Abstract: The Ministry of Defence (MOD) understands that a diverse and inclusive organisation is one that is stronger, healthier, more cohesive and resilient. Diversity and Inclusion (D&I) drives performance, it leads to better decision making and problem solving, increased flexibility to react to environmental changes and reduces the risks of group think, all of which are mission critical to meeting existing security challenges and threats (Defence Diversity and Inclusion Strategy, 2018-2030; Department for Business Innovation and Skills, 2013). The MOD wants to reap the benefits that a diverse workforce brings; reflect the society it serves and, in doing so, achieve its Defence Strategic Equality Objectives. However, despite continued efforts, Defence recognises that it struggles to recruit and retain people from backgrounds not traditionally associated with Defence, namely females and Black Asian and Minority Ethnic (BAME) personnel. To address this, the MOD commissioned a robust Whole Force qualitative study (unprecedented in scope and scale) to better understand the Lived Experience5 of females and BAME personnel, in comparison with white males, to inform actions to improve the representation of these minority groups across Defence.
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.