1Anne looks at the planning schedule for the month ahead. She won’t often be at home, and her on-call duties in the “reserve” operating theatre allow last-minute changes to be incorporated. She has to go immediately and see her daughter’s nanny, to get things sorted out. On the other side of Paris, Catherine has just taken her son to school and is checking through the times she will be away. She is a Head of Department, and will be away for virtually all of three weeks. As for Françoise, she is on call for a military hospital, and this Sunday evening she has just put her four-year-old daughter to bed when the Operational Centre contacts her: “You are expected in three hours’ time at Villacoublay airport, where a Falcon has been chartered. There are French military personnel who have been seriously injured.” During the night, she gets her kit together, calls her family, who live in the provinces, and leaves for the mission, which wasn’t scheduled and – though she doesn’t yet know it – will last a month and a half. Anne is an airline pilot and will soon be a captain, while Catherine manages a multinational’s internal audit department. All three have children. Catherine’s husband is a public works engineer, and currently project leader at a large site abroad. Anne is separated from her partner, who could no longer put up with her being away. Are these exceptional situations? No: they are just the logical result of the process towards equality at work, in responsibilities and in incomes between men and women in Western society.

2France’s armed forces started recruiting women in the 1980s, when military service was compulsory and External Operations (“opexs”) were mainly assigned to wholly professional units. With professionalisation underway and quotas abolished from 1998, the officers’ and sub-officers’ schools are now receiving more and more women. Each branch of the armed forces strove to gain publicity for this change by showing how much they were in tune with French society. You could see a proliferation of pictures in the media, showing women helicopter and fighter pilots, ships’ officers of the watch on the bridge, and group principals. The national day of 14 July never passed without an interview targeting a woman – generally something of a looker – in uniform.

3Why, then, do we question the idea of being a mother, when we don’t question deploying fathers on military operations? Is there a specific difference between motherhood and fatherhood in a military context? The question lies more in the unusual nature of a child’s relationship with each parent and the psychological consequences for the youngest when a parent goes away on a mission.

4After reviewing the situation regarding women’s position in the armed forces, we have chosen to look further into the implications of mother-child separation in the course of an External Operation, in order to understand what sources of distress there may be on each side. We are beginning a reflection that will be useful for the various parties with responsibility for human resources, who are often confronted with the need for difficult balancing acts.

A sociological change not to be misjudged

5France’s armed forces are now wholly professional, with the female component reaching 15% in 2009. Women account for 21% of air-force personnel and over 50% in the forces’ health departments [1]. This makes the French forces one of the most feminine in Europe. Women are more numerous in the lowest ranks of the hierarchy and, overall, they are younger. Three-quarters of them live with a partner. Some 55% of military personnel are parents before the age of 35, and by 45 eight women out of 10 are mothers.

6Women are now to be found in nearly all the divisions and specialities, including “contact” forces and fighter aircraft. This has resulted in the proportion of women on opexs or long-term on ships of the French navy being around 5%. The only exceptions are employment as fighters in the Foreign Legion, in submarine crews and positions as sub-officers in gendarme platoons. It should be noted that the US navy has just opened operational positions in submarines to women.

Operational availability

7The armed forces’ health service was a pioneer in accepting women. It should be remembered that, historically, France’s specialist air-evacuation nurses undertook not to have children, in order to be available at any time and anywhere. Geneviève de Galard’s account from Indochina revealed the role that female nurses played when dealing with the soldiers. For the latter, Geneviève was, at the same time, partly their mother, a sister, a friend and a confidante, her presence alone bringing some humanity into that hell of fire, mud and blood. She wouldn’t hand it over to anyone else. What about the fear? There simply wasn’t time! The anxiety and death? Collective imagination suggests these questions. How can a woman, and thus a life-giver, put up with the ubiquitous violence, the threat of death, and even killing to protect one’s own life and the lives of others, or simply to fulfil the mission entrusted to that person? Each person, whether woman or man, responds according to a personal history, social and family milieu, personality and occupational motivations.

