Our Female Veterans Deserve Better Healthcare

Mariah Brennan
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Women now make up 30% of veterans from the Post 9/11 service era. This large group of women is increasingly diverse, with non-Whites comprising 32% and Hispanics comprising 13% of female veterans.With women representing one of the fastest growing segments of our nation’s military, we must ensure that they have access to comprehensive high-quality care. The Department of Defense (DoD) and Veterans Health Administration (VHA) must continue to work toward improving healthcare quality and access so that women are fully supported in leading healthy lives when they separate from the military.

Access to VHA Care is Not Woman Friendly
Unfriendly platforms for care make people less likely to visit their providers. This is the case with the VHA. Among female veterans there is not only limited access to certain types of health care, but also negative perceptions about the care provided by the VHA, and lack of knowledge about availability and eligibility for benefits.2 These unfriendly qualities of the VHA have led to women being less likely than men to utilize Department of Veteran Affairs (VA) benefits. This underutilization is an institutional problem, and it is the VA’s responsibility to create female friendly care. Female friendly care must address the changing nature of female service as well as the gender-specific healthcare services women need.

Women Have Expanded Their Role in the Military
Roles within the military have drastically changed during the Post 9/11 era. Although they are still legally sanctioned from engaging in combat, military technology has evolved to the point where combat has become an ambiguous term. Women are not on the frontline with the infantry, but are becoming increasingly exposed to combat zones. The changing nature of female military service highlights the need for increased healthcare attention for women. We know that women are at an increased risk for developing Post Traumatic Stress as a result of Military Sexual Trauma (MST). Women may be unlikely to utilize available mental health services to help treat their MST because there is a fear that they will encounter individuals similar to their perpetrators at VA facilities.3 The DoD and VA must further efforts to eliminate sexual assault within the military and establish a safe environment for female veterans to receive necessary care.

Comprehensive Reproductive Care for Women Must Be Provided
The VA provides prenatal and preconception care, maternity care services and seven days of newborn care for women Veterans. However, the VA does not provide labor and delivery services on site. Pregnant women must seek out private providers or work with a Maternity Care Coordinator to determine the closest partner provider. Between 2000 and 2015, the number of women that were VHA patients with a VHA and/or private care obstetrics or gynecology visit increased by more than 100%.4 This creates an additional barrier that veterans must overcome in order to receive quality care. Fragmentation in care is likely to result in a loss of patient information across providers.5 Poor integration of care can result in women not receiving proper treatment for mental health, physical health, and pregnancy related concerns.

Through the years, the proportions of VHA patients who also used any outpatient services purchased through private care was consistently higher for women than for men.6 This suggests that there are gender-specific services that women need and are unable to access through the VHA system. A critical gender-specific area of care that appears to be lacking within the VHA is reproductive health services and maternity care. More than 50% of female veterans who have served following September 2001 and used their VA health benefits are of childbearing age.7 Ensuring that these women are receiving comprehensive reproductive care must be made a priority for the VA.

The DoD and VHA Need to Take Action
The DoD and VHA should collaborate to develop a comprehensive set of services for female veterans. The DoD has a responsibility to inform healthcare providers how the changing role of women in the military impacts their healthcare needs. The VHA must make a commitment to providing female specific healthcare services so that women are not required to seek services outside of the VHA network. Finally, because women are expanding their military presence, additional research efforts should be made to assess the needs of female service members so that they can be fully supported upon separation from the military.

References

  1. Waszak, D. L., & Holmes, A. M. (2017). The Unique Health Needs of Post-9/11 U.S. Veterans. Workplace Health & Safety, 65(9), 430–444.
  2. Evans, E. A., Tennenbaum, D. L., Washington, D. L., & Hamilton, A. B. (2019). Why Women Veterans Do Not Use VA-Provided Health and Social Services: Implications for Health Care Design and Delivery. Journal of Humanistic Psychology.
  3. Mattocks, K. M., Haskell, S. G., Krebs, E. E., Justice, A. C., Yano, E. M., & Brandt, C. (2012). Women at war: Understanding how women veterans cope with combat and military sexual trauma.Social Science & Medicine74(4), 537–545.
  4. Frayne, S. M., Phibbs, C. S., Saechao, F., Friedman, S. A., Shaw, J. G., Romodan, Y., Haskell, S. (2018, February). Sourcebook: Women veterans in the Veterans Health Administration: Vol. 4. Longitudinal trends in sociodemo- graphics, utilization, health profile, and geographic distribution. Washington, DC: U.S. Department of Veterans Affairs, Veterans Health, Women’s Health Services/Center for Innovation to Implementation, Women’s Health Evaluation Administration Initiative.
  5. Mattocks, K. M., Kroll-Desrosiers, A., Kinney, R., & Singer, S. (2019). Understanding Maternity Care Coordination for Women Veterans Using an Integrated Care Model Approach.Journal of General Internal Medicine34(S1), 50–57.
  6. Frayne, S. M., Phibbs, C. S., Saechao, F., Friedman, S. A., Shaw, J. G., Romodan, Y., Haskell, S. (2018, February). Sourcebook: Women veterans in the Veterans Health Administration: Vol. 4. Longitudinal trends in sociodemo- graphics, utilization, health profile, and geographic distribution. Washington, DC: U.S. Department of Veterans Affairs, Veterans Health, Women’s Health Services/Center for Innovation to Implementation, Women’s Health Evaluation Administration Initiative.
  7. US Department of Veterans Affairs, & Veterans Health Administration. (2013, December 17). VA.gov: Veterans Affairs. Retrieved from https://www.womenshealth.va.gov/WOMENSHEALTH/latestinformation/facts.asp.

Acknowledgments
The author would like to thank Shannon Monnat, the Lerner Fellows and Graduate Research Affiliates for their edits and suggestions on this brief.