Families within the Armed Forces have some specific needs when accessing services in respect to conception, maternity, perinatal mental health and adoption. Service life and injuries to Veterans can need special considerations to be taken into account to ensure no disadvantage, and to ensure continuity of care and access to help when needed. The following factsheet should help raise some awareness of the findings raised through research, NHS briefings, Family Federations and cases that the Armed Forces Network has dealt with.
Our thanks to our colleagues within the Sussex and East Surrey Local Maternity System and the Sussex and East Surrey Perinatal Mental Health Clinical Network for their input in the development of this factsheet.
There are over 190,000 Serving Personnel in the British Armed Forces, of which approximately 140,000 are based in the English regions. Serving Personnel are all registered with Defence Medical Services (DMS) GP practices; their spouses/partners and dependants usually have to register with a NHS GP practice, although there are a small number of DMS practices that will allow families also to register with them. Military spouses/partners are predominately female reflecting the gender balance in the Armed Forces with just over 10% of female Serving Personnel.
The unique circumstances and requirements of a military career - not least the frequent moves within the UK and overseas which can involve long periods of separation - can be very challenging for the partners and families of Serving Personnel, both in terms of continuity of care and impact on mental health. These challenges can be particularly difficult for female partners when pregnant and in the weeks that follow giving birth.
Armed Forces Serving Personnel are generally young and the Armed Forces community includes large numbers of female spouses/partners of childbearing age. Military careers can require regular moves of the family home, often far away from family support networks. As a result, vulnerable young women may be at greater risk of social isolation; they may find themselves having to move while pregnant and furthermore, their serving partner may be posted overseas for significant periods of time including during pregnancy, the birth and the postnatal period. Emotional vulnerability may be exacerbated by fears over the safety of their absent partners. There may further challenges for continuity of carer for women who live in one Local Maternity System (LMS) but give birth in another. For example, women from Thorney Island in West Sussex will often give birth within the Hampshire LMS.
The Army Families Federation, an independent organisation that works to improve the quality of life for Army families, reports that common concerns among pregnant partners include:
A recent literature review published in January 2019 identified a strong focus on spousal deployment as a risk factor for depressive symptoms and psychological stress during the perinatal period. Other risk factors included a lack of social/emotional support, and increased family-related stressors.
Female members of the Armed Forces may face significant peer pressure to continue in their roles during pregnancy. They are more likely to transition between local maternity services when pregnant – particularly Serving Naval Personnel – who may move from Defence Medical Service health care provision back to local NHS services for their home base where the birth is planned. Some may return to the UK for the birth if they have been posted overseas, particularly if the pregnancy is high risk. Serving women with service-related post-traumatic stress can have this re-triggered by giving birth, even in a relatively straightforward birth.
The Armed Forces Network has been contacted by families asking for support due to:
The individuals, when they know which area they are moving to, can review the National Health Service (NHS) website to choose a GP. If there any difficulties the local Clinical Commissioning Group (CCG) can provide support to get a GP ahead of moving to ensure the continuity of care. The family should ensure that they are identified as a British Armed Forces family in order to invoke the Armed Forces Covenant, and the GP practice should work to ensure continuity of care due to the family moving as a result of a partner being in the Armed Forces.
The family can contact the new local hospital and self-refer (remembering to state that they are moving due to being an Armed Forces Service Family):
Infertility is when a couple can't get pregnant (conceive) despite having regular unprotected sex. If a family have fertility problems, the treatment they are offered will depend on what's causing the problem and what's available from the commissioners for them.
There are 3 main types of fertility treatment:
IUI, also known as artificial insemination, involves inserting sperm into the womb via a fine plastic tube passed through the cervix. Sperm is first collected and washed in a fluid. The best-quality specimens – the fastest moving – are selected.
In IVF, the egg is fertilised outside the body. The woman takes fertility medication to encourage her ovaries to produce more eggs than normal.
The current NHS Armed Forces Commissioning Policy on Assisted Conception upholds the National Institute for Health and Care Excellence (NICE) guidelines of three cycles of treatment for couples who meet the eligibility criteria. Whilst Assisted Conception is classed by Defence Medical Services as non-essential elective procedures and, as such, are not required to return military personnel to operational ﬁtness, where possible and practicable, they will facilitate testing of Service Personnel for fertility issues to ensure they have equal access to this treatment as for any civilian.