8Behind these questions, however, lies the very simple one of operational availability if you are a soldier and a mother of young children. With half of them living with a partner, women in the military endeavour to reconcile family life with their professional activities, which is why, in some cases, they look for a stable job with predictable hours. Women with a family who are contracted to a speciality where they are liable to be sent on a mission have to find a way of organising their lives in terms of those relief duties. Many of them plan their pregnancies in terms of the positions they occupy. Some – those with very young children – sometimes refuse to go away on missions. That is clearly observed in the armed-forces health service. Six-month missions at Forward Operating Bases or Combat Outposts demand intensive preparation, which dramatically increases the time away. The Quotidien du Médecin daily newspaper recently published the results from a survey of French military doctors in Afghanistan [2]. Some extracts from respondents’ accounts are given below.

9“We can see a reduction in the number of doctors available, resulting from the increasingly female staffing. Pressure is being felt increasingly by the male doctors. If, in order to carry out my duty as a military doctor, I have to put my life at risk, I now have to accept in advance that I may be killed. While not being a hothead, that is part of the contract we have to honour… To avoid finding yourself in Afghanistan, some people focus on problems within the couple, together with worries about the children. But all that does is to push back the departure date a bit. Other people get themselves discharged on sick leave. Two cases where people resigned were also mentioned.”

10“The greatest problem results from the increasing reliance on women in the armed forces health service. Those of us who leave as part of an Operational Monitoring Liaison Team are liable to be incorporated into a unit of the Afghan army, from which women are excluded. In addition, during Inter-force Tactical Group missions, where the requirements are quite physical, there are not many women. People therefore mainly call on the male contingent. And it is always the same people who get on with it. This creates a problem, to which we alerted central management 10 years ago, when we asked for quotas to be instituted, or else physical tests to be included in the selection competition.”

11These accounts testify to the anger experienced in the face of a reality: the mothers of young children are less often operational. Their growing number presents problems of availability, in terms of human-resource management. It is nevertheless essential not to stigmatise women in the armed forces and to let it be thought that their sex puts them in an exceptional position that frees them from operational obligations. Rather, what is needed is for the specific medical and psychological features of motherhood to be taken into account and accepted. There would, indeed, by a danger in only taking a bean-counting approach, looking at personnel numbers available to be sent on missions and getting bogged down in a fear of the “small difference” that could arouse tension, and even lead to exclusion.

12Sigmund Freud used the concept of “narcissism of small differences”, in his Civilisation and its Discontents, to explain features that complete outsiders would see as barely noticeable but which become emphasised to distinguish certain individuals and/or groups. Freudian theory tells us about our need to rigidly categorise various groups of individuals by considering them as different beings, whom it becomes “necessary” to exclude. President Bush tried to keep the 200,000 women in uniform away from active fighting, bringing himself under attack from lots of feminist associations and politicians, for whom the armed forces, a bastion that women had conquered, remained “the only employer to practise sex discrimination”.

13And yet a story reported by afp on 15 October 2010 said: “The US army is testing its first-ever combat uniform expressly designed to fit the female figure … to make 160,000 women soldiers more comfortable.” That is 14% of the total personnel. In particular, there will be “more material to accommodate the buttocks.” Compared with the straightforward lines of the men’s version, the female uniform has a few centimetres’ indentation at the waist, lengthening of the coat over the hips, and vents in the back providing space for the bust. An elastic waistband replaces the trouser drawstring, and unneeded material is removed from the shoulders and crotch. It took five years’ study to design the female Army Combat Uniform, whereas there was already maternity-wear for women soldiers.

14So how can the various perspectives be reconciled, to end up with acceptance of the differences, given that the entry of women into Western armed forces is a fact, and even a necessity to meet the human-resource needs? Perhaps the viewpoint of a psychiatrist on mother-child relationships will give us a better understanding of the difficulties and issues at stake, so that we do not dismiss the problems in too simplistic a manner.

