“Some of us actually went to war, some of us had war right here in the States, going to work every day knowing we are going to be harassed,” said Procella, now 62 and living in Plano, Texas.

At the time, fewer than 3 percent of service members were women. Procella recalled the daily barrage of sexual comments, gestures and men grabbing her inappropriately.ÌýAnd one of her superiors made it clear that her hopes of moving up the career ladder were dependent on having sex with him.

“He was kind of discreet about the way he put it, but his one advance and my one acceptance of his advance led to my promotion,” Procella said.

At the time, Procella, who served in the Air Force until 1979 and then went on to the Texas Air National Guard until 1982, accepted the common belief that reporting the incidents would be bad for her career. “It definitely wasn’t talked about, you definitely did not report your superiors for any kind of harassment,” she explained. “At the time that it happens you sweep it away like you’re going to be OK.”

A majority of those who reported sexual abuse met the criteria for a PTSD diagnosis, the researchers said.

And a in the journal Women’s Health IssuesÌýfound that women ages 45-54 reported more sexual harassment and assault while in the military than other age groups.

“I was struck by the idea that it wasn’t just younger women,” said Carolyn Gibson, a women’s health research fellow at the San Francisco VA Medical Center and co-author of that study.

The research also found that the association between sexual trauma and its negative effects on health — such as cardiovascular disease, substance abuse and other physical and mental illnesses — was most pronounced among female veterans ages 45-64.

Gibson said these effects may be exacerbated among women in midlife because there was less awareness around the issue when they were in uniform and they felt compelled to bear the stress alone.

Midlife is also a time of great change for women, Gibson explained, both physically and emotionally, which could lead them to come forward about sexual trauma after their service ended.

“As people go through periods of transition, then those symptoms tend to pick up a lot more,” she said. More of the veterans who are younger now, she added, may go publicÌýabout their struggles with sexual trauma when they enter this phase of life 10 to 15 years down the road.

Battle For Recognition

The Veterans Health Administration coined the term “military sexual trauma” in 2004, and today about 25 percent of women and 1.5 percent of men who use VA health services have the diagnosis, according to the VA. The symptoms are closely associated with PTSD and put individuals at an increased risk for other mental health conditions, including anxiety, depression and eating disorders.

But getting a disability claim based on military sexual trauma can be a long and complicated battle. A 2014 Ìýfound that disability claims related to sexual trauma during military service used to be far less likely to be approved than PTSD claims from other sources. In 2010, 46 percent of all claims related to non-sexual trauma were approved by the Veterans Benefits Administration, while 28 percent of those related to military sexual trauma were, GAO said. By 2013, half of the sexual abuse claims and 55 percent of PTSD claims were approved.

The GAO and veterans groups say the increase came after the VA mandated training on military sexual trauma for employees processing claims at regional centers and for health professionals providing the veterans’ evaluations.

The VA has added resources specifically for women in recent years, even separate entrances for women at some counseling facilities. Still, it’s a challenge to get women through the door to receive help.ÌýAccording to a 2015 VA report on barriers to women’s health care, only 19 percent of female veterans used VA services.

“During the Vietnam era, a lot of veterans who came back had a hard time getting into the VA, especially women — they were put off by the VA for several years,” said Pam Maercklein, who coordinates women’s health care for the Texas Veterans Commission and is an Air Force veteran. “Now the VA, especially here in Texas, is doing a fairly good job of gender-specific treatment.”

Anna Baker, the manager of the commission’s women’s program, said women who are now middle-aged were forgotten when it came to treatment for sexual trauma at the time of their service and afterward.

“We’ve had several nurses who served in Vietnam who are just now coming out, who are saying that for so many years they just suppressed it,” Baker said, “and they’re just now starting to have those conversations and deal with those issues that are causing them anguish.”

While there’s a tendency to associate PTSD with military combat, a published in JAMA PsychiatryÌýfound that women who served in Vietnam had increased odds of PTSD. The effect, the report found, “appears to be associated with wartime exposures, especially sexual discrimination or harassment and job performance pressures.”

Delia Esparza, a psychiatric mental health nurse with the Vet Center in Austin, Texas, has been helping veterans — women and men — deal with sexual trauma for more than 22 years.