On top of this commitment, the Ministry of Defence (MoD) and NHS England have worked together to set out good practice in a Defence Instruction and Notice (DIN 2016DIN01-052 Assisted Conception and Fertility Policy). The MoD recognises that the investigation and diagnosis of fertility issues and any subsequent treatment takes time and, as Armed Forces personnel are more mobile than the majority of the UK population, this can impact on continuity of care and increase the stress associated with the process. Therefore again, where possible and practicable, the MoD will provide up to three years of geographic stability, in the United Kingdom, for military couples accessing Assisted Conception.
In vitro fertilisation (IVF) is one of several techniques available to help people with fertility problems have a baby. The National Institute for Health and Care Excellence (NICE) has published fertility guidelines that make recommendations about who should have access to IVF treatment on the NHS in England and Wales. If you are considering IVF, you may want to have a look at the links as they provide a lot of useful information:
As stated NHS England has written a specific commissioning policy for Armed Forces families , living in England, outlining the pathway and criteria for access to assisted reproduction methods such as IVF and Intra-Cytoplasmic Sperm Injection (ICSI).
This commissioning policy helps to prevent some of the issues that couples face due to mobility and accessing treatment. To qualify for treatment under the NHS Armed Forces Commissioning policy at least one member of the couple must be in the Regular British Armed Forces with more than six months left to serve. It may be either the Regular Servicewoman seeking assistance for themselves or their spouse/partner or Serviceman whose spouse/partner are seeking assistance and includes unmarried or same sex partners. However, couples should be aware there are several other clinical criteria which must be met before funding can be approved for NHS treatment and their doctor can advise further on these.
A copy of the application form can be found NHS England website.
Further information can be obtained via the Family Federations:
The Clinical Commissioning Groups (CCGs) commission the health service for Veterans, Reservists and their families. They have responsibility for the assisted conception for this community. There are variations on access and quantity for the population that each CCG covers. These members of the Armed Forces community would be treated the same as the rest of the local population as they would not have been disadvantaged through serving in the role as a Reservist.
However, it should be noted that there are exceptions which CCGs should take into account when making any decisions. If a Veteran/Reservist has been injured through serving and this has impacted on their fertility, they should have the same access to treatments as those funded by NHS England (i.e. 3 courses of IVF). The injury could be due to a chemical or physical injury.The other consideration is where the first marriage has broken down due to the service (it may due to several moves, or injury making the relationship irreparable) and the Veteran/Reservist is in a new relationship and wants to have child with that partner and had a child in the first marriage.
The MoD recognises that there are a number of Service Personnel and their families who are both willing and well suited to adopting a child or children and that there are many children who are waiting to be adopted.
Adoption can be a long process and military life may impact on this process. One reason could be that the families may move with the Serving partner. The family may experience difficulties in dealing with a Local Authority (LA), Devolved Administrations or other UK agencies.
The family are entitled to use any adoption service they wish to. Due to the potential difficulties of military life, many Service families prefer to register with SSAFA’s Adoption Agency because they often better understand the complexities of military life. SSAFA’s Adoption Agency is able to act directly for Service families or they can provide assistance in dealing with other adoption agencies.
In 2018, 40% of SSAFA adopters were in the same-sex relationships, four times higher than the national average. This has led the SSAFA’s Adoption Team to become experts in both military and LGBT+ adoption placements.
The Armed Forces Families Federations also provide specific information for Serving Personnel families on adoption and fostering:
Poor mental health in the perinatal period is associated with a number of adverse outcomes for the individual and the wider family. The challenges facing female military spouses and female members of the Armed Forces may increase their risk of pre and postnatal mental health problems. In addition, a female Veteran spouse or female Veteran may have higher risk due to injury of the Veteran whether physical or mental putting strains on the family in an environment where the culture is often that they should be able to manage and not seek help.
The Army Families Federation (AFF) supports family members of Serving Personnel until 2 years post discharge from the service. It has a page on mental health and within it (section 3) is information on Postnatal Depression along with some useful contacts. It also has the contact details for the AFF.
This is a community-based service which supports mothers who are experiencing, or who have previously experienced, severe mental health difficulties during pregnancy or up to a year after birth.
The Sussex Partnership NHS Foundation Trust provides support to women and their families across East Sussex, West Sussex, Brighton & Hove and East Surrey. Their leaflet explains the service in more detail for families and carers.
The Mother and Infant Mental Health Service (MIMHS) in Kent and Medway is split between East Kent and West Kent. More information about the service can be viewed via their website:
Having a baby can be joyful, exciting and rewarding. However, it is also common for pregnant women and new parents to experience anxiety, depression or emotional distress. As many as one in five women experience emotional difficulties during pregnancy and in the first year after their baby’s birth. This can happen to anyone.
