Measuring Civilian Moral Injury: A Comparison of the Psychometric Properties of Three Measures of Moral Injury among the General Population

Moral injury research has been expanded to populations beyond the military in recent years. A key barrier to further research into moral injury in civilian populations is the lack of valid, reliable measures of the construct appropriate for general civilian use. This paper addresses this barrier by exploring the psychometrics of three measures of moral injury in a general civilian sample: the Moral Injury Scale for Youth, and adapted versions of the Moral Injury Events Scale and Expressions of Moral Injury Scale-Military. A sample of civilian women (n = 192) and men (n = 88) completed a battery of questionnaires comprising the above measures, and additional scales designed to capture theoretically-supported correlates of moral pain, psychopathology, and wellbeing. Confirmatory factor analysis found that the factor structure of the three moral injury measures was replicated within our civilian sample. No scale showed significant association with age or gender, indicating discriminant validity. All measures correlated as predicted with measures of psychopathology and wellbeing at the total score level. Correlations of individual subscales with each of these measures were more varied, suggesting conceptual differences in how moral injury is experienced in civilian populations. Despite psychometric support, all three scales required error covariances for certain items to obtain satisfactory model fit and displayed problems in item wording which may inflate internal consistency and warrant further scale construction efforts for this population. Findings indicate that civilian populations also experience moral injury, but that existing measures may have certain problems capturing this effectively.

Troubling national commemoration in Dublin, London and Liverpool: ANU Production and CoisCéim Dance Theatre’s These Rooms

The cultural production These Rooms challenged traditional nationalistic commemorations of war and rebellion during the ‘Decade of the Centenaries’. Created by the Dublin-based ANU Productions and CoisCéim Dance Theatre, and funded by the Irish and UK governments, this series of theatre/dance performances, installations and public outreach projects in unconventional urban venues ran from 2016 to 2019 in Dublin, London and Liverpool, cities with mixed British and Irish populations. Fragmentary, embodied stories about the 1916 Easter Rising in Dublin communicated the perspectives of working-class Irish civilian women and confused young British soldiers through intimate domestic encounters that productively disrupted heroic narratives. Audiences were instead invited to create temporary communities of encounter and ‘unlearn’ dominant concepts supporting colonial, imperial and national spaces–times. As a critical agonistic artistic intervention, These Rooms offered more inclusive ‘potential histories’ and forms of belonging across political, social and temporal borders during the geopolitically uncertain times associated with Brexit.

P–720 Prevalence of Female Infertility in the UK Armed Forces

Study question What is the prevalence of female infertility among UK military personnel and does it differ from the Metropolitan Police Service (MPS) and civilian populations? Summary answer Prevalence of self-reported infertility was higher in servicewomen (31.7%) and female MPS officers (36.3%) than in civilian women (24.4%). What is known already Arduous employment is associated with numerous potential occupational hazards and behaviours that may be relevant to fertility. These include physical and psychological stress, smoking, alcohol drinking and other lifestyle factors. A preliminarily report in 2016 indicated that UK servicewomen over 30 years of age were more likely to present with fertility problems compared with reported civilian infertility data for age-matched women. Few previous studies have compared infertility prevalence of servicewomen with civilians, and none have compared infertility prevalence with other occupations. Study design, size, duration A cross-sectional study was undertaken in 2019 to determine prevalence of infertility. All eligible UK servicewomen (14,650) and MPS officers (8,262) aged 18–60 years were invited to participate with sisters of participants recruited as controls using a snowball technique. Data including pregnancy history, time to each pregnancy and self-reported infertility risk-factors were collected using an online questionnaire. We estimated a sample of 4898 servicewomen would give a precision of 1% around infertility prevalence estimates. Participants/materials, setting, methods The questionnaire was developed, piloted and adapted for electronic distribution. The occupational groups were invited by email to complete the questionnaire on three occasions. Prevalence of infertility was defined as the proportion of women at risk of pregnancy who had not become pregnant within 12 months. Only women with pregnancy outcomes, or fully tested for fertility (12 months or more of exposure), were included in the denominator. Main results and the role of chance Participants included 4806 (33%) women serving in the UK Armed Forces, 1237 (15%) female MPS officers and 435 (estimated 8%) non-military, non-MPS sisters (biological, half, step or adopted) of both groups. 98.4% of responses were complete. Prevalence of self-reported 12-month infertility was 31.7% (95% CI 29.9–33.5) in servicewomen, 36.3% (95% CI 33.1–39.7) in MPS officers and 24.4% (95% CI 19.6–29.8) in civilian women. Age, history of polycystic ovary syndrome, endometriosis, fibroids, tubal and pelvic surgery, hysterectomy and a short General Health Questionnaire (GHQ 12) score of > 4 (suggesting a minor psychiatric disorder) were associated with infertility and adjusted for in logistic regression models to estimate odds ratios. The adjusted odds ratio (aOR) of infertility in servicewomen was 1.0 (95% CI 0.8–1.2) compared with MPS officers and 1.5 (95% CI 1.1–2.0) in both servicewomen and MPS officers compared with sisters. Limitations, reasons for caution The major limitation is the low response rate, particularly in the two control groups, potentially resulting in response bias. Prevalence of infertility could have been further over-estimated if fertile women are more likely to have left the military or MPS. There is scope for residual confounding. Wider implications of the findings: Further analyses will explore the key risk factors to identify what aspects of these occupations contribute to infertility and which may be modifiable. Future cohort studies would be helpful to extend the understanding of the influence of occupation on infertility. Trial registration number Not applicable

