Defense Women's Health Research Program (DWHRP)
This Congressional Special Interest (CSI) Medical Research Program is currently not active and for information purposes only.
The Defense Women’s Health Research Program (DWHRP), a special Congressional appropriation in FY94, provided the opportunity to close the gap between men and women in military operational medicine research. Comprising nearly 14% of the U.S. military force, women experience several gender- and task-specific health related problems that can adversely affect performance. The DWHRP focused on several research areas in order to directly address these problems. Funds were distributed to 100 intramural projects and to complementary research in 27 extramural grants. Funds were also used to develop an innovative knowledge management system for the Defense Women’s Health Information Clearinghouse, several conferences, and Institute of Medicine reviews. Findings from the research promoted through this initiative have had far-reaching effects on policies and products that will provide health and performance benefits to servicewomen.
Upper Body Strength Mismatched to Equipment and Tasks
Research Problem: Studies showed that women lacked the required strength to lower landing gear and activate ejection seats, were slowed by ladder rung spacing while performing emergency damage control tasks onboard ships, and had impaired optimal performance due to personal equipment design.
Medical Research Solution: Biomechanical and training studies resulted in strategies to overcome strength limitations through improved equipment design, the identification of modes of failure and injury, substantial improvements in the ability to accomplish strength demanding tasks through training, definition of muscle changes for different types of training, and demonstrated that only task specific tests accurately reflect improved job capabilities.
High Rates of Musculoskeletal Injury, including Stress Fracture
Research Problem: Servicewomen in initial entry training have twice the rate of musculoskeletal injuries. Presently, stress fracture incidence rates for the US Army range from 3.4 – 21.0% for women compared to 0.9 – 5.2% for men in recruit training.
Medical Research Solution: New information about stress fracture occurrence, risk factors, and possible predictive methods based on bone geometry, calcaneal bone mineral density, total bone mineral density, and gene mutations has been gained from recent research. These studies included evaluating exercise to increase bone mineral density and treatment of pelvic stress fractures with electromagnetic fields. The research findings gave impetus to the current Bone Health and Military Medical Readiness Research Program .
Stress of Military Life Related to Attitudes and Social Roles
Research Problem: Sexual harassment rates are higher in Army units with fewer women and increased Soldier stress levels. These units had lower scores for unit readiness and poor scoring on acceptance of women. Several studies, examining external factors and personality characteristics that contribute to job satisfaction, mental health, and retention in the military, found that nearly half the women in each of three service studies reported premilitary unwanted sexual contact or sexually-related traumas; this was the greatest risk factor for development of posttraumatic stress symptoms. Female Soldiers who reported childhood abuse were twice as likely to experience in-military physical and sexual violence.
Medical Research Solution: Mixed gender units were studied to evaluate the effects of command climate, attitudes toward pregnancy and unit cohesion. One study demonstrated that the psychological health of the mothers and birth outcomes were correlated to supportive work environments. Group work was also examined to determine how mixed-gender crew configurations may influence communication and performance in combat control center simulations. New information obtained from a major conference and review of available data synthesized current knowledge on stress and military women, providing timely data for several commissions considering solutions to military gender integrations issues.
Personal Readiness Standards to be Based on Female Physiology
Research Problem: Half of pregnant Soldiers failed to return to their prepregnancy fitness levels 6-9 months postpartum, at least one third were overfat, and postpartum Soldiers were four times more likely to fail the APFT at their first postpartum fitness test compared to nonpregnant female Soldiers, supporting the need for a mandatory, graded postpartum PT program specifically targeting this population.
Medical Research Solution: New information on pregnancy-induced changes in body composition and physical fitness from a comprehensive study produced new data on postpartum return to duty readiness. The data supported the need for a mandatory, graded postpartum PT program specifically targeting this population. The Institute of Medicine developed recommendations for readiness standards, integrating nutrient and energy requirements of servicewomen, existing fitness standards, and special factors such as pregnancy and lactation. Several studies of menstrual cycle effects on physical and cognitive task performance documented a lack of important effects of this variable.
Enhancement of Performance Limits in Extreme Environments
Research Problem: Physiological limits, and interventions to extend the limits in operational environments, have been studied almost exclusively in males. There is a need to understand if there are gender-specific performance limits in extreme environments.
Medical Research Solution: Studies that examined energy metabolism and disruption of reproductive hormone secretion in scenarios with high energy expenditure and limited food intake confirmed the effectiveness of performance-enhancing drugs. These included caffeine and amphetamine for monotonous tasks and use after sleep deprivation, and using bright light and melatonin resynchronization of biological rhythms following deployment across time zones. Studies of the reduced female metabolic response to cold and menstrual cycle effects has showed the importance of menstrual phase in predicting thermal responses to exercise. Sex hormones had minimal effects in studies of estrogen on heat transfer or evaporative cooling, and progesterone on ventilatory drive and acclimatization for women in their luteal phase ascending to high altitude.
