Women have served in the military since the American Revolution1 with the stipulation they not be assigned to ground combat units (e.g., the infantry, special operations commandos, tank crews). Things began to change, and in the 1990s, Congress lifted the ban on women flying combat aircraft and serving on combat ships. Today, women soldiers in Iraq and Afghanistan are serving in support units as truck drivers, mechanics, medics, military police, helicopter pilots, and so on. About 180,000 (14% of total soldiers deployed) women soldiers are deployed in Iraq and Afghanistan.2 However, warfare in Iraq and Afghanistan includes improvised explosive devices, mortar attacks, suicide bombs, and rocket-propelled grenades. Both frontline and support units find themselves under attack and in battle because of this guerrilla warfare. Combat-related traumas include being shot at or ambushed, being wounded or injured, knowing someone who was seriously injured or killed, and taking care of the wounded and dead. Women soldiers are increasingly among the wounded and killed in combat. As of February 2010, 658 women soldiers have been wounded in action and 124 killed in action.3,4
In addition to combat events, female soldiers are exposed to sexual assault and other military sexual traumas, as are male soldiers. Data from the U.S. Department of Veterans Affairs (VA) universal screening program, which asks all veterans receiving care at the VA whether they experienced sexual trauma during their military service, indicates about one in five women (20%) and one in one hundred (1%) men responded "yes."5 The term military sexual trauma (MST) is defined by the Department of Veterans Affairs6 as "sexual harassment that is threatening in character or physical assault of a sexual nature that occurred while the victim was in the military, regardless of geographic location of the trauma, gender of victim, or the relationship to the perpetrator."
Among traumatic events, rape and combat exposure pose the highest risk for development of post-traumatic stress disorder (PTSD).7,8,9 Kang and colleagues10 reported sexual assault and harassment during military service continued to be associated with PTSD in both female and male veterans even after controlling for combat exposure. They reported the risk of developing PTSD associated with MST at 5.41 and the risk associated with high combat exposure at 4.03 for female veterans. For males, these numbers were 6.21 and 4.45, respectively. These findings suggest sexual assault by another soldier is the greater contributor to PTSD. For women, serving in a war zone can be particularly risky. Women soldiers have to deal with combat trauma and the potential for sexual assault.
What are the types of violence endured by women in uniform? In 2009,11 3,230 military sexual assaults were reported, an increase of 11 percent from fiscal year (FY) 2008. The 2006 Gender Relations Survey of Active Duty Members12 defines unwanted sexual contact as sexual touching (i.e., intentional touching of genitalia, breasts, or buttocks), sexual intercourse, oral or anal sex, or penetration by a finger or object. Among active duty women and men completing the survey, 7% and 2%, respectively, experienced unwanted sexual contact. Unwanted sexual touching was the most frequent MST experienced by women (78%), followed by attempted sexual intercourse (41%), completed sexual intercourse (17%), attempted oral sex, anal sex, or object penetration (24%), and completed oral sex, anal sex, or object penetration (17%). Among men experiencing unwanted sexual contact, 66% reported unwanted sexual touching; 27% attempted and 12% completed sexual intercourse; and 26% attempted and 12% completed oral sex, anal sex, or object penetration. Sexual harassment is defined as crude/ offensive behavior, unwanted sexual attention, and sexual coercion, and was reported by 34% of the women and 6% of the men completing the Gender Relations Survey of Active Duty Members. Fifty-two percent of these women reported crude/offensive behavior, followed by unwanted sexual attention (31%) and sexual coercion (9%). Female gender clearly confers a greater risk for sexual trauma during military service;13 thus, this chapter will mainly focus on women soldiers.
