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Run Toward the Fire: My journey through mental illness

Military personnel posing with their children Air Force Lt. Col. Angelina “Strike” Stephens serves as the commander of the 366th Maintenance Squadron at Mountain Home Air Force Base in Idaho, where her husband, Lt. Col. Travis “Plague” Stephens serves as an F-15E pilot and weapons officer, and commander of the 391st Fighter Squadron. Here they posed with their son, Logan and daughter, Inara (Still shot from video by Air Force Airman Natalie Rubenak, Mountain Home AFB).

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Suicide has been a part of my Air Force journey. It took a conversation with someone I trust and respect greatly, who also happens to be a mental health professional, to realize that suicide came nearer to defining my own story than I'd been willing to admit.

"I'm going to give you one piece of advice," he said.

"Run toward the fire."

I had been using 500 words to avoid the one that I was afraid of...suicidal.

I have been an ambassador for suicide prevention for over a decade. I have been on the other end of the phone line as a support system. I have been the shoulder to cry on at more funerals than I'd like to count. I have been the last known conversation. I have sprinted to my car to chase the ambulance to the room where it happened. I have been on the phone with the person who walked in as they discovered the aftermath. I've been asked to describe every interaction and memory leading up to the incident, for parents and friends looking for answers, who gave their loved one to the military and never got them back. I cared deeply, answered every call, listened, and became a fierce advocate for prevention. I could say the word, suicidal, and it held a profound meaning to me.

I knew what it looked like on someone else. I knew what it sounded like, but I couldn't understand "why." I guessed, assumed, prayed, reflected and questioned.

For the first 13 years of my career, although suicide was a part of my Air Force journey, I never understood what suicidal ideations felt like.

After I had my son in 2016, I spent a year fighting severe postpartum depression, severe postpartum anxiety and suicidal ideations. Although I had seen it on others, I didn't recognize it within my own mind. I spent a year battling suicidal thoughts, every minute of every day and I couldn't identify them for what they were.

Not thoughts...but beliefs. Facts.

Ideations

The word ideation meant something different to me once. I thought an ideation was a pre-determined plan. A conscious, active thought process that led you to a decision. Now, I understand that suicidal ideations don't always formulate as a clear, conscious desire to take your own life. Sometimes they are the wandering thoughts of a person who believes deep down that the world would be better off without them.

Military personnel posing for a picture
Air Force Lt. Col. Angelina “Strike” Stephens and her husband, Lt. Col. Travis “Plague” Stephens pose for a flight-line photo.

What it Felt Like: A view from the inside out

During that year, the involuntary images flashing across the backdrop of my mind didn't match my original definition of ideations. The flash of an oncoming car crossing into my lane, head on. A phantom feeling of falling while I stood on a balcony, followed by an odd sense of calm when I imagined falling to the ground below. Idle thoughts crossed my mind without a specific trigger or reason, and they felt like a simpler, more comforting path than the one I was on. I didn't believe I was useless, or that I didn't have a purpose, but I did believe that the world would be better off without me. In hindsight, there wasn't a rational structure to these thoughts, but in the moment, they felt rational.

Meanwhile, I was suffering from severe postpartum depression and anxiety. Together they consumed most of my attention and focus, allowing the suicidal ideations to drift past quietly, like passing daydreams. At times, the depression covered everything in darkness and made it quiet, too quiet. When the depression was dominant, I couldn't see clearly enough to allow the ideations to capture my attention. More often, the anxiety drowned everything else out with images and noise, forcing my focus to the irrational nightmares that played nonstop in my mind. The anxiety, in a twisted way, saved me from the darkness on many occasions. It shocked me out of the nothingness into something much harder to cope with, but also compelled me to put one foot in front of the other, keeping my ideations from becoming something more. The ideations were always there, capturing a small piece of my attention, threatening to pull me away with them if they caught me at the right moment.

