Prior to deploying, servicewomen are screened for  potentially deployment-limiting conditions. According to DOD officials and  health care providers with whom we met, such pre-screening helps  ensure that many female-specific health care needs are addressed prior  to deployment. DOD Policies Addressing the Health Care Needs of Deployed Servicemembers Include Female-specific Aspects

DOD components have put in place policies and guidance that include  female-specific aspects to help address the health care needs of  servicewomen during deployment. DOD Has Also Conducted Some Reviews of the Health Care Needs of Servicewomen during Deployments

DOD components have conducted reviews of the health care needs of  servicewomen while they are deployed. Health Care Providers and Servicewomen Said DOD Generally Meets Women’s Health Care Needs during Deployments

At the 15 selected locations we visited in Afghanistan and Navy vessels,  health care providers and servicewomen told us that the health care  services available to deployed servicemembers generally meet the needs  of servicewomen. Health care providers we spoke with in Afghanistan and  aboard Navy vessels told us they were capable of providing a wide range  of female-specific health care services—including treating certain  gynecological conditions such as urinary tract infections and conducting  clinical breast examinations—that women might seek while deployed. Based on information provided by the 92 servicewomen we interviewed at  selected locations in Afghanistan and aboard Navy vessels, the responses  from 60 indicated that they felt the medical and mental health needs of  women were generally being met during deployments, whereas the  responses from 8 indicated they did not feel the medical and mental health  needs of women were generally being met during deployments. The  responses from an additional 8 servicewomen suggested that they had a  mixed opinion as to whether the medical and mental health needs of  women were being met during deployments, and 16 told us they did not  know or did not have an opinion. Of  servicewomen who offered a mixed opinion, one female sailor told us that  she felt junior health care providers were limited in the types of  procedures they could perform and lacked practical experience. Further,  first responders such as Sexual Assault Response Coordinators and  Victim Advocates are not always aware of the specific health care  services available to sexual assault victims at their respective locations. The Office of the Assistant Secretary of Defense for Health  Affairs has performed these responsibilities for some medical issues in  DOD, but it has not established guidance for the treatment of injuries  stemming from sexual assault—a crime that requires a specialized level  of care to help ensure that forensic evidence is properly collected,  medical care is provided in a way that minimizes the risk of  revictimization, and a victim retains the right to disclose the assault with  confidentiality. Accordingly, we found that military  health care providers do not have a consistent understanding of their  responsibilities in caring for sexual assault victims. Additionally, we found that not all first responders fulfill the  requirement to annually complete refresher training on tasks DOD deems  essential to their role in responding to incidents of sexual assault. Recommendations for Executive Action

To help ensure that sexual assault victims have consistent access to  health care services and the reporting options specified in DOD’s sexual  assault prevention and response policies, we recommend that the  Secretary of Defense direct the Under Secretary of Defense for Personnel  and Readiness to direct the Assistant Secretary of Defense for Health  Affairs to develop and implement department-level guidance on the  provision of medical and mental health care to victims of sexual assault  that specifies health care providers’ responsibilities to respond to and  care for sexual assault victims, whether in the United States or in  deployed environments. DOD concurred, without comment, on our second recommendation that  the Under Secretary of Defense for Personnel and Readiness, in  collaboration with the military departments, take steps to improve  compliance with completing annual refresher training on sexual assault  prevention and response. Appendix I: Scope and Methodology

	Determining the Extent to Which the Health Care Needs of Deployed Servicewomen Are Being Addressed and Female- specific Health Care Services Are Available

In our review of female-specific health care services provided by DOD to  deployed servicewomen, our scope included each of the military services. Determining the Availability of Medical and Mental Health Care to Servicewomen Who Are Victims of Sexual Assault

To determine the extent to which medical and mental health care are  available to servicewomen who are victims of sexual assault, we obtained  and reviewed various documents, including legislative requirements and  DOD’s and the military services’ policies and guidance establishing  requirements for the prevention of and response to sexual assault.
Why GAO Did This Study

The roles for women in the military have been expanding and evolving. Servicewomen today are integral to combat, combat support, and counterinsurgency operations, and serve in many roles they previously did not hold. Pub. L. No. 112-81, 725 (2011) mandated that GAO conduct a review of the female-specific health care services provided by DOD to female servicemembers, including the treatment of servicewomen who are victims of sexual assault. In this report, GAO evaluates the extent to which (1) DOD is addressing the health care needs of deployed servicewomen; (2) female-specific health care services are available to deployed servicewomen; and (3) medical and mental health care are available to servicewomen who are victims of sexual assault. GAO reviewed pertinent DOD policies, guidance, and data. GAO also met with health care providers, servicewomen, and others during site visits to 18 locations where servicewomen are currently serving or deployed, including 15 installations in Afghanistan and Navy vessels.

What GAO Found

The Department of Defense (DOD) is taking steps to address the health care needs of deployed servicewomen. For example, DOD has put in place policies and guidance that include female-specific aspects to help address the health care needs of servicewomen during deployment. Also, as part of pre-deployment preparations, servicewomen are screened for potentially deployment-limiting conditions, such as pregnancy, and DOD officials and health care providers with whom GAO met noted that such screening helps ensure that many female-specific health care needs are addressed prior to deployment. GAO also found that DOD components have conducted reviews of the health care needs of servicewomen during deployments and are collecting data on the medical services provided to deployed servicewomen.
At the 15 selected locations GAO visited in Afghanistan and aboard Navy vessels, health care providers and most servicewomen indicated that the available health care services generally met deployed servicewomen's needs. In Afghanistan and aboard Navy vessels, health care providers said they were capable of providing a wide range of the female-specific health care services that deployed servicewomen might seek, and servicewomen GAO spoke with indicated that deployed women's needs were generally being met. Specifically, based on information provided by the 92 servicewomen GAO interviewed, 60 indicated that they felt the medical and mental health needs of women were generally being met during deployments; 8 indicated they did not feel those needs were generally being met during deployments; an additional 8 indicated a mixed opinion; and 16 said they did not have an opinion. For example, some servicewomen told GAO that they were satisfied with their military health care, given the operating environment. Among those who expressed dissatisfaction with their military heath care, GAO heard a concern about difficulty in obtaining medications. Among those who expressed mixed views, a comment was raised that junior health care providers were limited in the types of procedures they could perform and lacked practical experience.
DOD has taken steps to provide medical and mental health care to victims of sexual assault, but several factors affect the availability of care. For example, this care can vary by service and can be impacted by operational factors, such as transportation and communication challenges, that are inherent to the deployed environment. Further, military health care providers do not have a consistent understanding of their responsibilities in caring for sexual assault victims because the department has not established guidance for the treatment of injuries stemming from sexual assault--which requires that specific steps are taken while providing care to help ensure a victim's right to confidentiality. Additionally, while the services provide required annual refresher training to first responders, GAO found that some of these responders were not always aware of the health care services available to sexual assault victims because not all of them are completing the required training. Without having a clearer understanding of their responsibilities, health care providers and first responders will be impeded in their ability to provide effective support for servicewomen who are victims of sexual assault.

What GAO Recommends

To enhance the medical and mental health care for servicewomen who are victims of sexual assault, GAO recommends that DOD (1) develop department-level guidance on the provision of care to victims of sexual assault; and (2) take steps to improve first responders' compliance with the department's requirements for annual refresher training. DOD did not concur with the first recommendation, but cited steps it is taking that appear consistent with the recommendation. DOD concurred with the second recommendation.