Environmental Exposures and Infertility: What’s the Deal, Baby? Studies on the Reproductive Health of Australian Defence Force Veterans of the 2001-2009 Middle East Conflicts

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dc.contributor.advisorDavies, Michael
dc.contributor.advisorNeuhaus, Susan
dc.contributor.advisorAvery, Jodie
dc.contributor.authorWarner, Rachelle
dc.contributor.schoolAdelaide Medical School
dc.date.issued2024
dc.description.abstractThis thesis consists of a program of research investigating the effects of exposure to environmental factors during deployment on the reproductive health of the Australian military cohort that deployed to Iraq, Afghanistan and supporting areas during the period 2001 to 2009 using data collected in the Middle East Area of Operations (MEAO) Census Study. It is widely recognised that veterans were exposed to many substances that are considered to be, or suspected to be, reproductive toxicants. Thus, using descriptive statistical analysis, the presence of environmental exposures occurring during deployment to the Middle East Area of Operations was evaluated along with whether these exposures might be sufficient to influence reproductive health, potentially resulting in the adverse outcomes reported by veterans. Anecdotally, concern about infertility among serving Australian Defence Force members and veterans, particularly female, is prevalent. The epidemiology of self-reported fertility as well as adverse reproductive and infant outcomes, including miscarriage, ectopic pregnancy, stillbirth, neonatal death, congenital anomalies, and childhood cancer in offspring of operational veterans was investigated using quantitative and qualitative epidemiological and statistical methods. The actual self-reported infertility rate among respondents of the MEAO Census Study was 9%, in contrast with the Australian infertility rate of 16% (or one in six couples). A significant number of women who participated in the survey had never attempted to conceive, so their fertility has not been tested. The anecdotal concerns raised may only apply to a minority of participants who have actually tried to conceive. In the MEAO Census Study population, there are increased odds of the likelihood of stillbirth, neonatal death, and perinatal death which is inconsistent with both the broader Australian population, and similar military populations such as those in the US and UK. However, offspring of the MEAO Census population were less likely to have birth defects or develop childhood cancer than the general Australian population. While there are many limitations to self-report data that must be considered, and many methodological constraints that make it impossible to calculate precise estimates of risk, taken together, the findings of this work support the theory that exposure to reproductive toxicants encountered during deployment may be related to adverse reproductive outcomes in ADF members and veterans. Exposure to these toxicants may also modulate the effects of other genetic, psychosocial and lifestyle factors that contribute to an individual’s susceptibility to adverse reproductive outcomes. The results warrant continued investigation, especially when combined with previous findings related to pregnancy outcomes in the military population, the importance of reproductive outcomes, and the potential emergence of new hazards. The emerging evidence about physical and mental health outcomes in Australian military women and veterans over the past two decades illustrates the need for further investigation into women’s health both during and in response to deployments, and especially reproductive health outcomes. The ever-changing military milieu demands sex- and gender- based research that is contemporaneous with women’s occupational roles to meet the future demands of military women’s acute and chronic health care needs.
dc.description.dissertationThesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2024en
dc.identifier.urihttps://hdl.handle.net/2440/144604
dc.language.isoen
dc.provenanceThis electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legalsen
dc.subjectMilitary Medicine
dc.subjectReproductive Health
dc.subjectEnvironmental Exposures
dc.subjectVeterans
dc.subjectOccupational Medicine
dc.titleEnvironmental Exposures and Infertility: What’s the Deal, Baby? Studies on the Reproductive Health of Australian Defence Force Veterans of the 2001-2009 Middle East Conflicts
dc.typeThesisen

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