Suicidal Ideations: Falling down the rabbit hole

I now understand why the term "committed" suicide carries such pain. Suicide takes someone, but it's not always a plan laid out by a rational mind to commit an act. What I now recognize as suicidal ideations did not shock my system at the time. In fact, they didn't solicit much of an emotional response at all. That's what made them dangerous. I had no plan, no intent, just an idle reinforcement of the "fact" that the world would be better off without me. Passing thoughts that detached me from what my own life meant to me.

When you can consider your own death with the same passing indifference as choosing what pair of shoes to wear, or watching a bird fly by, it becomes easier to turn toward unhealthy coping mechanisms. I was breastfeeding my son at the time, which meant that substances weren't an option. I'm not a person who is prone to substance abuse, but if I had found that either alcohol, or painkillers, quieted the noise, or brightened the darkness, I'm not sure if I would have been able to turn away from that relief.

Reflecting on my own experience, I now understand that suicide isn't always a predetermined decision or plan. Sometimes, it's a rabbit hole you find yourself falling down, and you can't find your way back out.

Behind the Smile: Fighting to see past the noise

I could still put a smile on my face, I still had a sense of humor and I could still fight through the thoughts that consumed me to find small slivers of purpose in my job.

The fleeting moments of humor and sense of purpose gave me a healthy, and much needed, relief. They provided me a tether to normalcy, and a distraction at times. These moments were authentic, even if they were never able to capture my full attention, as I constantly fought to see past the noise and the darkness, through whatever pinhole of consciousness was left. Every ounce of strength I had was reserved to lift the heaviest burden I've ever carried while trying to see the path in front of me clearly enough not to stumble and fall.

There's a point where depression becomes more than a feeling and a threshold where anxiety becomes an unhealthy obsession. People don't generally talk about the severe ends of the spectrum when it comes to postpartum mental illness, and it's hard to find the words to express something you've never heard described by another person.

I can count on one hand the number of times in a year that my mind was quiet enough to wander with clear reflection. One of those moments was with my son, 12 weeks old at the time, on my last day of maternity leave. I was sitting in front of the Washington Monument. He was in a front carrier, staring up at me as I described to him what I saw, my words flowing aimlessly as I just sat there talking to him for about 30 minutes. I took a picture of him that I didn't even look at it until a week later, I saw him sitting there...just watching me. He managed to clear my focus a few times in that first year, as if he understood I needed a moment of reflection.

Military personnel posing with their newborn child
Following the birth of her son, Air Force Lt. Col. Angelina Stephens suffered from postpartum depression (Photo by: Still shot from video by Air Force Airman Natalie Rubenak, Mountain Home AFB). 

The Aftermath: Reluctance to embrace helping agencies

When Logan was just over a year old, something in me started to stabilize and the burden of depression and anxiety lessened, bit by bit. Eventually, I saw clearly enough to seek help, and made an appointment to speak with a mental health counselor. I was terrified of the appointment, and almost cancelled it several times. By the time I checked in for my first-ever mental health appointment, I was "better," past the point where I needed medication or treatment for severe mental illness.

The provider recognized what I had been through, and noted that I was lucky to have gotten through it alone. I only shared a sliver of what I had been through. When they asked if I needed medication or other resources, I paused. I didn't know what waited for me on the path ahead, but I felt like I could see more clearly, and I knew that I would speak up if the worst of it returned.

The person before me presented an easier path, an "out," and I took it. I told them I would come back if things got worse again, thanked them for their time, and walked away. The stigma associated with seeking medical treatment for mental illness is strong in the military, and I was afraid for a million reasons. Looking back now, none of them should have stopped me.

I found out later, the hard way, that I didn't have the tools to put my life back together. I thought I could walk away from it all and rejoin my life like nothing had happened.

Bracing for Impact: Fearing the birth of my second child

Less than a year later I found myself finally taking a breath, but I was terrified that I wouldn't be able to rebuild the foundation of my life as strong as it was before. I was pregnant with my daughter, and my son was now approaching the "terrible" twos. We had a miscarriage a month earlier, and didn't expect to find ourselves pregnant again so soon.

