Recently, 18 brave women graduated from the U.S. Army Infantry School, pioneers headed for fully gender-integrated “ground close-combat” units. Women have long served valiantly and effectively in almost every military role, but now they are tackling extremely physical combat jobs that, until recently, were designated men-only.

The Department of Defense is committed to increasing numbers of women in the ranks without delay. The commandant of the Marine Corps — considered the toughest of the armed services when it comes to physical requirements — has nonetheless set a goal: 10% of new recruits for all its jobs will be women. Military recruiters are aggressively targeting high school female athletes. Ads featuring women glamorize close-combat skills. And since all combat roles were opened to both sexes, Congress has repeatedly voted on legislation that would force women ages 18 to 26 to register for the draft, just like men.

In this push for more female recruits, it’s not at all clear that young women — or the civilian population in general — understand the unique, disproportionate health risks women face in combat roles. The dangers, which have been known for decades, will undoubtedly be exacerbated as women serve in the most physically demanding units. Although the Pentagon has published studies detailing these gender differences, no such information is readily found on the Army or Marine recruiting websites. And the neighborhood recruiter isn’t likely to fill you in, either. But avoiding hard truths isn’t a legitimate way to attract new volunteers to the military. At best, it’s manipulative; at worst, downright exploitative.

Disproportionate injuries and even physical disability are facts of life for many who serve.


Obviously, men and women are not the same. On average, an adult male produces 10 times more testosterone than an adult female, which almost doubles his muscle mass. (The average woman possesses only 55% to 58% of the upper body strength of the average man.)

Testosterone also causes development of a heavier and stronger skeleton in males and has a specific effect on shaping the male pelvis, adding greater strength for load-bearing tasks and enabling more efficient locomotion. It increases the size and function of their hearts and lungs and consequently males have 40% greater aerobic capacity, and higher endurance compared with females. Women’s smaller hearts require more blood to be pumped each minute at a given level of exertion because they have less hemoglobin in their blood to carry oxygen.

These differences will put women at a distinct disadvantage in newly opened infantry jobs, where they will be expected to carry 100-pound packs routinely, or in armor jobs, where they will have to load 35-pound rounds again and again. Women in these roles will have to constantly work at a higher percentage of their maximal capacity to achieve the same performance as men. No training system can close the gap.

Extreme physical activity, irregular meals, inadequate intake of calcium and vitamin D, sleep deprivation and stress are common in close-combat units. These factors can trigger “conservation mode” in women,which results in a decrease in female hormones, cessation of menstruation, and osteoporosis with a heightened risk of stress fractures.


We also know that if stress and exertion don’t suppress menstruation, many women in combat roles will choose to do so with hormonal contraceptive use. The side effects may include depression, weight gain and breakthrough bleeding. Depo-Provera, the contraceptive of choice for many military women, now carries a warning for loss of bone mineral density.

Pelvic floor injuries are another gender-specific danger for female troops. Studies have found heavy load bearing and paratrooper training can contribute significantly to urinary incontinence and pelvic organ prolapse among women.

Many of the consequences of taking on additional combat roles won’t be obvious until years later. Just ask Marine Capt. Katie Petronio, who wrote in the Marine Corps Gazette of muscle atrophy, endurance problems, weight loss and infertility she considers the results of two combat deployments. Women have proved themselves in combat, Petronio said, but in the most physically demanding roles, can they endure “and are we willing to accept the attrition and medical issues that go along with integration?”

The Pentagon is well aware of the occupational hazards unique to women in combat units. Much of this information is laid out in a 2015 literature review, “Physiological and Medical Aspects That Put Women Soldiers at Increased Risk for Overuse Injuries.”


Another study, “Musculoskeletal Injuries in Military Women,” published in 2011 by the Army surgeon general’s office, noted that women are approximately 67% more likely than men to receive a physical disability discharge from the army for a musculoskeletal disorder. Keep in mind, that statistic and the 2015 review were compiled before all combat jobs were opened to women.

Women are essential in America’s armed services. Unfortunately, disproportionate injuries and even physical disability are facts of life for many who serve. In targeting young women for recruitment into close-combat jobs, the Department of Defense must ensure they are fully informed of the risks, and as women take on other formerly restricted roles, their health must be meticulously documented and studied. Potential recruits, and all Americans, deserve to know the true effects of a completely integrated military.

Julie Pulley is a former Army captain, veteran of the Afghanistan conflict and graduate of West Point. Rear Adm. Hugh P. Scott is a retired Navy medical officer and an expert in medical physical standards.


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