Part D: Children
Question D1
Question D2
Question D3
Question D4
Question D5
Question D6
Question D7
Question D8
Question D9
Question D10
Question D11
Question D12
Question D1
At any time since your first day of service in Vietnam, have you and a partner ever tried for more than 12 months to conceive a child without success?
Question Veterans Responses Expected Number Expected Range Veteran and partner tried for more than 12 months to conceive child without success 37 (17%) 31b 26-48 29-45a
a 95% confidence interval for number of veterans reporting condition
b Expected based on a reproductive lifetime prevalence of infertility estimated for French women in 1988-8928Comment on Comparison
There are substantial methodological issues associated with determining infertility rates. Little is known about the prevalence of infertility in the Australian population29. Estimates vary considerably depending on the indicators and research techniques used. International research indicates that estimated rates for those who have ever experienced a period of infertility range from 14% to 26%49.
Conclusion
Whilst no comparable Australian data could be obtained, the number of female veterans reporting difficulty conceiving was consistent with international data.
Question D2
Since your first day of service in Vietnam, have you had any of the following:
Condition Responses
(number of women† and number of occurrences reported)Expected Number Expected Range Stillbirths Women 7 (3%) Stillbirthsb 7 (3% of 223) 2c 2-2 2-12a Miscarriages Women 35 (16%) life-time prevalence data not availablee life-time prevalence data not available 23-43a Miscarriagesd 56 (26%) 43-69a Terminations Women 15 (7%) 9-21a Terminationsf 21 (9%) 12-30a 49g 48-50 Ectopic Pregnancies Women 2 (1%) Ectopic pregnanciesh 2 (1%) 0-7a 2i 2-3 Live Births with Labour Complications (eg. breach birth etc.) Women 45 (20%) 36-54a Live Birth with Labour Complicationsj 88 (41%) 74-102a 69k 68-69
† = 223 women responded to this question
a 95% confidence interval for number reported by veterans
b 7 stillbirths out of a total of 215 live births
c Expected stillbirths based on calendar year and five year maternal age-specific foetal death rates per registered live births, Australia 1973-1992 (where foetus weighs more than 500gm or is later than 22 weeks gestation)31
d 56 miscarriages out of 215 live births
e 15 to 20% of all diagnosed pregnancies are reported to end in miscarriage50; lifetime prevalence would be a higher proportion because many women have multiple pregnancies
f 21 terminations out of 234 pregnancies in which early foetal loss did not occur
g Expected based on South Australian rate of induced abortions per pregnancies in which early foetal loss did not occur, 199432
h 2 ectopic pregnancies out of 215 live births
i Expected based on Queensland rate of 10.93 ectopic pregnancies per 1000 full term births, 198033
j 88 live births with labour complications out of 215 live births
k Expected based on percentage of non-spontaneous vertex deliveries per registered live births for Australian women, 199233Comment on Comparisons
Estimates of the incidence of miscarriage and stillbirth are difficult to obtain in community data. Apart from stillbirths and live births with complications, the other conditions listed in this question appear to be within or under the expected rates. Cautious interpretation is necessary because of the small number of births concerned and the difficulties in making valid comparisons with community data.
Conclusion
Notwithstanding potential problems with the community data, there appears to be a statistically significant excess of stillbirths and live births with labour complications in the veteran population.
Question D3
At any time since your first day of service in Vietnam, have you and a partner ever tried for more than 12 months to conceive a child without success?
Question Veterans Responses Expected Number Have you ever given birth to any children (live births only)? 110 (46%)a 206c 99-121b
a Reported percentage calculated as 110 mothers out of 223 respondents
b 95% confidence interval for number of veterans reporting condition
c Expected based on age-specific figures from a 1% sample of ABS 1986 census34Comment on Comparison
The 1986 ABS census data were used to establish a community comparison as it covered the time during which many of the veterans gave birth. However, the census data were insufficiently detailed to allow for the calculation of an expected range.