Reproductive health and contraception use by Ukrainian servicewomen in the current war zone: a questionnaire survey

The aim of the study is to define awareness level and use of different contraception methods by servicewomen in the current armed conflict in the East of Ukraine. Between October 2018 and September 2019, 507 military women serving in the Joint Forces Operation Zone in eastern Ukraine and 100 civilian women from the frontline region participated in the questionnaire-based survey. The survey was focused on the knowledge and use of different methods of contraception and STI preventing by military women in conditions of armed conflict in Donbas. Servicewomen reported using of different methods of contraception in 48.3±4.3% of the cases, which is 1.5 times less than civilian women (RR=1.5; 95% CI: 1.2 – 1.7, p=0.001). Among those who reported using contraception, hormonal methods were chosen by 8.2±3.4% of active duty military women, which is two times less than by civilians (RR=2.1, 95% CI: 1.1-4.1, p=0.03). The low use of effective methods of contraception by active-duty servicewomen according to results survey is one of the reasons for the disruption of female reproductive health during military deployment. The primary reserve of preserving women's health in the current war environment,besides access to modern contraceptives and counseling, is improving the education of military medics in the gender-specific issues of reproductive health and contraception.

Wartime Sexual Acts as Prosecutable War Crimes

Human history is littered with the mass rape of women particularly as a military strategy in warfare, dating back centuries from ancient Greek, Roman, and Hebrew concubines through the Middle Ages to the 20th century ‘comfort women’ of the 2nd World War. Ancient literature explicitly refers to rape or the seizure of vanquished women, who were regarded as the enemy’s property, to become wives, servants slaves, or concubines. The plight of women worsened in the twentieth century when civilian women suffered the most consequences of armed conflicts including rape. Rape served as an oppressive and humiliating tool to severe family identity to dominate, demoralize, and destroy the entire enemy society and way of life. In the past, there appeared to be no international law that specifically dealt with rape in armed conflicts. This was caused by the ambivalent relationship between the law of armed conflict and gender-based crimes. Rape was overlooked as an unfortunate yet inevitable by-product of war. Both international humanitarian and human rights laws did not initially recognize rape as a serious war crime and a fundamental breach of human rights. This deafening legal silence and gap are being addressed through an ongoing evolutionary process by criminalizing wartime predatory sexual acts as a war crime, crimes against humanity, and even genocide. However, with the developments of international law and its practice, for the first time in the history, mass rape and sexual enslavement in the time of war be regarded as ‘crimes against humanity’ in a landmark ruling from the Yugoslav War crime tribunal in the Hague on 22 February 2001. But, even before that, some prior legal instruments for example the Lieber Code, promulgated during the American Civil War regarded [wartime] rape as war crime with capital punishment. Thus, this paper aims to analyze how the historical legal instruments have articulated the extend of criminality and culpability of wartime rapes and other sexual violence and their nexus with crimes of humanity, genocide, and war crimes within the corpus of international norms and criminal prohibitions as well as the historical development of wartime sexual acts as prosecutable war crimes.

