From fiscal year 2007 through 2012, the total number of female servicemembers has grown from 200,941 to 208,905, with female servicemembers comprising about 14 percent of the total active duty force. During this time, the largest number of active-duty female servicemembers resided in the Army. (See fig. 1.) In fiscal year 2012, more than three-quarters of the Army’s female servicemember population was age 35 and under, with the largest group being between 18 and 24 years old. Recommendations for female- specific preventative health screenings are based on age, such as cervical cancer screening, which would be applicable for female servicemembers from an early age, while others, such as mammograms, are currently not recommended until age 50, absent any personal history of health problems of this nature. (See fig. 2.) DOD operates its own large, complex health system—the Military Health System—that provides health care to approximately 9.7 million beneficiaries across a range of venues, from MTFs located on military installations to the battlefield. These beneficiaries include active-duty servicemembers and their dependents, eligible National Guard and Reserve servicemembers and their dependents, and retirees and their dependents or survivors. The Military Health System has a dual health care mission: supporting wartime and other deployments, known as the readiness mission, and providing peacetime care, known as the benefits mission. The readiness mission provides medical services and support to the armed forces during military operations and involves deploying medical personnel and equipment, as needed, around the world to support military forces. The benefits mission provides medical services and support to members of the armed forces, their family members, and others eligible for DOD health care. The care of the eligible beneficiary population is spread across the military departments—Army, Navy, and Air Force. Each military department delivers care directly through its own MTFs, which are managed by their medical departments, including the Army’s Medical Command (MEDCOM); the Navy’s Bureau of Medicine and Surgery, which is also responsible for providing health care to members of the Marine Corps and their beneficiaries; and the Air Force Medical Service. Servicemembers obtain health care through the military services’ system of MTFs, which is supplemented by participating civilian health care providers, institutions, and pharmacies to facilitate access to health care services when necessary. Active-duty servicemembers receive most of their care from MTFs, where they receive priority access over other beneficiaries. Within the continental United States, the Army is organized into three medical regions—Northern, Southern, and Western—each headed by a subordinate regional medical command, which exercises authority over the MTFs in its region. Across the three regions, there are 27 domestic Army installations with a primary MTF, which report directly to the regional medical commands and are responsible for reporting information for other associated MTFs, which may include smaller MTFs, such as clinics, on the same installation, as well as MTFs on different Army installations or at installations operated by other military services. For example, at Fort Benning, there are multiple facilities located on the installation, including Martin Army Community Hospital—the primary MTF—as well as several clinics. In addition to reporting for all of those facilities, Martin Army Community Hospital also reports to the regional medical command for other Army facilities located off the installation, including an Army clinic at Eglin Air Force Base in Florida. All Army MTFs, both primary and associated, can be classified under one of three categories on the basis of their size: Army Health Centers/Clinics are generally the smallest facilities only offering outpatient primary care. Army Community Hospitals are larger than clinics and offer primary and secondary care, such as inpatient care and surgery under anesthesia. Army Medical Centers are generally the largest facilities offering primary and secondary care as well as other care, such as cancer treatments, neonatal care, and specialty diagnostics. Each of the military services is responsible for maintaining the medical readiness of its active-duty force. DOD’s IMR policy establishes six elements for the military services to assess in order to determine a servicemember’s medical readiness to deploy: 4. individual medical equipment,5. medical readiness laboratory tests, and 6. periodic health assessments (PHA). DOD’s policy establishes a baseline of standards for continuously assessing each of the IMR elements. In addition to this, each of the military services establishes its own policy that may include more specific criteria. Each military service is responsible for assessing and categorizing a servicemember’s IMR as follows: Fully medically ready, current in all categories. Partially medically ready, lacking one or more immunizations, readiness laboratory tests, or medical equipment. Not medically ready, existence of a chronic or prolonged deployment-limiting condition, including servicemembers who are hospitalized or convalescing from serious illness or injury, or individuals who require urgent dental care. Medical readiness indeterminate, inability to determine the servicemember’s current health status because of missing health information such as a lost medical record, an overdue PHA, or an overdue dental exam. All of the military services use different systems to collect information about IMR status. In addition, DOD requires that each of the services provide quarterly reports about the IMR status of their servicemembers. DOD and the military services have a number of organizations that fund or conduct research, including research on health care issues that affect those who have served in a combat zone. The Defense Health Program within DOD’s Office of the Assistant Secretary of Defense for Health Affairs receives significant funding for this research through its annual appropriation. Through an interagency agreement, the Army Medical Research and Materiel Command manages the day-to-day execution of this funding through joint program committees. There are several joint program committees that focus on specific research areas, including clinical and rehabilitative medicine and military operational medicine.Officials from the other military services participate in these committees. Research organizations from the military services, such as the Naval Medical Research Center, the Office of Naval Research, and the Air Force Medical Support Agency, also manage funds from the Defense Health Program for research. In addition to the military services, other organizations within DOD also fund or conduct research, including the TriService Nursing Research Program, which funds and supports research on military nursing. DOD’s policy establishes six elements for assessing the IMR of a servicemember to deploy, most of which are gender-neutral. Four of the six elements—immunization status, medical readiness laboratory tests, individual medical equipment, and dental readiness—are gender-neutral; they apply equally to female and male servicemembers. In order to pass these elements of the IMR assessment, servicemembers must be current for each element, by having immunizations, including MMR (measles, mumps, and rubella); medical readiness laboratory tests, such as a human immunodeficiency virus test and results current within the past 24 months; individual medical equipment, such as gas mask inserts for all personnel needing visual correction; and an annual dental exam. The remaining elements of IMR—deployment-limiting conditions and PHAs—include some aspects that are specific to female servicemembers. The Army, Navy, Air Force, and Marine Corps have policies that define pregnancy as a deployment-limiting condition. In addition, they also have policies that establish a postpartum deferment period—generally 6 months after delivery—when a female servicemember is not required to deploy. The deferment period was established in order to provide for medical recovery from childbirth and to allow additional time to prepare family care plans and child care. However, each of the military services has a policy that allows the servicemember to voluntarily deploy before the period has expired. In addition, cancer that requires continuing treatment and specialty evaluations can also be a deployment-limiting condition. Although cancer treatment could affect both male and female servicemembers, there are some cancers that would be specific to female servicemembers, such as ovarian cancer, while other cancers are specific to male servicemembers, such as prostate cancer. The PHA includes a review of information about preventative screenings and counseling for each servicemember. Some of the preventative screenings that are reviewed as part of the PHA are female-specific, such as mammograms and pap smears. To satisfy this element of IMR, a servicemember’s PHA must be current—the assessment of any changes in health status must have occurred within the past year—for both female and male servicemembers. The results of these preventative screenings do not negatively affect this element of a servicemember’s readiness assessment even when follow-on studies, labs, referrals or additional visits may be pending or planned. Nonetheless, these screenings could identify a health issue that would be considered a deployment-limiting condition—a separate element of IMR—and could therefore limit readiness. For example, the results of a mammogram may identify cancer that requires treatment or specialized medical evaluations that could be determined to be a deployment-limiting condition. On the basis of our survey, we found that most routine female-specific health care services—including pelvic examinations, clinical breast examinations, pap smears, screening mammographies, prescription of contraceptives, and pregnancy tests—were available through the MTFs at the 27 domestic Army installations with a primary MTF. Screening mammography services were not available at two of these installations; however, in those instances, this service was available from a civilian network provider. We did not survey about the availability of male and female providers to provide pregnancy tests as senior health care officials stated that this health care service is not one that is necessarily administered by health care providers. that she would have to wait 3 months to see a female provider, so she opted to see a male provider.