Mind the gap: Sex, Gender, and Intersectionality in military-to-civilian Transitions
Abstarct: The authors conducted a review of existing research on sex, gender, and intersectionality in relation to military-to-civilian transition (MCT). Extensive international studies and government resources, mostly from the United States, provide insight into the potential vulnerabilities and challenges encountered by historically under-represented military members and Veterans during MCT (i.e., by women, lesbian, gay, bisexual, transgender, and other sexual or gender minority, Black, Indigenous, and People of Colour military service members and Veterans). The reviewed sources also highlight government initiatives and tailored programs that exist internationally to address diverse Veteran needs. Canadian research and government initiatives on the topic are limited, and this gap needs to be kept in mind. To support equitable transition outcomes for all Veterans, research as well as policies, programs, and supports need to pay attention to sex and gender as well as intersecting factors such as sexuality, race, Indigeneity, and more.
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.