Voluntary and involuntary childlessness in female veterans Associations with sexual assault

Capsule:
Female veterans are at high risk of sexual assault in their lifetimes, which may increase their risk of infertility and the chance they will delay, forego, or terminate a pregnancy.

Authors:
Ginny L. Ryan, M.D., M.A., Michelle A. Mengeling, Ph.D., Brenda M. Booth, Ph.D., James C. Torner, Ph.D., Craig H. Syrop, M.D., Anne G. Sadler, Ph.D., R.N.

Volume 102, Issue 2, Pages 539–547

Abstract:

Objective:
To assess associations between lifetime sexual assault and childlessness in female veterans.

Design:
Cross-sectional, computer-assisted telephone interview study.

Setting:
Two Midwestern Veterans Administration (VA) medical centers.

Patient(s):
A total of 1,004 women aged ≤52 years, VA-enrolled between 2000 and 2008.

Intervention(s):
None.

Main Outcome Measure(s):
Sociodemographic variables, reproductive history and care utilization, and mental health.

Result(s):
A total of 620 veterans (62%) reported at least one attempted or completed sexual assault in their lifetime (LSA). Veterans with LSA more often self-reported a history of pregnancy termination (31% vs. 19%) and infertility (23% vs. 12%), as well as sexually transmitted infection (42% vs. 27%), posttraumatic stress disorder (32% vs. 10%), and postpartum dysphoria (62% vs. 44%). Lifetime sexual assault was independently associated with termination and infertility in multivariate models; sexually transmitted infection, posttraumatic stress disorder, and postpartum dysphoria were not. The LSA by period of life was as follows: 41% of participants in childhood, 15% in adulthood before the military, 33% in military, and 13% after the military (not mutually exclusive). Among the 511 who experienced a completed LSA, 23% self-reported delaying or foregoing pregnancy because of their assault.

Conclusion(s):
This study demonstrated associations between sexual assault history and pregnancy termination, delay or avoidance (voluntary childlessness), and infertility (involuntary childlessness) among female veterans. Improved gender-specific veteran medical care must attend to these reproductive complexities.

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