What about women soldiers in combat situations? Combat areas of interest where women soldiers have served include Bahrain, Iraq, Jordan, Lebanon, Syria, Yemen, Egypt, Djibouti, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates, Iran, Pakistan, Afghanistan, and Kyrgyzstan. According to the Department of Defense annual report for FY 2008, 241 sexual assaults occurred in combat areas of interest, a 38 percent increase over the prior reporting period.14 In FY 2009, this number increased by 16 percent to 279. If we look just at Iraq and Afghanistan, in FY 2008, 141 sexual assaults were reported in Iraq and 22 in Afghanistan, a 26% increase over FY 2007. And in FY 2009, there were 175 reports of sexual assault in Iraq and 40 in Afghanistan.11 Officials attribute the increasing numbers to the 2005 enactment of the Sexual Assault Prevention and Response (SAPR) program to encourage increased reporting of the crime, not to an increase in sexual assault.11 The Department of Defense report estimates only 10 to 20% of assaults are reported, or, put another way, 80% to 90% of sexual assaults go unreported by both female and male victims. This differs from the civilian population, where about a third of rapes/sexual assaults are reported to the authorities.15 Why is the report rate so low? The military legal system may contribute to the low reporting rate. If a sexual assault is reported to medical personnel, military police, or sometimes even a military chaplain, the assault must be reported to the command.16 The report then becomes part of her military record, and the soldier does not have the benefit of confidentiality. Once reported, the commander has the authority to decide if the case goes forward to court-martial. The commander also assigns the prosecuting and defense Judge Advocate General Corps (JAG) attorneys, oversees the investigation, and may have the ultimate say in any disciplinary action.16 With this system, the potential for abuse of power is evident, as is the possibility of conflict of interest in the event both the victim and perpetrator are under the same command. Additionally, MST victims may not have adequate legal representation. Though JAG attorneys are qualified to practice military law, they may not be familiar with the laws of the state where the assault occurred. Also, the JAG office functions as prosecutor and at the same time defense counsel, another potential for conflict of interest.16
The SAPR program created a "restricted option" of reporting sexual assault. Restricted reporting allows women to confidentially access medical care and advocacy services without initiating an investigation. While the restricted option seems positive, the downside is that unless charges are filed, the perpetrator is protected, and as a result he may even gain confidence in his ability to get away with rape. The challenges for female active duty ser-vicewomen to report are different than for civilian women. In the civilian world, knowing how to make a sexual assault report has been simplified, where a woman calls 9-1-1 or goes to an emergency room or police station. Whichever she chooses, her confidentiality is protected, and charges will be filed. In the military, since the SAPR program was instituted, she may contact the local sexual assault response coordinator, victim advocate, or a health care provider. Or she may contact her chain of command or law enforcement (military or civilian). However, if she reports to her chain of command or law enforcement, an investigation will be initiated and she will not have the option to make a restricted report.16
There are a number of fear-based reasons for not reporting a sexual as-sault.17 A woman working in any male-dominated field may have a fear of retaliation, harassment, or career disruption, particularly prevalent in the military. She may fear she will not be believed and hence labeled a troublemaker. She may feel her choice to join the service means she should not complain. Not wanting anyone to know about the sexual assault is a frequently cited reason. The lack of confidentiality, the concern she will be the target of gossip, and potentially ostracism or ridicule are not unrealistic. Then there is the possibility she will be removed from her unit, thus losing an important support system. In the military the mission is of utmost importance. She may not report because of guilt feelings about jeopardizing the mission and the cohesiveness of her unit. Or she may be strongly encouraged to keep silent about the assault to maintain unit cohesion.18 She may have been violating a rule when the assault occurred, such as underage drinking or fraternization. These behaviors could result in severe consequences.19
Another reason for not reporting MST is the belief nothing will be done about it. Sacks19 identified a list of factors considered by a commander when deciding how to dispose of an offense. These include the character and military service of the accused, possible improper motives of the accuser, reluctance of the victim or others to testify, and the availability and admissibility of evidence. Historically, rape victims are reluctant to testify, and MST can and often does occur without witnesses. In the military, only 8% of cases investigated result in prosecution of the perpetrator, and about 80% of those perpetrators convicted still receive an honorable discharge. The rape victim may then have to return to work with her perpetrator.
Other reasons for not reporting MST include believing the incident was not important enough to report, that reporting it would take too much time and effort, or believing the sexual assault is just part of being in the military.12,20,21 If a woman believes being assaulted is "just part of being in the military," military culture is doing a disservice to women who serve our country.
