“Even If the Policy Changes, the Culture Remains the Same”: A Mixed Methods Analysis of LGBT Service Members’ Outness Patterns
Abstract: Despite repeal of the Don’t Ask, Don’t Tell policy in 2011 and the ban on open transgender service from 2016 to 2019, lesbian, gay, bisexual, and transgender (LGBT) service members may be reluctant to disclose their identities to fellow military personnel. This study used data collected through the Department of Defense–funded mixed methods research study conducted from 2016 to 2018. A sample of 248 active duty LGBT service members completed a survey, while a sample of 42 LGBT active duty service members participated in an in-depth interview. Regression analyses tested for differences in outness by demographic and military traits; a thematic analysis of qualitative data contextualizes these findings. Outness to fellow service members varied greatly by rank, military branch, education level, sexual orientation, gender identity, and marital status. The lowest outness was to chaplains (38%), while the highest outness was to LGBT unit friends (93%). Implications for military leadership and service providers are discussed.
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.