The Austin Vet Center is one of 300 community facilities across the country that provide veterans (and family members) with free individual and group counseling, in addition to other readjustment services.

Esparza said that even with increased attention to military sexual trauma, many of the problems that Procella and other veterans experienced persist. Among them: Women especially feel stigmatized for speaking out.

She recalled that when she first started practicing she had a female client who was a veteran from World War II.

“She was very troubled by this whole thing,” Esparza said of the veteran, who was then in her 70s, “and when she talked about it she became very tearful.

“It stays with you.”

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Pero Ivy, su hermana menor, estaba en kindergarten en la misma escuela, donde un puñado de familias optó por no vacunar a sus hijos. Eso significaba que Ivy, de 6 años, estaba en riesgo de traer a casa gérmenes que podrían suponer un riesgo para Georgia.

“Ella iba a la escuela, regresaba a casa, e inmediatamente poníamos su ropa en la lavadora para mantener un ambiente saludable”, dijo la madre de las niñas, Courtney Moore.

La vigilancia de los Moore valió la pena. Georgia, que ahora tiene 16 años, tuvo muy pocas hospitalizaciones y ahora está libre de cáncer cinco años después de que terminara su tratamiento. Pero la batalla de Georgia contra el cáncer hizo que Courtney Moore abogara por las vacunaciones en Texas, donde un número cada vez mayor de padres están optando por no vacunar a sus hijos, y en donde no hay datos por cada escuela pública sobre el número de niños no vacunados.

Texas es uno de los 18 estados que permiten exenciones no médicas a las vacunas requeridas para la asistencia a la escuela. California también permitía exenciones no médicas hasta el año pasado, cuando promulgó una ley que impone uno de los requisitos más estrictos en el país. Esto ocurrió luego que, en el 2014, se encontrara en Disneyland el origen de un brote de sarampión, que infectó a más de 100 personas en todo el país.

Muchos de los padres que eligen darle la espalda a las vacunas, que son ampliamente recomendadas por los médicos, dicen que temen un vínculo entre las vacunas y problemas de salud como el autismo. Pero los estudios que citan esa relación han sido desacreditados por los funcionarios de salud pública.

“Año tras año hemos visto un aumento constante en el número de estudiantes con una exención de conciencia a la vacunación en Texas”, dijo Christine Mann, vocera del Departamento de Servicios de Salud del estado de Texas. “Pero en general, los números son pequeños”.

A pesar de que los niveles de vacunación en todo el estado siguen siendo altos, en más del 98 por ciento, lo que preocupa a los funcionarios de salud pública son los grupos cada vez mayores de áreas geográficas con altas tasas de niños no vacunados. Texas pasó de sólo 2.314 “exenciones de conciencia” en el 2003 a 44.716 este año, según el departamento.

Algunos padres están presionando a los funcionarios del estado para que les informen cuántos de los compañeros de sus hijos no están vacunados. Jinny Suh, quien tiene un hijo de 4 años, está ayudando a encabezar una campaña de peticiones pidiendo a los legisladores que cambien la ley estatal para que el número de exenciones escolares sea público. En la actualidad, las tasas de exención están disponibles para las escuelas privadas y charter, pero sólo en todo el distrito para las escuelas públicas.

Al menos dos proyectos de ley fueron presentados durante la sesión legislativa pasada que hubieran requirido que las escuelas notificaran a los padres sobre las tasas se vacunación en cada escuela. Pero no fueron aprobados.

“Como padre, hay muchas cosas por las que la gente se apasiona”, dijo Suh. “Pero por alguna razón, en mi experiencia, las vacunas siguen siendo un tema casi tabú, más allá de algunas personas apasionadas.”

Como es el caso en todo el país, las áreas donde los niños no están recibiendo vacunas en Texas tienden a ser lugares con más alta educación y con los residentes de más altos ingresos. La escuela con el porcentaje más alto de exención en el estado es la Escuela Waldorf de Austin, donde más del 40 por ciento de los estudiantes no están vacunados y la matrícula excede los $13.000 al año. Regents Academy, una escuela privada en el este de Texas, fue la segunda tasa más alta de exención, con casi el 38 por ciento de los estudiantes no vacunados.