The IAPT service (Improving Access for Psychological Therapies) covers the whole area and offers free, confidential talking therapy for people who have symptoms of anxiety or depression. They give priority to pregnant women and new parents.
It is common for pregnant women and new parents to experience:
It can be difficult to talk about how you are feeling and ask for help. Common reasons for this are:
Struggling emotionally at this time can happen to anyone.
IAPT services offer short-term talking therapy to give individuals space to talk. The types of therapy offered will vary depending on the local IAPT service. Partners can also be affected by mental health problems too around a pregnancy, the birth and the postnatal period and may also be able to access IAPT support.
Most IAPT services will accept self-referrals and these can be done by accessing their websites or contacting them directly via phone. If an individual is finding it hard to contact the service themselves, support should be sought from the midwife, health visitor, friends or a family member. GPs can also make the referral and the IAPT teams will offer an assessment and treatment as soon as possible. All IAPT services aim to be flexible and may allow for the new baby to be bought to sessions, with a choice of locations for appointments in accessible space.
|Brighton and Hove||Brighton and Hove Wellbeing Service||0300 002 0060|
|East Sussex excluding Brighton and Hove||Health in Mind||0300 003 0130|
|Crawley and Horsham||Time to Talk – West Sussex||01403 620434|
|Mid Sussex (Burgess Hill, East Grinstead, Haywards Heath)||Time to Talk – West Sussex||01444 251084|
|Adur, Arun, Chanctonbury & Worthing Henfield, Lancing, Littlehampton, Shoreham, Steyning, Storrington||Time to Talk – West Sussex||01903 703540|
|Bognor, Chichester and surrounding area Arundel, Loxwood, Manhood Peninsula, Midhurst, Petworth, Pulborough, Southbourne||Time to Talk – West Sussex||01273 265967|
|East Surrey||DHC Talking Therapies||01483 906392|
|East Surrey||ieso Digital Health||0800 074 5560|
|East Surrey Caterham, Oxted, Redhill, Reigate||We Are With You||01737 225370|
|East Surrey Caterham, Dorking, Epsom, Oxted, Redhill, Reigate||Mind Matters Talking Therapy||0300 330 5450|
|East Surrey Redhill, Reigate, Caterham and across Surrey||Centre for Psychology||01737 306020|
|Medway||Medway Talking Therapies||0300 029 3000|
|Kent Deal, Dover, Folkestone, Hythe and Rural||Dover Counselling Centre||01304 204123|
|Kent Ashford, Canterbury, Dartford, Deal, Gravesham, Swale, Swanley, Thanet||Insight Healthcare||0300 555 5555|
|Kent Ashford, Deal, Dover, Folkestone, Hythe and Rural, Maidstone, Mid Kent||We Are With You||0300 012 0012|
|Kent Canterbury, Coastal Kent, Swale||FCS Talking Therapies||01795 591019|
Feedback from Welfare Teams and from other services across the country has identified that those under the age of 5 years may have difficulties adjusting to the house moves and unsettlement in a service family’s life. It is an area where further research is required.
Attention deficit disorder (ADD) is a neurological disorder that causes a range of behaviour problems such as difficulty attending to instruction, focusing on schoolwork, keeping up with assignments, following instructions, completing tasks and social interaction.
Each type of ADHD is tied to one or more characteristics. ADHD is characterized by inattention and hyperactive-impulsive behaviour. These behaviours often present in the following ways:
Everyone is different, so it’s common for two people to experience the same symptoms in different ways. For example, these behaviours are often different in boys and girls. Boys may be seen as more hyperactive, and girls may be quietly inattentive.
There isn’t a simple test that can diagnose ADHD. Children usually display symptoms before the age of 7. However, ADHD shares symptoms with other disorders. A doctor may first try to rule out conditions like depression, anxiety, and certain sleep issues before making a diagnosis.
Families can access the HCP teams by a variety of routes - themselves, through children’s centres, schools or doctor’s surgeries. No referral is necessary – any woman who is pregnant will automatically have contact with her health visitor, as should families with young children who move into an area.
Health Visitors/ Healthy Child Programme links:
All areas have a Maternity Voices Partnership (MVP) which is a NHS working group: a team of women and their families, commissioners and providers (midwives and doctors) working together to review and contribute to the development of local maternity care. Every woman on the maternity pathway has a chance to have her voice heard about the service she is receiving through an MVP.
Local Contacts - Chairs of Maternity Voices Partnerships:
You can also find details of the different Maternity Voices Partnerships around England via the National Maternity Voices website.