I was trying hard to look forward and create distance from what I'd been through. I refused to slow down and reflect on that year, hoping it would just continue to fade away into the past. Deep down I was terrified I was going to descend into darkness again once my daughter was born.

My husband and I talked honestly about my struggles; that I wasn't ok for a time. We both had scars from that year, but neither of us acknowledged how deep they went. One thing my journey to mental health gave us were words to describe the first layer of what I'd dealt with: Postpartum Depression and Anxiety. Acknowledging it on the surface helped a bit, and helped us to talk about what we would do differently if it happened again. Neither of us talked about the full impact it had on us. We didn't dive into the harder conversations about what it felt like from the inside out, and even harder to acknowledge, what it looked and felt like from the outside in. We were too busy bracing and trying to prevent the same thing from happening again.

A New Frame of Reference: Experiencing a "normal" postpartum journey

Several months later, the military moved us across the country, just weeks after my daughter was born. When we arrived, my husband had to leave for several months of training, right around the same time postpartum I started losing myself the first time around. We were scared, but we thought we were prepared. We knew we would immediately seek help if we saw any signs of what we experienced before. We poured our energy and fear into preparing for the worst, and hoping for the best, but the worst never came.

My second postpartum experience was entirely different than my first. I remember so many instances in the year after having my daughter where I would find myself in a quiet moment, wondering if the darkness would come for me again. Wondering if the noise in my mind would turn up. I embraced each quiet moment, tried to breathe it in and reflect on my own existence. I was constantly searching for the signs within myself, feeling the boundaries of my own perspective, and relieved to a point of emotion every time I realized nothing was closing in on me threatening to pull me away.

I had days where I felt depressed, I had days where I felt anxious. I experienced feelings in ways that were completely absent from the year after I had my son. With this new experience as a point of reference, I started to realize how extreme my first postpartum journey was. I realized that what I went through with my son was Severe Postpartum Depression and Anxiety. The year after my daughter's birth was still difficult, but this time, when people made comments about "baby blues," the turmoil, emotional rollercoaster and postpartum emotions of raising a baby, their description came much closer to what I was experiencing. I felt anxious, depressed, overwhelmed, scared, happy, excited, amazed, and I was mentally present to experience every high and low of the journey.

Military personnel posing with their son
Air Force Lt. Colonels Angelina and Travis Stephens share the joys of life with their son, Logan (Still shot from video by Air Force Airman Natalie Rubenak, Mountain Home AFB).

I needed help at times, and I asked for it. The difference this time, is that I wasn't overcome by mental illness. Sometime after my daughter's second birthday, I heard someone else's story. A coworker's wife, who was a veteran herself, told her story in a video shot by the same person who filmed mine a year later. I heard her describe passing thoughts of her own death in her words, albeit under very different circumstances. I'll never forget that moment. I was leaning on the counter of my kitchen. As I heard the words come out of her mouth, I completely broke down and fell to the floor, sobbing uncontrollably. I had spent three years accepting that I experienced postpartum depression and anxiety. I could describe each one, although they were still hard to think about. As I listened to someone else describe their own suicidal ideations, memories came flooding back to me and gave a name to something I hadn't acknowledged until that moment. I saw what felt like hundreds of images of every scenario that could have taken my life over the course of a year. I remembered specific thoughts floating past me while I fought to keep the depression and anxiety at bay. And for the first time, I realized what they were.

What it Looked Like: A view from the outside in

The hardest thing to acknowledge in the aftermath is that the people closest to me were probably the LEAST likely to break through and see what was going on under the surface. The louder the noise got, the more I fought to keep it at bay, creating an armor around myself to keep anything from getting out. This had the secondary effect of preventing anyone else from getting in. The moments I did put in the effort to reach through and engage were so hard fought, I felt like I was trying harder than I ever had to make a connection. But to anyone on the other side, it felt like I wasn't trying at all, because so little was getting through. I wore a mask, and it was glued on tight.

