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Highlights from Fertility and Sterility: Female Veterans' High Risk of Sexual Assault Affects Fertility and Reproductive Decision-Making

May 30 , 2014
by: ASRM Office of Public Affairs
Published in ASRM Bulletin Volume 16, Number 27

Women veterans in the United States are at high risk of sexual assault throughout their lifetimes and  especially during their military service.  Exposure to sexual assault increases the likelihood that they will delay, forego, or terminate a pregnancy and may increase their risk of infertility.

In a study designed to identify the connections between childlessness and lifetime experience of sexual assault in female veterans, researchers in Iowa and Arkansas interviewed 1004 female veterans aged 20 to 52 who were enrolled at one of two Midwestern Veteran's Affairs Medical Centers or outlying VA clinics.  

Participants were interviewed by telephone, answering questions related to demographics, gynecologic history, physical and mental health history, behavior affecting their health risks, and their medical care.  

The veterans were asked about their lifetime history of exposure to attempted and completed sexual assault using the definitions adopted by the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG).   Women who had been exposed to sexual assault were asked further questions about the number times they experienced such incidents and at what time in their lives the assaults had taken place-  in childhood, in pre-military adulthood, during military service or after military service. Women who reported a completed sexual assault were asked further questions about how it affected their child-bearing decisions.

The majority of veterans interviewed (620 women or 62%) reported exposure to sexual assault during their lifetime; 33% reported exposure while in the military.  Fifty-one percent (511 women) reported a completed sexual assault in their lifetimes, with 25% of these occurring during military service.  Many of the women had been sexually assaulted during more than one period of their lives.  

Generally, women exposed to sexual assault in childhood, in the military, or post-military service were more likely to report having terminated a pregnancy compared to women who had never been exposed to sexual assault (31% vs. 19%).  While a history of pregnancy termination was not tied to a particular incident of sexual assault, the data analysis showed that women assaulted during their military service were more likely to terminate a pregnancy.

Exposure to sexual assault also had an effect on women veterans' decisions about whether or when to have a child.  Twenty-three percent who had been subjected to a completed sexual assault reported having delayed or forgone pregnancy as a result of the experience. 

Infertility was reported almost twice as often by the veterans sexually assaulted in childhood and/or in the military, compared to those who had never been sexually assaulted (23% vs. 12%).  However, of the women reporting infertility, those exposed to sexual assault were less likely to have been medically evaluated for the disease (48% vs. 64%). 

ASRM President, Rebecca Sokol, MD, MPH commented, “The degree to which women serving in our military are exposed to sexual assault is extremely disturbing.  Changes must be made in the culture to make it completely unacceptable to assault one's fellow soldier. And as the proportion of women veterans increases, the VA needs to increase the availability of medical resources supporting women's health. Reproductive health care is essential for female veterans; they need and deserve access to the best.”

Ryan et al, Voluntary and Involuntary Childlessness in Female Veterans- Associations with Sexual Assault, Fertility and Sterility, in press. 

 

ASRM is a multidisciplinary organization dedicated to the advancement of the science and practice of reproductive medicine. The Society accomplishes its mission through the pursuit of excellence in education and research and through advocacy on behalf of patients, physicians, and affiliated health care providers. The Society is committed to facilitating and sponsoring educational activities for the lay public and continuing medical education activities for professionals who are engaged in the practice of and research in reproductive medicine. www.asrm.org  


The ASRM Bulletin is published by ASRM's Office of Public Affairs to inform Society members of important recent developments. Republication or any other use of the contents of the Bulletin without permission is prohibited. To request permission to quote or excerpt material from the Bulletin, contact Sean Tipton at stipton@asrm-dc.org.   

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Sean Tipton
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Email: stipton@asrm-dc.org

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