Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017
The literature on the reproductive health and healthcare of women Veterans has increased dramatically, though there are important gaps. This article aims to synthesize recent literature on reproductive health and healthcare of women Veterans. We updated a literature search to identify manuscripts published between 2008 and July 1, 2017. We excluded studies that were not original research, only included active-duty women, or had few women Veterans in their sample. Manuscripts were reviewed using a standardized abstraction form. We identified 52 manuscripts. Nearly half (48%) of the new manuscripts addressed contraception and preconception care (n = 15) or pregnancy (n = 10). The pregnancy and family planning literature showed that (1) contraceptive use and unintended pregnancy among women Veterans using VA healthcare is similar to that of the general population; (2) demand for VA maternity care is increasing; and (3) women Veterans using VA maternity care are a high-risk population for adverse pregnancy outcomes. A recurrent finding across topics was that history of lifetime sexual assault and mental health conditions were highly prevalent among women Veterans and associated with a wide variety of adverse reproductive health outcomes across the life course. The literature on women Veterans’ reproductive health is rapidly expanding, but remains largely observational. Knowledge gaps persist in the areas of sexually transmitted infections, infertility, and menopause.
Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans
Reproductive-age women are a fast-growing component of active-duty military personnel who experience deployment and combat more frequently than previous service-era women Veterans. With the expansion of the number of women and their roles, the United States Departments of Defense and Veterans Affairs have prioritized development and integration of reproductive services into their health systems. Thus, understanding associations between deployments or combat exposures and short- or long-term adverse reproductive health outcomes is imperative for policy and programmatic development. Servicewomen and women Veterans may access reproductive services across civilian and military or Veteran systems and providers, increasing the need for awareness and communication regarding deployment experiences with a broad array of providers. An example is the high prevalence of military sexual trauma reported by women Veterans and the associated mental health diagnoses that may lead to a lifetime of high risk-coping behaviors that increase reproductive health risks, such as sexually transmitted infections, unintended pregnancies, and others. Care coordination models that integrate reproductive healthcare needs, especially during vulnerable times such as at the time of military separation and in the immediate postdeployment phase, may identify risk factors for early intervention with the potential to mitigate lifelong risks.
Infertility Services for Veterans Enrolled in Veterans Health Administration Care
Background
Infertility care is provided to Veterans through the Veterans Health Administration (VHA) medical benefits package and includes infertility evaluation and many infertility treatments.
Objective
Our objective was to examine the incidence and prevalence of infertility diagnoses and the receipt of infertility healthcare among Veterans using Veterans Health Administration (VHA) healthcare from 2018 to 2020.
Methods
Veterans using the VHA and diagnosed with infertility during October 2017–September 2020 (FY18–20) were identified in VHA administrative data and through VA-purchased care (i.e., community care) claims. Infertility was categorized among men as azoospermia, oligospermia, and other and unspecified male infertility, and among women as anovulation, infertility of tubal origin, infertility of uterine origin, and other and unspecified female infertility using diagnosis and procedure codes (ICD-10, CPT).
Key Results
A total of 17,216 Veterans had at least one VHA infertility diagnosis in FY18, FY19, or FY20, including 8766 male Veterans and 8450 female Veterans. Incident diagnoses of infertility were observed in 7192 male Veterans (10.8/10,000 person (p)-years) and 5563 female Veterans (93.6/10,000 p-years). A large proportion of Veterans who were diagnosed with infertility received an infertility-related procedure in the year of their incident diagnosis (males: 74.7, 75.3, 65.0%, FY18–20 respectively; females: 80.9, 80.8, 72.9%, FY18–20 respectively).
Conclusions
In comparison to a recent study of active duty servicemembers, we found a lower rate of infertility among Veteran men and a higher rate among Veteran women. Further work is needed to investigate military exposures and circumstances that may lead to infertility. Given the rates of infertility among Veterans and active duty servicemembers, enhancing communications between Department of Defense and VHA systems regarding sources of and treatment for infertility is essential to help more men and women benefit from infertility care during military service or as Veterans.
Women make up more than 16.5 percent of the active-duty force and serve in all military occupations. Therefore, their health and well-being are critical to overall force readiness. Given the importance of service women's health and well-being, the 2016 National Defense Authorization Act (NDAA) required the U.S. Department of Defense (DoD) to provide service women access to comprehensive family planning and counseling services, including at health care visits before and during deployment and annual physical exams. The 2017 NDAA required DoD to conduct a survey of service members' experiences with family planning services and counseling. As a result of these mandates, in 2018 the Defense Health Agency asked the RAND Corporation to conduct a survey on select aspects of the health of active-duty service women (ADSW) to help determine whether their reproductive health needs were being addressed. To address this request, RAND developed the Women's Reproductive Health Survey (WRHS) of ADSW.
The WRHS represents the first DoD-wide survey of only women since 1998. The only requirements in terms of survey content were topics identified in the 2016 and 2017 NDAAs (e.g., access to contraceptive counseling and family-planning methods, experiences with use of contraceptives, and availability of preferred methods); the research team identified other related items to also include in the survey. Findings summarized here focus on:
-health care utilization
-birth control and contraceptive use
-reproductive health during training, predeployment, and deployment
-fertility and pregnancy
-infertility
Menstrual Suppression for Military Women Barriers to Care in the United States
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