Most people around me didn't see what my husband saw in the rare moments when I did take the mask off. Those moments didn't appear how either of us would have expected mental illness to look. I was still fighting to keep everything inside, I just wasn't using what energy was left to try to engage with the outside world. It was easier to pull back than to stay engaged outside of myself. In those same moments, I felt comforted by his presence, because those were the only moments I didn't feel like I had to fight with every ounce of energy to put on a show. But from his perspective, I appeared more disconnected than I ever had before.

When I asked my husband years later what it looked like from the outside in, he said it felt like sometimes he was a ghost, like I didn't see him or anything going on around me. When the depression took over, and covered me in darkness, he said I simply "wasn't." When I was fighting the "noise" of severe anxiety, I appeared hyper focused. At times, something caught my focus and allowed me to see past the noise. There wasn't rhyme or reason to the things that were able to capture my attention, but if something pulled me away from the noise, I fought to keep it in my gaze no matter what else was going on, in some cases to a point of obsession that didn't makes sense from an outside perspective.

The effort it took to get any fraction of my attention through the noise took everything he had and more. He was so close, and cared so much, it was affecting him as much as it was me. I can't imagine what that was like, feeling alone with the person you were once closest to in the world.

I was trying so hard to protect the people closest to me from the worst of it, I wouldn't let any of them see enough of the puzzle to put the pieces together. They were trying so hard to help me shoulder the burden they did see, there was zero chance I was going to make it heavier for them to carry by letting them all the way in.

Follow the Path Through Fire: Gaining strength by confronting the past

I didn't seek the help I really needed until two years after my first visit to mental health. It took being a commander, where I supported my own Airmen suffering mental illness. They went through the Air Force experience, trying to get help, afraid of being judged or seen differently upon return to the unit. I had very strong people, Airmen and NCOs, who shared their experiences with me. They reflected on the stigmas they experienced, preventing them from getting help sooner. I realized how severely those stigmas had suffocated me when I suffered my own illness.

I went back to mental health; this time I didn't let anyone give me an "out." I talked to professionals who knew how to help me unpack what I'd been through. I spoke with friends and colleagues who were able to help me understand my experience from another perspective. I wrote pages upon pages, trying to get my thoughts out in a way that made sense. I talked to my husband and asked him all of the questions I'd been afraid to ask for fear of hurting him, and he did the same. We became stronger together with every conversation.

We were so focused on moving forward, we hadn't allowed ourselves to look back and work through what we experienced. For four years we ran away from the fire, when what we needed was to face it. We had to confront our fears head on, to find our way out the other side, stronger. We both had to face the thing that scared us the most.

We had to run toward the fire.

Military personnel siting in their living room
Commander of the 366th Maintenance Squadron, Air Force Lt. Col. Angelina Stephens breaks down her struggles with postpartum depression and suicide ideation, the stigma around seeking mental health and her recovery (Still shot from video by Air Force Airman Natalie Rubenak, Mountain Home AFB).

Looking Back: Gaining perspective through reflection

I don't remember crying once. When I asked my husband if he remembered seeing me cry during that year, he couldn't think of a single example. I cried in my garage the other day thinking about writing this article, but over the year I was living it firsthand, nothing. It's strange to think that the hardest year of my life was so void of emotions on either end of the spectrum.

I wasn't sad, I was consumed by darkness. I wasn't anxious, I was fighting off waking nightmares. There were times I was screaming on the inside, fighting to say something but I didn't know what to say, or I was in a rare moment of relief and I didn't want to disrupt it by blurting out, "My thoughts are scrambled and dark, and I don't understand what's going on in my head." I didn't consider myself to be suicidal, and the HARDEST part of my experience wasn't the suicidal thoughts.

