# Reproductive and Female Health in the Australian Defence Force 2002-2023: A Systematic Review and Synthesis

## TL;DR

This review summarizes research on reproductive and female health in the Australian Defence Force from 2002 to 2023, highlighting gaps and the need for better studies.

## Contribution

The paper provides a systematic synthesis of existing evidence and identifies critical research gaps in reproductive and female health among ADF members.

## Key findings

- Only 8 studies on reproductive health and 14 on female health were identified, with limited data on female-specific outcomes.
- Deployment to the Middle East was not linked to infertility or birth defects in males, but female data remains sparse.
- Most female health studies focused on musculoskeletal injuries rather than reproductive health.

## Abstract

Military service involves potential exposure to a range of physical, chemical, and biological hazards that could impact reproductive health. Females represent 20% of Australian Defence Force (ADF) members and, like many military services, the ADF is prioritizing their recruitment and retention. However, given that females have different physiology and anthropometry, specific female occupational research is essential. This systematic review aimed to retrieve and summarize the findings of research involving currently serving ADF personnel with outcomes relevant to male or female reproductive health or any aspect of female health.

Reproductive and female health studies between January 2002 and April 2023 that included serving ADF members were identified through a systematic search of 5 scientific databases. Data were extracted and synthesized, alongside a risk of bias assessment following PRISMA-ScR guidelines.

Overall, 8 studies relating to reproductive health and 14 studies related to female health were identified. Studies were methodologically heterogeneous: few studies were at low risk of bias and few covered the same health outcome, preventing pooling of data. Four studies of males concluded that deployment to the Middle East was not associated with risk of infertility or birth defects. Female reproductive health studies provided very limited data. Other female health research primarily covered musculoskeletal disorders and injuries from basic training.

Studies of reproductive and female health in ADF members do not currently provide a cohesive or comprehensive body of evidence in either area. This review serves as a systematic map of the existing evidence to identify gaps and set future strategic research agendas. More high-quality longitudinal studies with sex-stratified analyses are urgently needed, as is a strategic focus on health outcomes that may affect military preparedness and fitness for deployment.