The number of female veterans who have ever given birth is substantially below the population expectations. As the study population possibly under-represents married women this finding was expected. However, a possibility exists that sampling difficulties obscure other reproductive problems in this group.
Conclusion
Due to the methodological problems inherent in the sampling method no conclusions can be drawn.
Question D4
How many children have you had that were conceived since your first day of service in Vietnam (live births only)?
Question Number Reported by Veterans Expected Number
How many children have you had that were conceived since your first day of service in Vietnam (live births only)? 215a 427b
a 215 live births reported by 223 respondents: not all respondents had had children, and many had had more than one child.
b Expected based on total fertility rate for Australian women 1981-8535Comment on Comparison
The expected number was calculated based on an Australian fertility rate of 1.9 children per woman35. National figures given in these data provide a reliable comparison.
Conclusion
Fewer children were born to female veterans than would be expected. This may be explained by the possible under-representation of married women in the survey population. Additionally, some veterans gave birth before Vietnam service (see question D3), but estimates of the exact number of children born pre-Vietnam are not available from the survey.
Question D5
Please indicate year of birth and sex of each of these children below:In total, female veterans gave birth to 215 children since their first day of service in Vietnam, of which 54% were male (95% confidence interval, 47-61%) and 46% were female (95% confidence interval, 39-53%).
The overlap of these wide confidence intervals indicates that there is no statistically significant difference between the proportion of males and females in this small sample. Population surveys indicate that in Australia, at present, the sex ratio is 105.9 male births per 100 female births49, consistent with the findings of the present survey.
The median age at which women gave birth was 33 years. The median year of birth was 1974 and the median age of the children was 23 when the survey was conducted.
Question D6
Have any of those children listed in D5 ever been diagnosed as having:
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Question D6.1 to 6.2
Condition Number Reported by Veterans Expected Number Expected Range Sight problem not able to be corrected by spectacles 3 (1%) 14b 14-15 1-9a Long term hearing problem or ear problem 12 (6%) 8c 8-9 5-19a
a 95% confidence interval for number of veterans reporting condition
b The expected number for sight problems was based on Australian age- and sex-specific prevalence of long term disorders of refraction and accommodation as reported in the NHS2
c Expected based on Australian estimates of age- and sex-specific prevalence of long term complete or partial deafness2Comment on Comparisons
Definitional problems rule out precise comparisons. Despite this, NHS data suggest that these conditions are not excessive.
Question D7
Have any of those children listed in D5 been diagnosed by a doctor as having:
Condition Number Reported by Veterans Expected Number Expected Range Spina Bifida 0 (0%) 0b 0-0 0-4a Anencephaly 0 (0%) 0b 0-0 0-4a Down's Syndrome 1 (<1%) 0b 0-0 0-6a Tracheo-oesophageal Fistula 1 (<1%) 0c 0-0 0-6a
a 95% confidence interval for number of veterans reporting condition
b Estimated using AIHW Birth Defects Series publication31
c Expected based on notification rates for total births registered in Qld, SA and Tas in Oct-Dec 198136Comment on Comparisons
There were too few respondents in the female veterans survey to allow community comparison of these relatively rare birth defects.
The report on the male Vietnam veterans survey recommended that validation of the incidence of Down's syndrome and tracheo-oesophageal fistula in the children of male veterans take place. For the reasons given at Section 8.6, validation of the two cases listed here is not recommended. However, it is recommended that these cases be considered alongside the results of the male validation study.
Question D8
Have any of those children listed at D5 ever been diagnosed by a doctor as having at birth:
Condition Number Reported by Veterans Expected Number Expected Range Cleft Lip or Palate 0 (0%) 0b 0-0 0-4a Absent Body Parts 1 (<1%) 0c 0-0 0-6a Extra Body Parts 2 (1%) community data not available community data not available 0-6a Any Other Abnormality 15 (15%)d community data not available community data not available 8-22a
a 95% confidence interval for number of veterans reporting condition
b Estimated using AIHW congenital malformations monitoring report37
c Estimated using AIHW Birth Defects Series publication31
d Fifteen women reported that they had had children diagnosed with other abnormalities (15% of 100 women who had given birth since their first day of service in Vietnam, which differs slightly from the data in D3)Conclusion
As outlined in question D4, this survey does not contain complete information about the total number of children born to veterans.