Reflecting on my experience, I don't know if someone could have done or said something to break through to the darkest parts of what I was internalizing. How do you ask a question that would have prompted me to share that I just pictured myself falling out of a window to my death, or imagined oncoming traffic veering into my lane, ending my life? Those thoughts would run through my mind every day. It became normal, in any circumstance that could have taken my life through a freak accident or incident, I would automatically picture it happening. I wasn't imagining taking my own life, but thoughts of my life ending floated by regularly, and they didn't scare me. They were easier to think about than the chaos of my extreme anxiety. They made more sense in my mind than the darkness that would wash over me, when the depression was dominant.

I still struggle to describe the "noise" in my head. It was unlike anything else I've ever experienced in my life. The darkness was completely different than any sadness or depression I've felt. I wasn't struggling to cope with something, I was suffering a mental illness that was beyond my control, and beyond my understanding.

Survivors' Perspectives: Guiding others to find their path

I've been asked what someone, anyone, could have done to change my experience. I honestly don't know. It's most likely to be someone outside of your inner circle who has the ability to get past the armor; someone who is less likely to get the full force of your efforts to protect them from collateral damage. Based on my own experience, and the perspective of those who have been open with me about their own journeys, there are a few things I'd recommend to connect with someone who is suffering mental illness or suicidal ideations.

Don't approach someone's mental illness as a problem to solve, or something to fix. Give them space, and the trust to be comfortable in that space. Ask questions that can give you meaningful relative comparison; describe a good day, describe a bad day. Try talking about a scale of 1 to 10, and try to understand what a 4 and a 9 feel like to them. Don't be afraid to say "you don't seem like yourself." When you move past the initial reaction, find ways to be curious, not judgmental. Ask open ended questions to acknowledge and reassure them that you're still listening. Don't be afraid of silence as they find the words to describe their thoughts.

Don't try to fix it, try to understand it.

When you're seeking to understand, don't try and give someone an answer to your own question. Give them the space to find the words. And more importantly, follow up after they've had time to reflect on the thoughts that may have been provoked by your questions. Don't be afraid to voice your observations out loud and allow them to do the same. You're not sending them down the rabbit hole, you're showing them they matter. You're helping them work through whatever they're fighting and prompting reflection that might save their life.

Most importantly just because they seem disengaged, don't assume they would not want you to ask them about it or that they want space. In my experience, most people jump quickly to that assumption, which is why most people never get past the first layer of armor.

Military personnel posing with their children
Air Force Lt. Col. Angelina Stephens eventually sought help from a mental health counselor, and prevailed over the stigma associated with seeking medical treatment for mental illness (Still shot from video by Air Force Airman Natalie Rubenak, Mountain Home AFB).

The Stigma: Fear of medical intervention

I was in an extremely distracting headspace. It was all consuming, but when I see pictures or memories, I can vividly recall almost every moment of that year unlike any other moments of my life. I was focusing intensely on every little thing, having to work so hard to see clearly, I noticed everything. As a person who is extremely self-aware, I struggle with the fact that I couldn't see how far I'd strayed from the person I once was.

If I had sought help earlier, I would have less rubble and fewer broken pieces to reassemble on the back end. The associated stigmas and fear keep many of us from seeking the treatment we need, but my family and career would have survived and I would still be where I am today. My husband and I both realize that the stigmas of seeking mental health as military members, especially as officers, had a huge impact on our journey. Understanding that there's a point where mental illness needs medical treatment, no matter the support system or resiliency of the individual, was a lesson we learned the hard way.

I was incredibly lucky that the worst of my mental illness resolved itself before my ideations came to fruition.  But if we had it to do over again, we wouldn't try to face it alone. It takes professional intervention to beat the most severe illnesses we face as humans. Mental illness is no different.

Fear of medical intervention takes lives at an alarming rate. Not because people are beyond saving, but many people lost to suicide are fighting something they don't understand, and never even attempt to get the life-saving care they need.

