnancies among these sailors are unintended. Now we’re learning that across the military, sexually-transmitted infections (STIs) among servicewomen may be out of control. In fact, the STI rate among women in the military is seven times than that of the general population.
A new article published in the Journal of Women’s Health reviewed the available literature on women in the military to determine both STI rates and sexual behavior. Though research directly comparing servicewomen with the general population is slim, the literature suggests that high-risk sexual behavior is common among military women. Specifically:
- In one study, only 36 percent of sexually active unmarried active duty military women reported using condoms during last intercourse.
- In the same study, those who reported more sexual partners were more likely to use condoms at last intercourse but less likely to use condoms every time.
- A separate study of over 13,000 female Army recruits found that 27 percent of servicewomen surveyed reported more than one partner in the previous 90 days. In that group, only 17 percent reported that her partner always wore a condom.
- In another study of over 1,000 male and female Army recruits, nearly 60 percent reported having more than one sexual partner within the last year.
- That same survey found that 33 percent of female recruits reported binge drinking in the previous month, as compared to just 6 to 7 percent of women in the general U.S. population. (Binge drinking is associated with unprotected sex.)
- In another survey of over 1,800 female Marine Corps recruits, 31 percent reported having sex under the influence of alcohol or drugs in the previous three months.
Studies similarly found that rates of STIs are higher among servicewomen than in the general population, though there is very little research that offers direct comparisons. For example, the study of Marine Corps recruits found that 14 percent tested positive for chlamydia, gonorrhea, or trichomoniasis, compared to 8 percent in the non-military population during that same time. Research has also found that asymptomatic military personnel who were randomly screened for chlamydia tested positive at higher rates than the general population, while rates of HPV and HPV-related precancerous changes are also higher among servicewomen as compared to women in the general population.
The authors of the article acknowledge that mandatory screening for certain STIs such as chlamydia may account for some of the higher rates among military personnel but note that these do not explain the higher risk behaviors. “It is unknown if the military environment leads to high-risk sexual practices or if those who join the military are more likely to engage in high-risk behaviors because of demographic factors that are independent of their military status,” they write.
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The latter makes sense, as much of the research into sexual behaviors and STIs was done on recruits, suggesting that their risky behavior took place before they actually entered the military. That said, the authors write that “(Navy) women reported feeling stigmatized as promiscuous if they requested condoms and believed their male counterparts to be exempt from the same criticism. They also reported not using condoms because if found, it would be evidence that they were violating the military policy that prohibits sexual activity when deployed.”
The perception that sex is forbidden or looked down upon is common among military women. Nancy Duff Campbell, co-president of the National Women’s Law Center, which has advocated for greater healthcare rights for women in the military, said that she heard this from servicewomen in focus groups. However, the actual rules are not as strict as many women seem to think—or perhaps have been told by their colleagues or commanding officers.
In their article “Contraception access and use among U.S. servicewomen during deployment,” Kate Grindlay and Daniel Grossman note that consensual sex among members of the same rank is legal, though “the 2012 Manual for Courts-Martial United States, an Executive Order of the President that expands on the military law in the Uniform Code of Military Justice” makes sexual relationships a chargeable offense in a number of circumstances. These include adultery, cohabitation by unmarried people as husband and wife, and fraternization or wrongful personal relationships between a commissioned or warrant officer and enlisted member. These “offenses” can be punished with up to four months of confinement, dishonorable discharge, and loss of all pay and benefits.
Grindlay and Grossman conclude: “Confusion or concern about these laws might put women at increased risk of unintended pregnancy since some are led to believe that they will not need contraception for deployment and because they may be fearful of asking for contraception.”
Of course, the same behavior would also put women at risk for STIs. Nancy Duff Campbell agrees that regardless of the real rules, perception is enough to change behavior though many of the military women she had spoken to about contraception said that condoms were readily available whereas female methods of birth control were harder to come by. The presence of condoms should help prevent STIs, but only if women are comfortable taking and using them. Campbell suggested it would be important to find out whether STD rates were also higher among military men in order to truly understand what the risk factors are; is it that there is an epidemic of STIs being spread between military men and women, or are men faring better because of access to condoms and less stigmatization of their behavior?
Either way, she notes that more education about STDs, explanations of the real rules, and availability of condoms and contraception without stigma are al important for the health of our Armed Forces.