Reproductive Health Management for the Care of Women Veterans

Abstract

There are more than 2 million women veterans living in the United States. Many women do not identify themselves as veterans. As women's health care providers, it is important to understand and recognize the potentially complex health and social needs of women veterans and the role of military service on their lives. The reproductive health needs of women veterans may be shaped by their military experiences and coexisting medical or mental health conditions. Military sexual trauma and combat exposure are common causes of posttraumatic stress disorder and can affect overall health and well-being. Screening for military service is important in all women, and inclusion of this as a key demographic variable in research and clinical encounters can further inform health care considerations. The following key topics are addressed: who are women veterans, health and social risk factors associated with a history of military service, reproductive health across the life course, military sexual trauma and reproductive health of women veterans, how to take a military history, and the essential role of women's health providers, including obstetrician-gynecologists, in enhancing health systems and providing high-quality care to veterans.

Critical questions

“…Women with a preexisting PTSD diagnosis before labor have a greater risk for having an exacerbation of PTSD following childbirth (Andersen, Melvaer, Videbech, Lamont, & Joergensen, ). These findings highlight the importance of reproductive life planning and preconception care supported with available contraception to optimize the health of Veterans before pregnancy so that the risk for poor outcomes (physical and psychological) can be minimized (Zephyrin, ).…”

“…In the more recent wars, close to 300,000 females have been deployed overseas in support of combat zones in Iraq (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) (Defense Advisory Committee on Women in the Services, ). Increased exposure to combat and near‐combat positions for women may result in greater risk for physical and mental health issues and related disabilities (Frayne et al., ; Mattocks, ; Street et al., ; Zephyrin, ). Mental health effects of war are invisible, and they can exacerbate physical health conditions.…”

“…Because these young women are exposed to the health effects of war earlier, their life‐long health trajectory may shift toward a greater burden of illness and increase in their risk for chronic health conditions (Haskell et al., ). To effectively serve these women, it is imperative for clinicians to recognize that military service poses distinctive health challenges that influence the overall health of female Veterans (Mattocks et al., ; Murdoch et al., ; Zephyrin, ). The purpose of this article is to review the healthcare needs of women Veterans and their implications for primary and reproductive health care.…”

Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data

“…; Fox et al. ; Zephyrin ). At the same time, changes in VA's role as insurer (U.S. Congress ) led to the coverage of maternity care, and subsequent expansion (U.S. Congress ) to include newborns’ health care coverage in the first 7 days of life.…”

“…While women remain a distinct minority, <7 percent, of the patient population cared for by the VA, the absolute number nearly doubled from 2003 to 2012 and likely will continue to rise . Accordingly, the past decade has witnessed significant growth in VA's attention (programmatic and research) to women Veterans' health care needs (Vogt, Barry, and King 2008;Yano et al 2010Bean-Mayberry et al 2011;Hayes 2011;Frayne et al 2013;Maisel et al 2015;Fox et al 2016;Zephyrin 2016). At the same time, changes in VA's role as insurer (U.S. Congress 1996) led to the coverage of maternity care, and subsequent expansion (U.S. Congress 2010) to include newborns' health care coverage in the first 7 days of life.…”