Breaking Through the Stigma: Creating a new narrative

I would have NEVER considered myself suicidal. I never actively thought about committing suicide.

My existence was a fight for survival every day and I'm lucky I'm still here to talk about it. My story could have ended differently, my survival relied on luck and circumstances. Now my journey is focused on creating a world where mental illness is just as easy to talk about as any other medical condition, without fear of judgment, with a focus on healing, recovery and support along the way.

To the person reading this who is fighting their own battle; it doesn't have to be this hard, you don't have to do it alone. You aren't weak for needing help. The world would NOT be better off without you. Your leaders, peers and subordinates won't look down on you for getting help. Many of us can relate more than you'll ever know.

It has been about four years since the fog lifted and the noise grew quiet enough for me to begin my path to recovery. At first, I struggled to realize that I couldn't fully rejoin my life until I went back and acknowledged what I went through. I was fighting to put everything behind me, instead of allowing myself to learn from my own mistakes.

Looking Forward: Learning to embrace life

I look back on two years of Command, the most incredible experience of my Air Force career, which has only been strengthened by my ability to face and share my own experience. I wonder how much stronger we would be as Airmen if we fought together to defeat the stigmas that keep us from being the best versions of ourselves.

The last year hasn't been easy, but with every hard conversation I feel stronger. Every time I find a new way to express the hardest parts of what I went through, the words help me put the pieces back together. Just like any obstacle in life, I look back and see things I should have done differently but I continue to move forward and choose to focus on the future I see in front of me.

I choose to focus on leaving clear footprints that show a better path for those who come behind me, helping others find the words to describe something they don't yet understand, and to overcome the fear that keeps them from getting the support they need and deserve.

Most importantly, I see a life I could have missed altogether.

I see my son, now almost 5 years old, sneaking out of bed early to claim a lap seat for his favorite superhero cartoon, staring up at me with the same big blue eyes that showed me the way through the darkness.

I see my daughter, now 3 years old, full of joy and determination, making the world brighter for every path she crosses, who wouldn't be here if I had chosen a different path for myself.

I see my husband by my side, my rock and soulmate, looking forward to a life of adventure with our family, stronger together because he was willing to guide me through the fire and discover what waited for us on the other side.

I see a life of infinite possibilities, and I'm grateful every second of every day that I'm here to live it.

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12/21/2017
Did you know…?  •	From 2012 – 2016, there were 63,879 live births to women of childbearing potential in the active component. The overall live birth rate was 64.9 live births per 1,000 person-years (p-yrs). The live birth rate decreased steadily from 69.8 per 1,000 p-yrs in 2012 to 59.7 per 1,000 p-yrs in 2016. The decrease was primarily driven by declining rates among women in their 20s. Overall, live birth rates were highest among women who were: •	30-34 years old •	Army members •	In healthcare occupations •	Married Of the total 63,879 live birth deliveries: •	24.7% were cesarean •	75.3% were vaginal Pie chart depicting this information displays. United States map displays showing the highest numbers of deliveries during the surveillance period reported by military hospitals at: •	Naval Medical Center Portsmouth, VA (7.4%) •	Naval Medical Center San Diego, CA (6.1%) •	The Carl R. Darnall Army Medical Center, TX (4.1%) •	Womack Army Medical Center, NC (3.8%) •	Tripler Army Medical Center, HI (3.7%) Live birth rates were broadly similar among the race/ethnicity groups, although the overall rate was slightly higher among American Indians/ Alaska Natives. Access the full report in the November 2017 MSMR (Vol. 24, No.11). Go to: www.Health.mil/MSMR

This infographic documents live births among female service members, active component, U.S. Armed Forces from 2012 – 2016.