“Si uno de esos niños está incubando una enfermedad infecciosa y los otros niños no están vacunados, entonces se propagará como un incendio forestal”, dijo Catherine Troisi, epidemióloga de enfermedades infecciosas del Centro de Ciencias de la Salud de la Universidad de Texas en Houston.

Troisi explica que, para una enfermedad como el sarampión, la inmunidad del grupo debe ser del 95 por ciento para prevenir un brote. Si los niños sanos no están recibiendo vacunas, están poniendo en un riesgo mucho mayor de infección a los niños más pequeños y a las personas con sistemas inmunológicos comprometidos.

Peter Hotez, profesor del departamento de pediatría y virología molecular y microbiología del Baylor College of Medicine de Houston, calificó el número creciente de niños no vacunados como “extremadamente preocupante” en un comentario publicado en octubre en la revista científica de internet PLOS. Señaló que en algunos condados la tasa de vacunación había bajado casi hasta el límite del 95 por ciento — como el condado de Gaines en la parte occidental del estado, donde las exenciones están ahora en 4,83 por ciento y el condado de Briscoe, en el Panhandle de Texas, con 3,55 por ciento. Y Hotez, que tiene una hija con autismo, destacó la situación en Austin, donde la tasa de exenciones de las escuelas públicas es del 2 por ciento, pero muchas de las escuelas privadas superan el 20 por ciento.

En septiembre, la Academia Americana de Pediatría, emitió una declaración animando a los pediatras a ser más efusivos sobre la importancia de las vacunas para los niños lo suficientemente saludables como para recibirlas.

Pero algunos padres están recelosos de los esfuerzos de salud pública puestos en las vacunas. “Creemos que los padres deben tomar decisiones médicas para sus hijos, no el estado”, dijo Jackie Schlegel, director de Texans for Vaccine Choice, un comité de acción política que se formó parcialmente en oposición a la legislación del 2015 para acabar con las exenciones de vacunas no médicas del estado.

“Hicimos campaña de puerta en puerta, y lo haremos de nuevo ante todo esfuerzo por pisotear nuestros derechos paternales”, dijo Schlegel. Cuando se le preguntó si apoyaba el derecho de un padre a saber el número de niños no vacunados en una escuela pública específica, Schlegel dijo que “el consentimiento informado y la privacidad son preocupaciones muy grandes y necesitan ser evaluados por ambos lados de la moneda”.

Otros son aún más inflexibles en su oposición. “Ese es un terreno resbaladizo”, dijo Del Bigtree, uno de los productores de “Vaxxed: From Cover-Up To Catastrophe”, una película del 2016 que plantea un vínculo entre el autismo y las vacunas y alega que los científicos federales han encubierto la investigación. Fue dirigido por Andrew Wakefield, el ex gastroenterólogo británico que ahora vive en Texas, autor de un estudio publicado en 1998 y desacreditado por toda la comunidad científica, que vincula a las vacunas con el autismo. Bigtree, que dejó de vacunar a sus hijos, dijo que cree que cualquier esfuerzo por divulgar las tasas de inmunización en las escuelas está motivado por el miedo.

Como madre que ha visto el tema de cerca, Moore espera que los padres entiendan cómo su decisión de no vacunar a sus hijos podría tener consecuencias de largo alcance.

“Es una decisión muy personal… “, dijo Moore. “Pero tienes que reconocer que, si decides no vacunar, hay una alta posibilidad de que esa decisión personal tenga un impacto en muchas personas”.

Esta historia fue producida por , un programa editorialmente independiente de la .

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But her younger sister Ivy was in kindergarten at the same school, where a handful of families opted out of vaccinating their children. That meant 6-year-old Ivy might bring home germs that could pose a risk to Georgia.

“She would go to school, come home and immediately we’d put clothes in the washer to keep a healthy environment,” the girls’ mother, Courtney Moore, said of the family’s after-school routine.

The Moores’ vigilance paid off. Georgia, now 16, had very few hospitalizations during the course of her treatment and is now cancer-free and five years out of treatment. But Georgia’s battle against cancer made Courtney Moore a vocal advocate for immunizations in Texas —Ìýwhere an increasing number of parents are opting against vaccinating their children, and data about the number of unvaccinated kids in individual public schools is not available.

