Women’s Experiences with War in Iraq & Afghanistan: Women
Veterans Coping with Combat Exposure Military Sexual Trauma
Kristin M. Mattocks1,2, Jody Sindelar3, Sally Haskell1,2,
Amy C. Justice1,2, Cynthia Brandt1,4
1Department
of Medicine, Yale University School of Medicine, New Haven, CT
2VA Connecticut Healthcare System, West Haven, CT
3Department of Epidemiology and Public Health, Yale University, New Haven,
CT
4Center for Medical Informatics, Yale University, New Haven, CT
Background: US Global War on
Terrorism (GWOT)
• Includes Operations Enduring Freedom
(OEF) and Iraqi Freedom (OIF)
• Over 1.7 million American troops have served in
OEF and/or OIF.
• 837,458 veterans have left active duty and become
eligible for VA healthcare since FY 2002
OEF-OIF Women
• Changing demographics of military
– 15% of active duty
– 17% of Guard/Reserves
– 20% of new recruits
• Over 170,000 women soldiers deployed
to Iraq and/or Afghanistan
– Many experience multiple deployments
» Gulf war women: 41,000
» Vietnam: 7,000
Women’s War-Time Experiences
• Women excluded from serving in direct
combat specialties (infantry or armor), but
serve in a variety of support positions that
place them at risk.
– Among 4243 US casualties in Iraq, 109 have
been among women.
• 61% of women’s deaths ‘hostile’ (IED, mortar
attack, small arms fire).
• Remaining deaths from injury/illness, accidents,
suicides.
Post-Deployment Coping
Mechanisms
• Literature and popular press emphasize
men’s wartime experiences and stressrelated coping mechanisms:
– Substance abuse
– Violence (domestic violence, interpersonal
violence)
– Self-injury/suicide
• Very little is known about women veterans’
experiences with war, societal re-entry and
coping with post-war stress.
Research Questions
• What are women’s experiences with war in
Iraq and Afghanistan?
• What types of post-deployment stressors
do OEF/OIF women face?
• What kinds of stress-related coping
mechanisms do women employ upon
return to the US?
Methods: Sample and Design
• Women Veterans Cohort Study
– Phase I: Administrative cohort of OEF/OIF
veterans enrolled in VA (n=452,405)
• OEF/OIF roster provided by DOD Defense
Manpower Data Center
– Those with military discharges from 10/1/200104/30/2008.
– Veterans must have enrolled for VA services to
be included on roster.
– Phase 2: Observational cohort of consented
patients in CT and IN (n=500/site)
Methods: Focus
groups/interviews
• Invited consented OEF/OIF women veterans
from CT to participate in focus groups (individual
interviews if could not attend focus group).
• Participants asked questions regarding:
– Wartime experiences
– Societal re-integration
– Stress-related coping mechanisms
• Focus groups/interviews transcribed and
analyzed using constant comparative method of
qualitative analysis.
Results
• Five focus groups (25 women)
– Age range: 23-58 (mean age: 42)
– 64% White, 20% Hispanic, 16% Black
– Education:
• 40% high school diploma
• 20% college degree
• 40% graduate degree
– Type of Service:
• 40% Reserves (Army, Navy)
• 50% National Guard (Army, Air Force)
• 10% Active Duty (Air Force)
Major Findings
• Deployment Stressors
– Mission-Related Stressors
– Interpersonal Stressors
• Post-Deployment Stressors
• Stress-Associated Coping Mechanisms
Mission-Related Stressors
– Combat Experiences
– Gender Expectations for Women
– Difficult Living/Working Environment
Mission-Related Stressors
(Combat Experiences)
“I had the unfortunate experience of
having to kill a child, an Iraqi child. Our
convoy had broken down and this kid
came running for us, he wouldn’t stop and
he was wired and it was me and my battle
buddy or the kid and they were using kids
as bait, so it was the kid that was going.”
Mission-Related Stressors
(Gender Expectations for Women)
• “Women definitely have to do twice the
work, twice as hard, and twice as often, in
order to be viewed the same. There’s an
expectation that we cannot meet the same
standards as our male counterparts.”
Mission-Related Stressors
(Difficult living/working environment)
• “We were some of the first women over there, so
they didn’t really want us mingling with the men
too much when we weren’t working because of
the potential trouble. So, instead of sleeping in
the big bay with everybody else, they made us
sleep in an old supply closet. Let me tell you, it
was awful. It was like 140 degrees in there.
There was no air to breathe, and the smell was
terrible.”
Interpersonal Stressors
– Military Sexual Trauma
– Gender-Specific Health Issues
– Leaving Children Behind
Military Sexual Trauma
• “One of the problems in Iraq for female
veterans is that there’s a lot of sexual
harassment, and rape is a problem. It
doesn’t matter if you’re 18 or 55…if you’re
there, its gonna happen to you.”
Military Sexual Trauma
• “There are so many women that are
having (MST) problems and they’re afraid
to report it because of the repercussions.
(Women) don’t have to be worried about
enemy fire…they have to worry about the
guy working next to them, you know, that’s
supposed to be protecting them and taking
care of them. He becomes Public Enemy
#1”.
