Military Service, Combat Experience, and Civic Participation
Abstract: Military service is a highly social—and potentially socializing—experience. However, the long-term social effect of military service is a little-studied topic, and some have dismissed any direct impact of service on civic participation. Using data from a large, national survey, our estimates show, in contrast, that the likelihood and intensity of group participation is higher among veterans than other men and that combat veterans have the highest level of participation. Mettler argued that education funded through the GI Bill gave veterans both resources (“civic capacity”) and a desire to reciprocate to society (“civic predisposition”) for the generous benefits they received, but she did not allow for the possibility that service itself could also increase both civic capacity and predisposition. Furthermore, our estimates confirm that education is strongly associated with higher civic participation and that the association between military service and participation is largely independent of education.
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.