Mother-child separation: a psychological perspective

15Saying that being a mother does not affect women’s operational availability reflects a profound misunderstanding of the psychological processes at work, resulting more from simplistic thinking. Recruiting and training women for the armed forces is by no means a straightforward matter, and necessarily has implications for the way the military is organised, and for its ability to send personnel on missions. That reality is confirmed on an everyday basis in operational units, and is also observed medically. Psychiatrists, paediatricians and psychoanalysts were worrying about the issue of young children being separated from their mothers long before our contemporary experience of mass enlistment by women. The psychological consequences of a separation that is too long or too sharp are well known and have resulted in very detailed analyses being written [3].

16Small children’s ability to tolerate separation from their mothers develops bit by bit during their first years. They first learn to recognise their mothers and begin to trust them. They then experience being alone, while the mother is nearby, in the next room or briefly out shopping, etc. The absences should be progressive, and allow the child to develop the ability to play by him- or herself, to dream, and to think about the mother, even when she is not physically present. This is an ideal scenario for a child to find out about his or her own life, with the relationship neither too distant nor too close. The children then become able to do without the mother’s actual presence and should be able to manage their frustrations. If the mother is in good (mental and physical) health, she will be able to respond neither too soon nor too late to her child’s cries. If these first experiences of frustration are too long or too sharp, the child may show difficulty in gaining independence and experience lasting anxiety problems. Assisted by the people around her, the mother figure has a fundamental role to play in harmonious development of the child’s personality. In addition, she supports and confirms the father’s authority.

17Apart from the adverse consequences for the child of too long or too sharp a separation, there are also consequences for the mother. The efforts she should make to adjust psychologically to separation from her child necessarily affect her operational availability, her effectiveness and her ability to withstand stress. There are, obviously, exceptional women – adventurers, women in humanitarian roles, and legendary female fighters – whom we admire, but here we are not talking about those exceptional women; we are concerned with those with ordinary abilities in terms of courage, educational abilities and affective capacity.

18In 1956, Donald W. Winnicott, an English paediatrician and psychoanalyst, described what he called the “primary maternal preoccupation”, referring to a mother’s ability to adjust to her child’s needs [4], and his ideas have not been disputed. This biological and psychological stage involves a necessary deference towards the young child. The mother leaves this stage only gradually, over several months. She lessens her attention imperceptibly as her child grows, in phase with the progress made by the infant.

19In contrast, with a woman in an occupation that involves a lot of “operational” activity or that is highly “masculine”, it may be difficult to fully experience that stage. Finding herself torn between her professional duties and this special bond, she may insidiously develop psychological manifestations that prevent her complete involvement in the mission. In addition, instead of reaping the benefits to be gained from early and adequate mothering of her new-born, there is a risk, over the years, of having to deal with her child’s anxiety and behavioural disorders. These too can have a long-term impact in terms of operational availability.

20Without necessarily questioning the commitment of mothers – and hence of women in general – in the armed forces, we should also consider, without any preconceptions, the specific features of the relationship between a mother and her young child. By ignoring these “ordinary” psychological aspects, serious problems can emerge, both within soldiers’ families and in carrying out the mission. These points can, of course, always produce controversy and criticism along the lines “What about the father?” and “Is there no need to consider the possible consequences for him and/or his young child of leaving on opexs?”

21There are indeed exceptional, but real, situations where the father is effectively the maternal figure for the child. In these situations, his departure can prove just as problematical. There are also situations where the mother, lacking support from her partner, has problems in adequately carrying out her nurturing role for the infant. If the father is absent for reasons connected with his occupation, the rest of the family, or wider social circle, will have to take his place to provide this reassuring support.