THE FEATURES OF THE «I-CONCEPT» OF RUSSIAN FEMALE POLICE OFFICERS

The article presents data from an empirical study of the features of the “I-concept” of Russian female police officers. An increasing number of women realise themselves in professions traditionally seen as those suitable principally for men, including working in the police. The authors consider the socio-psychological issue of transformation of gender-role behavior and related stereotypes, which contributes to a blurring of the boundaries between male and female in the structure of the psyche of the person, and naturally causes a transformation of the «I-concept» of female police officers. Differences in the cognitive component of the “I-concept” of female police officers and civil women were revealed: women working outside military forces are more likely to think of themselves in an aesthetic and family context, while female police officers imagine themselves in a social and professional context, which is more typical for the “I-concept” of male type. The proportion of female police officers using male-type behavior and strategies to identify themselves “I am a police officer” is significantly larger than the proportion of civilian women who prefer masculine patterns of behavior when identifying with their organization. The cognitive component of the “I-concept” of female police officers is characterized by the pronounced ambivalence in the family and socio-professional spheres. Given the priority of the family sphere in the “I-concept”, professional activity and its effectiveness become a secondary and tertiary concern, or the priority of the police service in the “I-concept” of female police officers assigns only the second and third role to the family sphere. Statistically significant differences were revealed in the structure of self-esteem, self-sympathy and self-acceptance of women of two groups, namely: female police officers are more self-confident, their self-respect is based on faith in themselves and their strength, independence, their reliance on their abilities, skills and capacities manifested against a backdrop of unstable auto-sympathy and a high need for social approval, prevailing focusing on social norms and success criteria. In contrast, civilian women have higher self-esteem, an active life position concerning themselves and society, trust and a positive attitude towards themselves, and awareness of their creative potential for a productive life and activity.

Implantation capacity of endometry of veteran women, with contusion in anamnesis, with unrealized reproductive function

The objective: improving the efficiency of diagnosis and treatment of pathology and implantation ability of the endometrium in women of reproductive age who took part in hostilities and received concussions. Materials and methods. The study of endometrial pinopodia was carried out in 35 women of reproductive age who took part in hostilities and received concussions, who on the 21st day of the MC underwent operative laparoscopy and hysteroscopy with endometrial sampling for histological examination and scanning electron microscopy. Of these women, 22 patients – a comparison group – of reproductive age with a history of trauma without post-concussion syndrome and 13 in the main group, women of reproductive age, have the consequences of contusion in the form of post-concussion syndrome. Served as control 10 samples of endometrium from civilian women of reproductive age. The average age of the surveyed was 27.08±4.23 years. The period of stay in the combat zone was 29.34±9.21 months, the time from the moment of receiving a slight traumatic brain injury (contusion) was 18.8±9.2 months. Results. In combatant-women with contusion in history, there are disturbances in the receptivity of the endometrium, manifested by abnormalities in the development of pinopodia and their microvilli during the implantation window: areas without pinopodia in 47.50% of cases (p<0.006), pinopodia of sizes – in 77.50% (p<0.01) and abundant microvilli – in 37.50% (p<0.02); a decrease in the frequency of the presence of developed pinopodia by 2.12 times (p<0.01), large pinopodia by 2.29 (p<0.01), and a small number of microvilli by 4.00 (p<0.0001), an increase in the occurrence of medium-sized pinopodia by 3.00 (p<0.02) times, and a moderate number of microvilli by 4.00 (p<0.0001). A characteristic feature of endometrial pinopodia in the above patients is the presence of mosaicism of their shape (65.00%) and size (67.50%). Conclusions. Women in the military who have been injured in combat are diagnosed with reproductive health problems caused by both the traumatic brain injury itself and the stressors associated with military service. Keywords: reproductive health, female veterans, post-contusion syndrome, receptive endometrial enlargement, office hysteroscopy.