Acceptance matters: Disengagement and attrition among LGBT personnel in the U.S. military
Abstract: The U.S. military has undergone several changes in policies toward lesbian, gay, bisexual, and transgender (LGBT) service members over the past decade. Some LGBT service members report continued victimization and fear of disclosing their LGBT identity, which can affect retention of LGBT personnel serving in the military. However, there is little research on this population. This study uses data from a survey funded by the U.S. Department of Defense (2017-2018) and completed by 544 active-duty service members (296 non-LGBT and 248 LGBT) to better understand the career intentions of LGBT service members. Of transgender service members, 33% plan to leave the military upon completion of their commitment, compared with 20% of cisgender LGB and 13% of non-LGBT service members. LGBT service members were twice as likely as non-LGBT service members to be undecided as to their military career path. Lower perceived acceptance of LGBT service members in the workplace was associated with a higher risk of leaving among LGBT service members. Lower perceived unit cohesion was associated with attrition risk for all members, regardless of LGBT status. These findings suggest that the U.S. military can do more to improve its climate of LGBT acceptance to prevent attrition.
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.