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ALWAYS AN AFTERTHOUGHT
Mary G. Barry, MD
Louisville Medicine Editor
[email protected]
N
ever a priority: that’s the way US
female veterans feel about the care
they’ve received from the VA.
Currently, women account for a bit more
than 15 percent of active duty personnel,
and about 30 percent of post-9/11 veterans,
the highest percentage of women ever to
need care from the VA. Fifty-seven percent
of female veterans have a diagnosis qualifying them for disability in the VA system,
compared to 46 percent of male veterans,
according to a VA report from Feb 2014.
In 2008, recognizing that women would
need all kinds of services, the VA began
an investment of $1.3 billion to improve
women’s health care. Yet today, one-fourth
of VA hospitals have no designated gynecologist, and about 15 percent of primary
care outreach clinics have no doctors or
nurses who specialize in the care of women.
According to 2014 VA records, nearly two-thirds of female veterans have a
VA-qualifying disability based on injury or
illness of the musculoskeletal system; over
one-third have substance abuse or mental
disability. However Dr. Patricia Hayes, then
the VA’s chief consultant on women’s health
affairs, said that the VA typically covers all
gender-specific health care for women, with
the exception of IVF and abortion. The VA’s
stated goal is to have a GYN-trained doctor
or PA or Advanced Practice Nurse in every
one of those outreach clinics.
Women who must drive miles and miles
to get OB care or GYN care are supposed
to be reimbursed by the VA for travel
costs. This is a particularly sore point on
the female veterans’ message boards. They
must navigate the federal paperwork over
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and over and over for basic health needs,
and afterwards are still refused payment
because of delays in processing the paperwork, delays that they could not control
or even know about. If they deliver a baby
emergently instead of in the planned “window” of labor and delivery by due date, they
may not be reimbursed at all because of
the change of date – counter to the official
policy, but subject, as always, to the people
on-site processing the request. They have
to fight a bureaucratic battle for their primary, everyday health needs, which male
veterans do not.
Wait times for women, because of the
lack of providers, are longer even than for
men. A woman with several disabilities who
needs multiple clinic appointments might
well despair. Women of child-bearing age
– the great majority of post-9/11 veterans
– are also far more likely to be given medications dangerous for those who might turn
up pregnant. Nearly half of them had been
in the VA’s internal study, as compared to
one in six women with outside providers.
Half is a very, very bad number, considering
that from a young age doctors are drilled
to consider the effects of all medicines on
pregnant women.
Assuring that older female veterans get
mammograms has been an area of focused
effort for the VA, but because so many are
done outside the system, getting the results
back to women has been slow and frustrating, with nearly double the wait for women
who anxiously seek their results.
But the biggest problem facing the
modern military and our veteran care networks is that of suicide. Suicide rates among
those actively serving are viciously high
since 9/11, compared to those who fought
in previous wars. Tragically, the rates rise
even more for veterans. Typically, data on
women (always the afterthought) did not
come to light until t