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Women's Health

Pregnancies among female service members, Active component, U.S. Armed Forces, 2012 – 2016

Infographic
12/21/2017
With the increasing numbers of service women and the expansion of roles available to women within the military, understanding the epidemiology of pregnancy is important for both the health of U.S. service women and the readiness of the U.S. fighting force, two closely related issues. Between 2012 – 2016, 344,536 unique women of childbearing potential (WOCBP) served at least 1 day in the military, and of those, 132,466 spend at least 1 day as a recruit trainee. Of the 224,718 WOCBP who served at any time in 2016, 13.1% had at least one pregnancy-related event during that year. A “pregnancy-related event,” refers to a health care encounter (visit) for which the record contains a diagnosis code for either pregnancy or a positive pregnancy test. In 2016, the highest prevalence of pregnancy-related events was among service women 30-34 years of age (16.8%) and among senior enlisted women (13.7%). Pie chart displays depicting the information. The annual prevalence of pregnancy-related events decreased slightly, from 14.2% in 2012 to 13.1% in 2016. Line plot graph displays this information. FINDINGS •	Prevalence of pregnancy-related events was approximately evenly distributed among the race/ethnicity categories and military occupation groups. •	A slightly higher percentage of WOCBP in the Army (14.5%) had pregnancy-related events compared to WOCBP in the other services. •	A higher percentage of women who were married (21.4%) had a pregnancy-related event, compared with those in the single (5.7%) or “other” (8.8) categories. •	Only 0.2% of women who served during a recruit training period in any given year had a pregnancy-related event. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to www.Health.mil/MSMR.  Graphic on infographic shows a pregnant service member.

With the increasing numbers of service women and the expansion of roles available to women within the military, understanding the epidemiology of pregnancy is important for both the health of U.S. service women and the readiness of the U.S. fighting force, two closely related issues. This infographic documents pregnancies among female service members, active component, U.S. Armed Forces from 2012 – 2016.

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Women's Health

Tdap vaccination coverage during pregnancy, active component service women, 2006 – 2014

Infographic
8/14/2017
Pertussis, commonly known as “whooping cough,” is a vaccine-preventable illness more common and more severe in children than in adults. Infections during the first few months of life can be particularly severe, with almost all deaths from pertussis occurring in infants less than 6 months of age. A vaccinated mother’s antibodies against pertussis protect the baby during pregnancy until it can receive the vaccine at two months of age. Approximately 400 probable and 50 confirmed cases occur annually among service members and other adult beneficiaries of the Military Health System. In 2012, the Advisory Committee on Immunization Practices recommended Tdap for every pregnancy to reduce the burden of pertussis in infants. This surveillance study assessed Tdap vaccination coverage among pregnant service women during 2006 through 2014. FINDINGS: •	There were records of a total of 137,133 live birth deliveries to service women •	Only 1%  – 3% of service women received a Tdap vaccine during pregnancy from 2006  – 2011 •	Tdap vaccination coverage increased substantially  – 8% in 2012 to 54% in 2014 •	Navy women had the highest  annual proportion of vaccine coverage at 65% in 2014 •	First deliveries had the highest vaccination coverage at 57% in 2014 •	Fourth or subsequent deliveries had the lowest coverage at 41% in 2014 More education and attention by military physicians and pregnant service women about the benefits of Tdap vaccination are needed to bring coverage closer to 100%. Learn more in MSMR Vol. 22 No. 5 May 2015 at Health.mil/MSMR  Images on graphic: •	Baby icon to depict live birth deliveries •	Pie charts showing the findings in visual form •	Line graph showing the percent vaccinated among Navy, Marine Corps, Army, Air Force and Coast Guard The line graph shows the annual percentages of active component service women with a live birth delivery who received a Tdap vaccine during pregnancy, by year of delivery and service, 2011– 2014.

This infographic documents findings from a surveillance study that assessed Tdap vaccination coverage among pregnant service women during 2006 through 2014.