Personal Equipment Designs to Female Body Type and Physiology
Research Problem: Military equipment and materiel design considerations need to address female anthropometrics and physiology.
Medical Research Solution: Anthropometric studies led to modifications of female aviator clothing and improved cockpit compatibility. Studies of moisture vapor transmission rates for garments worn by men and women showed lower skin wettedness in women and a smaller effect on body cooling. Gender differences in G-force endurance disappeared when the standard anti-G suit was modified for a best fit for females. Fatigue and injury criteria appropriate to the thinner female neck were developed for helmet-mounted equipment. Female vibration exposure criteria were developed to optimize aircraft and vehicle seat cushions, showing that low frequency vibrations are especially fatiguing to women.
Gynecological Health Care in Military Deployments
Research Problem: Infections of the vaginal tract are not given priority among infectious diseases of military importance, yet these can have a significant impact on readiness, impair a woman’s reproductive health and fertility, and have even been cited as reasons why women should not serve in the field.
Medical Research Solution: Studies of infection prevalence and better diagnostic and treatment methods found that 40% of patients in Army STD clinics tested positive for Mycoplasma genitalium-specific antibodies–suggesting rates 4-5 times higher in women than men; and identified high rates of chlamydia (9.2%) in female recruits–suggesting cost effectiveness of screening for asymptomatic recruits. Other studies explored new drug treatments for Candida yeast infections, a prototype vaccine for toxic shock syndrome, effect of bacterial vaginosis on adverse pregnancy outcomes, and mucosal immune responses in the female genital tract which may be important in transmission of HIV.
Clinical Causes of Performance Impairment for Servicewomen
Research Problem: Clinical issues translate into important performance limiters for military women. Most active duty debilitating headaches such as migraine occur in women.
Medical Research Solution: Premenstrual syndrome studies identified aggravating factors and tested treatments including sertraline and biofeedback training. One third of female Soldiers reported urinary incontinence during exercise and field training, restricting fluids to reduce these problems; urethral biofeedback and pelvic muscle exercises were shown to be useful treatments. Many women developed transient anal incontinence after pregnancy, some symptoms not diminishing for over 6 months. Other studies included improved diagnostic algorithms for chest pain in young women, treatments for severe breast pain (mastodynia), and assessment of health care delivery to military women with endocrine deficiencies.
Prevalence and Causes of Injuries and Illnesses
Research Problem: Psychiatric and stress-related hospitalizations, attrition, and sick call rates are higher in military women than men, not simply due to gynecologic or obstetric care. Factors may include administrative policies, selection criteria, and a greater tendency for women to seek medical care when ill.
Medical Research Solution: Ongoing research and the Defense Medical Epidemiological Database, which continues to consolidate databases across services for medical surveillance, will address medical health issues. A unique composite database (TAIHOD) linking data from diverse Army sources found that female light-wheeled vehicle mechanics have the highest rate of musculoskeletal hospitalizations, and female parachutists have a high incidence of injury attributable to their landing falls. Other epidemiologically-based studies of risk behaviors considered approaches to behavioral interventions to prevent female smoking relapse and unintended pregnancy, and examined delivery of health care to women during the Gulf War deployment.
Protection for Women of Childbearing Age to Military Occupational Hazards
Research Problem: Ten percent of female Soldiers are pregnant at any given time. Occupationally, servicewomen or their developing fetus may be exposed to multiple health hazards, including toxic chemicals, prophylactic drugs, vibration, ionizing radiation, and electromagnetic fields.
Medical Research Solution: Properly identified hazards can be eliminated or protected against when women are warned about exposure risks. Birth outcomes within occupational specialties revealed no specific job associations as shown in a study of pregnant women exposed to the anti-malarial drug mefloquine in the Somalia deployment whose newborns had no gross malformations resulting from this drug. Other studies included: a pregnancy-safe antibiotic (azithromycin) for effectiveness in protection against malaria and treatment of typhus; the basis of female attractiveness to malarial mosquitoes to improve protective strategies; and, the discovery of the basis for increased malaria susceptibility in first pregnancy women, suggesting an approach to an effective vaccine. Validation tests were conducted for a bioassay-based developmental toxicity screen, and a large animal study confirmed the absence of injury to reproductive organs following blast exposures typically encountered in field artillery. Reproductive outcomes in flight attendants continue to be studied to assess the importance of ionizing radiation exposure at high altitude.
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[Download Health & Performance Research for Military Women: The 1994 Defense Women’s Health Research Program (DWHRP94)]
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