Women Veterans Health Care

1. Women Veterans Health Care Laura Herrera, MD, MPH Director, Comprehensive Women’s Health Women Veterans Health Strategic Health Care Group Veterans Health Administration U.S. Department of Veterans Affairs November 11, 2010

2. Population of Women Veterans Source data supplied 7/9/10 by the Office of the Actuary, Office of Policy and Planning, Department of Veterans Affairs 2

3. Women Active Duty Personnel by Branch of Service (Sept 09) US Dept of Defense, Defense Manpower Data Center as of September 30, 2009. 3

4. 4

5. 5

6. Demographics: Ethnicity and Race VA Health Care Utilization Among 137,942 Female OEF/OIF Veterans through 3rd Qtr. FY 2010 Environmental Epidemiology Service 6

7. Demographics: Age • Average age of VA users • Female Veteran = 47 • Male Veteran = 61 • Among women VA users returning from OEF/OIF • 76.8% are age 40 or below • 47.1% are 30 or younger VA Health Care Utilization Among 137,942 Female OEF/OIF Veterans through 3rd Qtr. FY 2010 Environmental Epidemiology Service 7

8. Trimodal Age DistributionWomen Veteran VA Patients Frayne SM. VA Women’s Health Evaluation Initiative. Plenary Presentation at the VA HSR&D Women’s Health Services Research Conference in Washington DC July, 2010 8

9. Women’s Deployment Health

10. How Does Combat Affect Health? • Physical injuries with residual pain • Diagnosable mental health conditions • Unexplained symptoms with general health decline • Hearing problems • Dental problems • Psychosocial distress: marriage/work/social disruption • Post-war death/injury from “incidental trauma” 10

11. Deployment Risk Factors • Combat exposure (mortars, IED, RPG) • Heavy gear • Ceramic vests • Moving heavy equipment • Walking, jumping, running • Driving long distances • Extreme temperature • Hygiene issues • Dietary issues • Interactions with male counterparts • Family and other relationship issues 11

12. Reintegration and Service Needs of Women Veteran Mothers: Family Feeling isolated; difficulty communicating with family and friends Not having enough time to “readjust” Family members expecting a quick return to former roles and “old selves” Difficulties bonding with children (differed depending on age of child, time/distance away) Feeling need to “compensate” for being away Feeling “out of sync” with children, partners/family Gudrun Lange, PhD (PI) & Karen Quigley, PhD (Co-PI) NJ War Related Illness & Injury Study Center - WRIISC 12

13. Reintegration and Service Needs of Women Veteran Mothers: Work Employment concerns (with or without children) Making more $ in military than since returning home Difficulty finding civilian job that pays as well as military Going back to school as attractive option (GI bill) Difficulties in money management From having basic needs (housing, food, clothing) taken care of to learning how to budget/manage $$ Made more difficult by lower earning power Tensions about (mis)management of $$ while away Gudrun Lange, PhD (PI) & Karen Quigley, PhD (Co-PI) NJ War Related Illness & Injury Study Center - WRIISC 13

14. Post-Deployment Medical Conditions 14

15. Musculoskeletal Disorders • Joint Disorders • Back Disorders • Disorders of Soft Tissues • Disorders of Cervical Spine 15

16. Genitourinary Disorders • Menstrual disorders • Disorders of cervix, vagina, vulva • Disorders of the urethra • Pain associated with female genital organs 16

17. Reproductive Health Concerns • Contraception • Pregnancy/Lactation • Infertility/Birth Defects/Miscarriages • Abnormal Uterine Bleeding • Pelvic Pain • Sexually Transmitted Infections 17

18. Mental Health Disorders • Adjustment reaction • Depressive disorders • Post Traumatic Stress Disorder • Nondependent abuse of drugs 18

19. Military Trauma among Female Veterans • OEF/OIF female Veterans may experience both Military Sexual Trauma (MST) and combat trauma • 20% of female OEF/OIF Veterans accessing VA health care screened positive for MST • Combat trauma rates not yet known • Survivors of childhood abuse are at risk for • re-traumatization, depression, and substance use 19

20. Women Veterans Comprehensive Health Care

21. Mission: Women Veterans Health Strategic Health Care Group Ensure that all women Veterans receive equitable, high-quality, and comprehensivehealth care services in a sensitive and safe environment at all VA facilities Be a national leader in the provision of health care for women Veterans, thereby raising the standard of care for all women 21

22. “Since the Revolutionary War, America’s women have earned America’s gratitude and respect for their contributions to the military and to the nation. VA will continue to improve our benefits and services for women Veterans as we transform into a 21st century organization.” – Secretary of Veterans Affairs Eric K. Shinseki March 10, 2010 22

23. Full-time Women Veterans Program Managers (WVPMs) Roles: • Improve advocacy • Increase outreach • Facilitate improvements in the quality of care • Help develop best practices 23

24. Revised VHA Handbook 1330.01: “VHA Services for Women Veterans” Outlines specific services that must be provided at VA facilities and CBOCs Defines Comprehensive Primary Care for Women Veterans Requires women to be seen by designated Women’s Health Primary Care Providers Offers three primary care clinic models Details safety and security requirements Establishes systematic data collection process 24