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Armed Forces Health Surveillance Branch | Tetanus-Diphtheria-Pertussis | Women's Health

Interim Guidance for Prevention of Sexual Transmission of Zika Virus

Policy

With this update, CDC is expanding its existing recommendations to cover all pregnant couples, which includes pregnant women with female sex partners. This guidance also describes what other couples (those who are not pregnant or planning to become pregnant) can do to reduce the risk for Zika virus transmission. CDC’s recommendations for couples planning to become pregnant have been published separately (9).

Zika Virus and Pregnancy

Infographic
6/21/2016
infographic about Zika virus and pregnancy

Zika can cause certain birth defects. This infographic offers information to pregnant women about how to protect themselves from the Zika virus.

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Preventing Mosquito-Borne Illnesses | Zika Virus | Mosquito-Borne Illnesses | Women's Health

The HPV Vaccine Saves Lives

Infographic
5/16/2016
The Defense Department recommends male and female military service members, ages 17-26 years, receive an HPV vaccine series to generate a robust immune response to the quadrivalent human papillomavirus vaccine (HPV4). This graphic highlights information the benefits of the HPV vaccine. The vaccine is most effective among fully vaccinated individuals.   Cancer Prevention Facts •	HPV is the most common sexually  transmitted infection (STI) •	There are more than 40 HPV types that can infect the genital areas •	Some HPV types give warts •	Some HPV types develop cancer  Effective Against STI Transmission •	The HPV vaccine is a safe and effective way to protect yourself from the virus •	The HPV vaccine provides nearly 100% protection from HPV types 6,11,16 and 18 •	HPV vaccine shows early signs of success in reducing HPV infections and related illnesses •	Protection is expected to be long-lasting  Safety Tips •	Getting your HPV vaccine and practicing safe sex such as wearing a condom may lower the risk of HPV •	Limiting the number of lifetime sex partners can also lower the risk of HPV •	When given the HPV vaccine, the body makes antibodies in response to the protection to clear it from the body  Get the Facts •	2,091 female service members aged 17-26 years received 1-3 HPV4 doses during 2006-2012, stratified by number of doses (1, 2, or 3).  Get the HPV Vaccine •	Only 22.5% of eligible service members initiated the series •	Of those, only 39.1% completed the full three-dose series as of June 2011.  Even though the 3 dose regiment provides nearly complete protection against HPV16 and HPV18, in the U.S., only 12% and 19% of female adolescents among commercial and Medicaid plans respectively complete the series.  Read HPV Facts from the CDC: https://www.ok.gov/health2/documents/IMM_Teens_HPV_Facts.pdf  Read the STI issue of the Medical Surveillance Monthly Report at Health.Mil/MSMR   Get the conversation started. Ask your healthcare provider about the HPV vaccine today. Follow us on Twitter @AFHSBPAGE and use hashtag #VaccinesWork.

The Defense Department recommends male and female military service members, ages 17-26 years, receive an HPV vaccine series to generate a robust immune response to the quadrivalent human papillomavirus vaccine (HPV4).

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Medical and Dental Preventive Care Fitness | Immunizations | Men's Health | Human Papillomavirus | Armed Forces Health Surveillance Branch | Women's Health

Breast Cancer

Infographic
5/9/2016
infographic about the breast cancer and how to protect against it.

In the U.S., with the exception of skin cancer, breast cancer accounts for the greatest number of cancer diagnoses in women and the second most common cause of female cancer-related deaths. This infographic shows seven ways to protect yourself from breast cancer.

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Medical and Dental Preventive Care Fitness | Women's Health

Smallpox Vaccine in Pregnancy

Publication
2/26/2016

The National Smallpox Vaccine in Pregnancy Registry was created to follow the pregnancy outcomes of women who were exposed to the smallpox vaccine during pregnancy.

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Smallpox (ACAM2000) | Women's Health

Cervical Health Awareness Month

Infographic
1/11/2016
Infographic about Cervical Health Awareness month

January is Cervical Health Awareness Month

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Women's Health | Medical and Dental Preventive Care Fitness
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