In the case of 'other abnormalities', the question does not allow veterans to identify how many of their children have a disability, or the number and type of disabilities each child has. Because of these limitations it is not possible to calculate the total number of children with 'other abnormalities'. The other abnormalities reported by veterans are listed in Appendix C1, Table 4.
These problems aside, the number of women responding to this question was too small to allow meaningful community comparisons.
The Male Vietnam Veterans Morbidity Study report recommended that validation of the incidence of absent and extra body parts in the children of male veterans take place. For the reasons given in Section 8.6 of this report, validation of the three cases listed here is not recommended. However, it is recommended that these cases be considered alongside the results of the male validation study.
Question D9
Have any of those children listed at D5 ever been diagnosed by a doctor as having:
Condition Number Reported by Veterans Expected Number Expected Range Any Cancer 2 (1%) 1 0-5 0-7a Leukaemia 0 (0%) 0 0-4 0-4a Wilms' Tumour (tumour of the kidney) 1 (<1%) 0 0-4 0-6a A Tumour of the Nervous System 0 (0%) 0 0-4 0-4a Any Other Type of Cancer (melanoma) 1 (<1%) 1b 0-4 0-6a
a 95% confidence interval for number of veterans reporting condition
b Calculated using Australian Cancer registry data18Comment on Comparisons
There is an insufficient number of children involved in this survey to make adequate statistical comparisons for these conditions.
The Male Vietnam Veterans Morbidity Study report recommended that validation of the incidence of Wilms' tumour in the children of male veterans take place. For the reasons listed in Section 8.6 of this report, validation of the one instance listed here is not recommended. However, it is recommended that this case be considered alongside the results of the male validation study.
Question D10
Have any of those children listed at D5 ever suffered any other major illness?Comment
Of the 100 female veterans who had given birth since Vietnam, 28 (28%) reported that at least one of their children suffered from another major illness. As the number reported refers to the women rather than specific illness among their children, no community comparison can be made. These responses are detailed in the ACNielsen report at Appendix C1, Table 11.
No conclusions are drawn from this data at this stage.
Question D11
Now thinking about all your children (born at any time), have any of them died due to the following causes:
Condition Number of Veterans Reporting Condition Illness 4 (4%) Suicide 0 (0%) Accident/Other 1 (1%)
Comment
Community comparisons are not possible, because the exact number of children, their age distribution, and the types of illness, accident or other cause of death, are not known.
However, considering the age distribution of the children of veterans that were recorded, it is possible to apply the age- and sex-specific death rates for all causes for 198151 to obtain an expected number of at least 3 deaths. This 'expected number' is probably an underestimate due to the uncertainty relating to the total number of children. It is unlikely that a statistically significant excess of deaths has occurred amongst the children of female Vietnam veterans.
The Male Vietnam Veterans Morbidity Study report recommended that validation of the incidence of accidental death in the children of male veterans take place. For the reasons listed in Section 8.6 of this report, validation of the one instance listed here is not recommended. However, it is recommended that this case be considered alongside the results of the male validation study.
Question D12
Have any of your children (born at any time), ever been diagnosed by a doctor as having:
Condition Number of Veterans Reporting Condition Expected Number Psychiatric Problems 8 (7%) Community data not sought Anxiety Disorders 25 (23%) 26a
a Based on NHMRC 199846
Comment
These questions asked women whether any of their children had ever experienced these conditions but did not ask them to specify how many of their children they were referring to. Consequently the subject of this question is the proportion of mothers whose children have psychiatric problems or anxiety disorders rather than the number of their children suffering these conditions. Specific reference data is not available for this information, however general comparisons indicate that these problems are not excessive3, 4. For example, as many as 24% of adolescents will have a major episode of depression by the age of 1846.
Therefore, it is unlikely that the prevalence of these problems in the children of female veterans is excessive.
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