22Just as we have described the concept of an individual’s “internal basis of security”, we can talk about a family’s “basis of security” [5]. This term was described by Professor M. Delage, former head of the psychiatric service at the Sainte-Anne Armed Forces Training Hospital, in Toulon. As a doctor, he was interested in the influence of traumatic events and problems on the family unit as a whole. He explained that there are vulnerability factors and protective factors within all families. Each reacts differently, depending on its beliefs, its history and its abilities to open up and communicate. For him, a family with young children is necessarily inward-looking. Intra-family bonds are inevitably very tight, in view of the mother-child system’s needs for protection. That is a normal development.

23A young mother’s departure for an opex thus upsets the whole family unit, but the disruption will be borne better if the family has, within itself, a good “basis of security” in terms of psychological resources and abilities to communicate. A family with no external resources to draw on, and which is already, for a variety of reasons, weakened in psychological terms, will have difficulty in handling and reacting to the mother’s absence.

24The young mother’s departure (which is currently a frequent situation) therefore raises specific problems that the military organisation, in recruiting women, should not ignore. What measures can then be taken to protect and prepare the recruits, and to support them and avoid them – suddenly or insidiously – finding themselves ill equipped to deal with the situation?

Mothers’ departure on opexs – How should it be considered?

25Without our wishing to act as a substitute for the high command, it is reasonable to call for reflection on some practical issues:

• How large a proportion of recruitment can be accounted for by women?
• How should they be distributed: in which units and for which missions?
• Are there periods in the life of a family that are incompatible with the woman leaving for an opex?
• What social, family and possible psychological support measures should be introduced?
• Should that support take place before, during and/or after the mission?
• What could be the costs of this for the military, looking at those incurred both in an ideal situation, where everything goes well, and one where problems of appropriate adjustment emerge on various time scales?

26It should be stated from the outset that the operational potential of mothers in the armed forces do not come within the skill range of psychiatrists. In theory, that is a choice made when they enlist; a choice for which preparation is made with tools and with psychological and social modes of assistance. There are already support measures for the families of soldiers before they leave on opexs. cafs, or “Family Assistance Cells”, in the units or staff headquarters (particularly cabat, the Army Wounded Assistance Cell, and cabmf-air, the Air Force Wounded, Sick and Family Assistance Cell) act as solidarity and information centres before and during the missions. Social assistants are involved in these provisions and can take action at any moment in the event of particular distress in the course of an opex. These general provisions are essential, and it should be ensured that they are appropriate for the very special dangers associated with separation between mothers and their young children. How responsive they are will determine those families’ futures in the event of material or educational problems arising during a mission. Without that social support, a family that is suffering, even if assisted by the unit’s doctor or a psychologist, may feel abandoned, exacerbating the experience of separation.

27It is therefore not a question of discrimination between men and women or between childless women and mothers, but of thinking about problems that will not go away. If these matters are not considered, there is a danger that the people who act (unit commanders, unit doctors, social assistants and individual supervisors) could find themselves in an emergency situation that may be serious, and which they have to manage alone and without consultation or planning. Often, the simple fact of looking at a family or social problem, and listening attentively with respect for the members’ privacy, makes it possible to defuse the tensions that are prejudicial to the health of individuals and the mission’s success. Assessments of those situations involving separation should be carried out well beforehand, with no attitude of distrust or discrimination, but in a confidential and respectful atmosphere; that alone will enable the departures to succeed and allow satisfactory accomplishment of the mission.

28What is needed is to offer assistance through the allocation of time for an interview with the person concerned, without dramatising the situation or playing down the implications. Just being prepared to consider the specific features of those situations often allows the young mother to withdraw more easily, without feeling guilty or a failure, or – on the contrary – to back up a strong motivation to depart on the mission, while also knowing that she has been listened to.

29There are important factors, given below, that a unit commander can assess through an interview.

