The Pentagon has talked a lot about putting a stop to sexual abuse and harassment in the military, including abuse carried out by general officers. Yet a new report from the investigative arm of Congress finds it's mostly that – talk. It catalogs how the military still hasn't fixed a host of systemic obstacles that contribute to sexual assault and make it less likely for survivors to get help.

According to a report released Wednesday by the Government Accountability Office (GAO), while the Pentagon has made some progress in recent years at trying to stop sexual abuse, treatment isn't always available. Medical first-responders are undertrained and not always aware of services available for survivors. Perhaps worse, the Office of the Assistant Secretary of Defense for Health Affairs – which oversees the military's health resources – hasn't "established guidance," required by the Pentagon, "for the treatment of injuries stemming from sexual assault."

Among those guidelines: standardizing procedures for collecting evidence; providing specialized medical care; and, perhaps most alarming, keeping the identities of survivors private. Instead, sexual assault survivors within the military have to navigate a hodge-podge of different standards between branches – even at individual bases. "These inconsistencies," the report states, can "erode servicemembers' confidence. As a consequence, sexual assault victims who want to keep their case confidential may be reluctant to seek medical care."

All these systemic obstacles to ending sexual abuse persist despite endless pledges from Pentagon officials to finally do away with one of the military's most glaring sources of injustice. "If we don't take steps to deal with it – if we don't exercise better leadership to confront it – it'll get worse," Defense Secretary Leon Panetta told NBC News in September. "In a May 2012 letter to military commanders signed by Gen. Martin Dempsey, the chairman of the Joint Chiefs of Staff, the chiefs stated: "As military professionals we must fully understand the destructive nature of these acts, lead our focused efforts to prevent them, and promote positive command climates and environments that reinforce mutual respect, trust and confidence."

The Pentagon has had an overarching sexual-abuse policy since 2005 which "calls for sexual assault prevention ... to be gender-responsive, culturally competent, and recovery-oriented; and for an immediate, trained sexual assault response capability to be available in deployed locations," according to the report. But the Pentagon has fallen short of establishing and enforcing policies that are more specific, and trained first-responders may not always be available or trained properly to respond.

A huge problem is confidentiality – a reoccurring issue in sexual assault cases where victims may fear retaliation for reporting the crimes. First, sexual assault cases can be reported in the military using two ways: unrestricted reports and restricted reports. For an unrestricted report, a survivor reports an assault to superiors and military law enforcement, who – in theory – begin an investigation, and provide medical care and counseling. A restricted report, on the other hand, allows a survivor to confidentially inform superiors about the assault without sparking a criminal investigation. The survivor, according to military policy, should still receive medical care, but personally identifying information will be kept anonymous.

But that's not always the case. At one unidentified military installation, the installation's medical policies "did not ... offer health care providers alternative procedures for documenting and reporting medical issues associated with restricted reports of sexual assault," the GAO finds. And across different bases, medical personnel were being given conflicting instructions about how to report the assaults from different levels of command. These contradictory policies "created confusion for health care providers regarding the extent of their responsibility to maintain the confidentiality of victims who choose to make a restricted report of sexual assault."

And there's no single method for victims to access medical and mental health care across the military branches, according to the GAO. The Army requires each brigade "to deploy with a health care provider who is trained to conduct a forensic examination, whereas the Air Force deploys trained health care providers based on the medical needs at specific locations." The Navy doesn't require ships to have a sailor aboard who is trained to conduct forensic examinations, instead preferring a policy of transferring victims to ships that do – or onto shore. If a trained examiner is out of reach, the policy is for medical providers to "do their best ... using the instructions provided with examination kits."

Meanwhile, the military's medical first responders are "still unsure of the health care services available to sexual assault victims at their respective locations." According to the report, there's no consistent instructions on where sexual assault survivors should go for examination, even though evidence in such cases is perishable. "Refresher training" for sexual assault cases, which the Pentagon requires military first responders to undergo every year, is also below standards, with thousands of personnel missing annual courses.

The report comes a week after the House Armed Services Committee brought in Gen. Mark Welsh III, the Air Force's top general, for a grilling about the Lackland Air Force Base sexual abuse scandal. The sprawling base in San Antonio, Texas, where the Air Force sends all its recruits for basic training, has been the focus of an investigation into sexual abuse of at least 59 recruits and airmen by their instructors. Thirty-two instructors have been disciplined – including prison terms – for charges ranging from aggravated sexual assault to rape. There's also the case of Army Brig. Gen. Jeffrey Sinclair, accused of "forcibly sodomizing" a woman Army captain and threatening her military career "if she ended their sexual relationship," as stated by military documents acquired by Danger Room in December. On Jan. 22, Sinclair deferred entering a plea at his court-martial.

There's hope things could be different. On Thursday, Dempsey argued to reporters that sexual abuse in the military is partly owed to how the military treats women: as less than equal. "When you have one part of the population that's designated as warriors, and another part of the population that's designated as something else, I think that disparity begins to establish a psychology that, in some cases, led to that environment," Dempsey said while announcing plans to integrate women in combat roles and units.

Dempsey never said that equality by itself would be a solution, for the simple reason that it's true. For a start, it means recognizing that talk is talk. It's quite another thing to step up and do something about it.