Many of the parents opting out of the immunizations, which are widely recommended by doctors, say they fear a link between the vaccines and health problems such as autism. But studies that they cite have been widely debunked by public health officials.

“Year after year we’ve seen a steady increase in the number of students with a conscientious exemption from vaccination in Texas,” said Christine Mann, a spokeswoman for the Texas Department of State Health Services. “But overall, the numbers are small.”

Even though statewide levels of vaccinations remain high, at over 98 percent, what concerns public health officials are the growing clusters of geographic areas with high rates of unvaccinated children. Texas went from just 2,314 “conscientious exemptions” in 2003 to 44,716 this year, according to the Texas Department of State Health Services.

Some parents are pressing state officials to let them know how many of their children’s peers are unvaccinated. Jinny Suh, who has a 4-year-old son, is helping spearhead a drive asking legislators to change state law so that the number of school exemptions is public. Currently, exemption rates are available for individual private and charter schools, but only district-wide for public schools.

At least two bills were introduced during the past legislative session that would require schools to notify parents about vaccination rates at the school level, but neither were approved.

“As a parent, there are lots of things that people get very passionate about,” Suh said, “but for some reason, in my experience, vaccinations remains an almost taboo topic besides a few passionate people.”

As is the case across the country, areas where kids aren’t receiving vaccinations in Texas tend to be places with more highly educated and higher-income residents. The school with the highest percentage exemption rate in the state is the Austin Waldorf School, where more than 40 percent of students are unvaccinated and tuition exceeds $13,000 a year. Regents Academy, a private school in East Texas, was the second-highest exemption rate, at almost 38 percent of the school.

“If one of those kids is incubating an infectious disease and the other kids aren’t vaccinated, then it’s going to spread like wildfire,” said Catherine Troisi, an infectious disease epidemiologist at the University of Texas Health Science Center at Houston.

Troisi explains that for a disease like measles, you want “herd immunity” to be at 95 percent to prevent an outbreak. If healthy children aren’t receiving vaccines, they are putting children who are too young to receive the vaccine and people with compromised immune systems at a much greater risk of infection.

Peter Hotez, a professor in the department of pediatrics and molecular virology and microbiology at the Baylor College of Medicine in Houston, called the growing numbers “extremely troubling” in a on the PLOS online science journal.ÌýHe noted that some counties were getting close to that 95 percent marker, such as Gaines County in the western part of the state where the exemptions are now at 4.83 percent and Briscoe County in the Texas Panhandle with 3.55 percent. And Hotez, who has a daughter with autism, highlighted the situation in Austin, where the public school rate for exemptions is 2 percent but many of the private schools exceed 20 percent.

The American Academy of Pediatrics in SeptemberÌý encouraging pediatricians to be more vocal about the importance of vaccines for children healthy enough to receive them.

But some parents are leery of the public health efforts on vaccinations. “We believe parents should make medical decisions for their children, not the state,” said Jackie Schlegel, director of Texans for Vaccine Choice, a political action committee that was formed partially in opposition to 2015 legislation to do away with the state’s non-medical vaccine exemptions.

“We campaigned, we block-walked and we’ll do it again for anyone else who would like to trample on our parental rights,” said Schlegel. When asked if she supported a parent’s right to know the number of unvaccinated children at a given public school, Schlegel said “informed consent and privacy are very big concerns and need to be evaluated on both sides of the coin.”

Others are even more adamant in their opposition. “That’s a slippery slope,” said Del Bigtree, one of the producers of “Vaxxed: From Cover-Up To Catastrophe” a 2016 film drawing a link between autism and vaccines and alleging the federal scientists have covered up the research. It was directed by Andrew Wakefield —Ìýthe former British gastroenterologist now living in Texas who authored a discredited research paper linking vaccines to autism in 1998. Bigtree, who stopped vaccinating his children, said he believes that any efforts to disclose immunization rates in schools are motivated by fear.

As a mother who has seen the issue up close, Moore hopes parents understand how their decision not to vaccinate their child could have far-reaching consequences.

“It’s a very personal decision…” Moore said. “But you have to recognize that if you choose not to [vaccinate], there’s a good possibility that that personal decision will impact a lot of people.”

This story was updated to note that more than one bill was introduced in the legislature that would have required schools to notify parents about school vaccination rates, but none was passed.

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