Gender-Specific Health Issues
• “One of the big concerns for a lot of our ladies was…we
all had to get pap smears before we went through
mobilization. I remember almost half of our young ladies
had some kind of HPV-positive screen and were
supposed to be getting 6-month paps, but we couldn’t
get them there. A lot of the young ladies were like “I’ve
got to have a pap smear, I’ve got to get checked out. I
don’t want cervical cancer”.
Leaving children behind
• “My children were 3, 6 and 10 when I left
for Iraq for a year and a half. I had to
separate my feelings for them, because I
had a job to do. I would call but I would
not ask them too much about what was
going on in their lives because I had to
create a distance between us. It was
hard, but I had a job to do and I couldn’t
do it if I was worrying about them.”
Leaving children behind
• “I left for Iraq when my daughter was only
4 months old. I wasn’t that into being a
mother yet, so it wasn’t hard, and I knew
my mom would take good care of her
when I was gone.”
Post-Deployment Stressors
– Dealing with the aftermath of war
– Re-integration with family/friends
– Employment re-integration
– Stigma
Living with the aftermath of war
“I went to the race last weekend in Dover
and here I am sitting in this big racetrack
with thousands of people and I’m thinking
to myself this would be a perfect thing to
blow up. You know and my husband sitting
here going what is wrong with you? And I
said you know this would be a good
terrorist target, and he says will you just
shut up!”
Living with the aftermath of war
• “…but you know carcasses, the dead deer
on the side of the road still irks me, still
freaks me out, and I’m like ‘I’m coming into
that lane buddy’ because I’m not even
trying to drive by this thing cause God
knows if it’s going to blow up…”
Family Integration/Disruption
• “I returned from Iraq in March, and had
abdominal surgery just eight weeks later.
The day after I got out of the hospital, my
husband died suddenly of a pulmonary
embolism. He had taken care of our three
children for the whole year and a half I
was in Iraq, and I had no time to get to
know him again as my husband. Now he’s
dead and I’m lost.”
Re-integration with friends
“My friends really didn’t understand. I don’t talk
to a lot of them anymore only for the fact was I
think when I went away in their minds it was
almost like ‘well she’s not talking to me anymore
so I’m not going to talk to her’ . So we lost
communications while I was over there and I
took it as ‘well if you don’t want to talk to me
while I’m getting shot at and in a combat zone, I
don’t want to be your friend’.”
Friendships
“(Talking about) treating people that have
been blown up and all that, is not that
relatable of an experience to most people
you meet in Connecticut.”
Employment Problems
“(After Iraq) I kept on quitting my jobs and
you know (I had) violent attacks of anger
and you know I’m just screw you and the
horse you came in on, I’m quitting, you
quit in a second and you’re like okay now
what do I do to pay the bills?”
Stigma as a woman/mother
soldier
• “It wasn’t easy for my husband (when I
went to Iraq). He wanted to trade places
with me. All of our friends thought that
since he was the man, he should be out
fighting wars and I should be home taking
care of the children. Some people I know
seemed angry because I left my children
for a year, even though their father was
the one caring for them.”
Stress-Related Coping
Mechanisms
– Overeating/Isolation
– Exercise
– Excessive spending
Stress-Related Coping
Mechanisms: Overeating
“When the depression hits I just go to the
grocery store and I go when there’s no
crowds, I go when it’s supposed to open
cause I don’t like crowds. But I buy
whatever I want to and then I sit on the
couch and eat chocolate. I buy enough to
last me the week.”
Stress-Related Coping:
Overeating and Isolation
“I put on about twenty pounds when I
came back. But I think mostly it’s cause I
would isolate myself. You know, I don’t
want to be around people, I don’t want to
hear the stupid stuff they’re talking about,
you know? I would eat and then I would
just isolate myself. ”
Stress-Related Coping:
Shopping/Gambling
• “My thing is I like to go to the casino by myself. I
can be there for eight hours by myself and I
don’t hear anyone, I’m anonymous, no one
knows who I am, I’m just another person playing
a slot machine. I can go shopping, I like to go
shopping by myself, but I have no concept of the
money I spend…I’m really into the instant
gratification.”
Stress-Related Coping
Mechanisms: Exercise
“You know they always taught us to
exercise. So I would like exercise to
excess and really to excess to the point
where I would be sick. Exercise was my
addiction and I was constantly throwing
up. I don’t know what that was about…I
got super skinny.”
Conclusions
• Women experience significant war and
post-deployment stress
– Combat experiences
– Gender expectations
– Military sexual trauma
– Gender-specific health concerns
– Re-integrating with family and friends
– Employment
Conclusions
• Women use a variety of stress-related
coping mechanisms:
– Overeating/Isolation
– Exercise
– Excessive spending
• No mention of substance abuse or
violence to date.
• Women veterans display incredible
resilience and dedication to their country.
Research and Policy
Implications
• The VA must continue to tailor its services to the
needs of women veterans, who experience
significant war and post-deployment stress.
• More research is needed to investigate the
impact of military and post-deployment stress on
women’s health.
• VA should collaborate with state agencies
(Departments of Public Health, Departments of
Veterans Affairs) to ensure women veterans are
receiving needed health services.
Final Thought
“I really think it’s important as women
veterans to share our experiences. I think
we generally learn a lot from each other in
conversation and have great experience
and knowledge to share, so I for one am
more than willing and really would love to
see there be more follow up and more
connection between us.”