What sociocultural factors set the stage for MST? Myths about rape are still prevalent, even in today's society.22 Some common myths suggest that sexual assault is provoked by the victim; victims ask for it by their actions, behaviors, or by the way they dress; most rapes are reported by women who "change their minds" afterward or who want to "get even" with a man; and once a man gets sexually aroused, he can't just stop. And within the military, there is also the myth that false reports of MST are common,19 and there are negative perceptions about women soldiers who report MST. Examples of negative perceptions are that women do not belong in the military; female soldiers are less valuable because they cannot engage in front-line combat; sexual harassment is what you get when a woman tries to do a man's job; and rape is inevitable when women are in the company of large groups of men who are on deployment without easy access to consensual sex.19 Myths that keep men silent about being sexually assaulted suggest that men can't be sexually assaulted by women; men can't be sexually assaulted because they are able to defend themselves; only gay men are sexually assaulted; and erection or ejaculation during sexual assault means you "really wanted it" or consented to it, which can feed into distressing issues of self-doubt about sexuality and manliness. Sixty percent of men felt the incident was not important enough to report, and 47% did not want anyone to know about the incident.12
Misogyny is defined as a cultural attitude of hatred, dislike, or distrust for females simply because they are female. Military culture has been described as misogynistic,23,24 as revealed in common military language. For example, drill instructors routinely denigrate recruits by calling them ladies, girls, bitches, and pussies. This is not limited to drill instructors. Sexist insults permeate the everyday speech of soldiers. Pornography, including violent pornography, is prevalent, and then there are the misogynist rhymes (Jody calls)25,26 commonly used during drills. For example, Burke's book cites this Naval Academy chant: Who can take a chainsaw; Cut the bitch in two; Fuck the bottom half; And give the upper half to you . . . .24
Are certain women at higher risk? Risk factors for MST include entering the military at a younger age and being of enlisted rank, with lower education, a negative home life, and a history of sexual assault.12,27 Lipari and colleagues12 report that women in the Army and junior enlisted members were more likely than women in other services or of higher rank to experience unwanted sexual contact. The offender was most likely male and a military coworker (54%) or a military person of higher rank (52%). The most likely place for the unwanted sexual contact was at a military installation, while at work. Only about a third of women report the use of alcohol and/or drugs at the time of the trauma by either the perpetrator or the female soldier. About a third of women experiencing unwanted sexual contact reported they were sexually harassed before the assault.
About a third of the women completing the Gender Relations Survey of Active Duty Members reported sexual harassment. Again, junior enlisted women in the Army were more likely than women in other services to experience sexual harassment.
What makes MST in a combat zone more stressful? Military personnel, including military police and medical staff, may not be trained to handle sexual assault cases. They may accept common myths regarding sexual assault; for example, it wasn't rape if there are no physical injuries, a man cannot rape his wife, or men cannot be raped. They may not be trained in the dynamics of sexual assault (e.g., rape is rarely a crime of passion; it is a way to dominate, humiliate, control) or in performing a sexual assault examination, including carefully collecting and preserving evidence. The consequences of a sexual assault can include a sexually transmitted infection and, for women, the risk of getting pregnant. In a conflict zone, access to emergency contraception, antibiotics, and abortion may be extremely limited. In addition, female soldiers fighting in countries where women are expected to be in more traditional roles, such as Middle Eastern countries, are treated with disdain and are at higher risk for sexual assault by civilian males if not accompanied by male soldiers.28
It is more difficult in the military for a female soldier to avoid her assailant if he is also a soldier, especially if stationed on a remote combat base.16 In the military, the mission is of utmost importance. Command might decide it is in the best interest of the mission to not separate the female sexual assault victim from her perpetrator. She may feel threatened by or actually experience additional attacks in the context of the mission. Escaping or even avoiding her assailant may not be possible. Imagine having to show respect for the man who assaulted you or to have to rely on him for basic needs or depend that he will support you in a conflict situation.
In war, the need to trust fellow soldiers takes on high importance. Being victimized by a fellow soldier intensifies the sense of betrayal. The traumas of combat exposure and sexual persecution are often borne alone. Women frequently serve in a platoon with few or no other women, experiencing loneliness instead of the camaraderie that every soldier depends on for comfort and survival.29
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