Abstract: The analysis presented in this report pertains to the third Cobseo Members survey, undertaken in May 2021, which builds on evidence from the May and October 2020 Members’ surveys. The results presented in this report provide a comparison between results obtained over all three surveys to help chart the evolving impact of the pandemic on Cobseo Members as they continue to serve beneficiaries under challenging circumstances.As noted in the first Members’ survey of May 2020, qualitative responses combined with figures appear to show a notable difference between Members who are delivering front-line services, compared with organisations who are not direct service delivery organisations. While only 18% of all respondents reported a risk of beneficiary need/ numbers being unmanageable within one-year, there is clearly increased demand for mental health and wellbeing services, which require front-line delivery and continued cash-flow to support. This area has the potential to see further increase in need as the pandemic continues to bear on individual’s mental wellbeing. Additionally, those unable to access stretched services now, may present later with more complex and compounded needs, further stretching services. DSC recommends close monitoring of the current situation with Members providing frontline services, particularly for mental health and wellbeing, to develop a detailed understanding of funding and service delivery challenges with which to inform policy efforts.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.