• Motivation. If, for example, this is solely financial then, for the reasons given above, it will not survive the pressures imposed by the mission: the dangers, stress, fatigue and efforts to adjust to the situation of separation from a young child. Similarly, the desire a mother exhibits to prove her willingness to participate or to display loyalty to the group should be noted by the commanding officers. These mothers, who are young or even very young, want to prove themselves: all the more so because they are women. Some are ready to accept departure just to show how “strong” they are. Criticisms made of them, whether or not overt, strengthen their resolve to show their determination and courage, especially if they have come back from a long period of maternity leave. Sometimes, their departure follows that of their partner, if he is also in the military, and that produces even more disruption to the childcare and to the robustness of family bonds. Those departures involving weak motivation are a source of great family fragility, often leading to a rapid deterioration in suitability during or at the end of the mission (going on sick leave, taking a long period off or asking for discharge, etc.).
• Nature of the wider family and social circle. How available is the father, and what is his position in relation to “maternal” aspects of infant care? Is he used to dealing with the young child? Where do other members of the family live, and how available are they? Is there already a family plan in existence to deal with the young mother’s absence? Does the mother trust these arrangements?
• Families invited to get in touch with the unit’s social department. In the event of inadequacies in the infant’s milieu, the social assistant can also arrange for forms of assistance in advance of the departure. This can reassure the mother and child, as the difficulties will have been identified and allowed for in advance, before any crisis occurs.
• The existence of specific problems: serious illness in the child, existing separation from the father, single-mother situations.
• Post-maternity leave. What happened when this young mother returned to her duties after her pregnancy, and how did she re-adjust to the limitations imposed by her position in the unit, in peacetime conditions with no operational demands? If lasting or repeated problems of withstanding stress and remaining available have already emerged, considerable thought should be given regarding departure for an opex.

A difficult balancing act

30While some military specialities remain barred to women for easily understood physical reasons or the psychological environment, others have become areas where they predominate (60% success rate in the competition for entry to the armed forces medical school). At the same time, the French forces have seen a considerable reduction in their numerical strength, and increasing opexs, with battles becoming increasingly violent, to the point where people have started to talk of “war”. It would have been unthinkable for the health service to have kept its female staff out of armed conflict, or even from the most violent engagements. It had to remain credible, with a genuine future role. Asserting that that hasn’t presented some problems in terms of staff management would be a lie.

31While the period of compulsory military service and the nato-Warsaw Pact stand-off made it possible to think of a hospital career, or a future as a unit or hospital doctor just in French or German garrisons, the reality is very different today. Being sent on missions is the rule, and confronting violence and death is unavoidable. No candidate in the entry competition or applying for a position in the health service can ignore it any longer. The women, like the men, have chosen to be professional soldiers, even if it was to bring relief and provide care. The mandatory course to prepare for opexs, with its programme of training in handling arms and shooting, is, furthermore, unambiguous in this field.

32Other women make the choice in complete freedom, to serve in combat units, or those providing back-up or support. During the basic training and in the military schools, the end-purpose of professional soldiers is in no way concealed. For some of the women recruits, with fixed-term contracts, going into the armed forces will be an initial experience of work, with no effect on their private lives and family responsibilities. Those who continue with military careers will, like Françoise, Anne and Catherine, have to reconcile family life and motherhood with their occupational lives, while remembering that their choices were deliberate, made in full knowledge of what was involved.

33The public-functionary status offers men and women strict equality in terms of pay, for equal responsibilities and equal rights, but it also involves a duty to carry out the same missions in whatever is the individual’s speciality or expertise. It is by demonstrating, through their acts, their availability, their capabilities and their professional effectiveness – and not by invoking some specific status and right to be treated differently – that women soldiers will stand out in a world that is still too ruled by machismo.

34On the other side, the military establishment will have to stop referring to the women in its ranks as “exceptions”, who present problems. France’s armed forces, like all other Western armies, are faced with questions of recruitment and ensuring loyalty. They cannot afford to neglect potential female recruits, but must take pragmatic steps that will enable continued existence of the resource.