The Impact of Lifetime Sexual Assault and Post-Traumatic Stress Disorder on Voluntary and Involuntary Childlessness in American Women Veterans

Ryan GL, Mengeling M, Booth BM, Torner J, Syrop CH, Sadler AG. The Impact of Lifetime Sexual Assault and Post-Traumatic Stress Disorder on Voluntary and Involuntary Childlessness in American Women Veterans. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2013 Nov 7; Philadelphia, PA.

Related HSR&D Project(s)

• DHI 05-059 – Physical and Sexual Assault in Deployed Women: Risks, Outcomes and Services
• DHI 08-136 – Combat, Sexual Assault, and Post-Traumatic Stress in OIF/OEF Military Women

Objective: To assess the reproductive health of women veterans, especially with regards to the impact of lifetime attempted or completed sexual assault (LSA) and post-traumatic stress disorder (PTSD) on voluntary and involuntary childlessness in this population. Methods: Cross-sectional study of health history and healthcare utilization of 1004 women veterans using a computer-assisted telephone interview. Subjects were < 52 years old with and without LSA or PTSD who had enrolled in care from one of two Midwestern VA medical centers (VAMC) in the 5 years preceding study interview or during the study period (July, 2005-August, 2008). Measures included socio-demographic variables, insurance status, general health status including psychiatric diagnoses, gynecologic diagnoses and care utilization, and reproductive history. Results: 62% of those surveyed had experienced an attempted or completed sexual assault during their lifetime (LSA), with 46% of these women having experienced such an assault in the military. 28% of women with LSA reported delaying or foregoing pregnancy due to their history of sexual assault, and they were significantly more likely to have terminated a pregnancy than women without a history of LSA (31% vs. 19%, p < .05). Women with LSA were also twice as likely to self-report infertility (23% vs. 12%, p < .0001). 24% of those surveyed reported having been diagnosed with post-traumatic stress disorder (PTSD), and this diagnosis was significantly more common in women with LSA than those without (32% vs. 10%, p < .0001). After multivariable regression analysis, PTSD was not independently associated with pregnancy termination or infertility. Racial minorities were no more likely to experience LSA or PTSD or to terminate, delay, or forego a pregnancy than white veterans. However, minority women veterans were more likely to self-report infertility (24% vs. 18%, p < .05) and less likely to undergo infertility treatment. Conclusions: Almost two-thirds of women veterans have experienced an attempted or completed sexual assault. Such trauma has broad and interrelated impacts on reproductive and psychiatric health including increased rates of post-traumatic stress disorder and voluntary and involuntary childlessness.