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Don’t Call Me ‘Mister’: Report Says VA Needs Cultural Change in Women’s Care

by U.S. Medicine

July 12, 2012

By Annette M. Boyle

WASHINGTON — Female veterans experience more physical and mental health issues than male veterans, yet are 30% less likely to enroll in VA services than men. Part of the problem, according to a recently released report, is that the needs of women veterans differ substantially from those of their male counterparts and, historically, the VA has not offered gender-responsive services to meet those needs.

The recently released Department of Veterans Affairs draft report, “Strategies for Serving our Women Veterans,” notes that improving care for women veterans has become a high priority for the VA as a consequence of the sharp rise in the number of women eligible for and accessing services over the last 10 years.

“The number of women veterans using VHA has more than doubled in the past decade, from nearly 160,000 in FY 2000 to more than 337,000 in FY 2011. We have a strong commitment to ensuring women veterans receive equitable, high-quality, comprehensive healthcare,” said Sally Haskell, MD, acting director of Comprehensive Women’s Health for the Women Veterans Health Strategic Health Care Group.

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Women make up 15% of all the nation’s active-duty forces and 18% of guard and reservists. Consequently, VA projections show the number of women veterans continuing to increase, rising from 1.8 million in 2011 to 2 million by the end of the decade. By 2020, women will account for nearly 11% of the total veteran population, up from 8% today. 

Recognizing that female veterans have a different health profile than male veterans, the draft report proposes increasing “capacity to provide consistent and coordinated access to comprehensive services and benefits that meet the unique needs of women veterans” and addressing gaps “in personal privacy, dignity, security and respect that impact the overall women veterans’ experience in VA.”

Military Sexual Trauma

As indicated by comments on the draft report posted on official websites, www.vawomenvetstratplan.uservoice.com and www.regulations.gov, these changes cannot come soon enough for the one in five women veterans who have experienced military sexual trauma (MST). For many of these women, the lack of privacy common in VHA facilities creates tremendous anxiety. As one posted, “women need simple courtesies at the VA, such as being able to sit in a private waiting area so they do not have to be subjected to the intrusive glares and stares that male veterans sometimes inflict on them. MST victims are triggered very easily, and they need a safe and dignified place to seek treatment.”

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Don’t Call Me ‘Mister’: Report Says VA Needs Cultural Change in Women’s Care

Cultural Change

In the report, the Women Veterans Task Force also recognizes that creating an environment where women feel comfortable asking for and receiving healthcare services requires more than attention to staff numbers and room dividers. It requires a “culture change across VA to reverse the enduring perception that a woman who comes to VA for services is not a veteran herself, but a male veteran’s wife, mother or daughter. Women veterans often report feeling that their service in the military is not recognized or respected.”

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As one Air Force veteran commented, “you can redesign physical facilities, you can add healthcare services, you can assign women coordinators … but until culture change comes about, nothing will actually change across the whole fragmented system. … I’m going to suggest that some kind of national campaign be developed along the lines of: Assume That Every Female in the Facility is a Veteran! Every time! Every Encounter! Every Female!”

Another comment suggested: “Do something about the [templates] for lab results, letters and the like. As it stands right now, they are only able to print with ‘Mr. Veteran’ as the greeting.”

The VA has launched a national campaign designed to educate staff and make women veterans feel more welcome, with a “Please Don’t Call Me Mister” poster that echoes these comments.

The cultural change represented in the draft strategic report “requires ongoing adaptation and transformation” of VA services, training, staff, facilities and attitudes, the report says.

Haskell points out that the draft report is the first step in creation of a comprehensive cross-VA action plan to improve services for women veterans.

“Ultimately,” she said, “our mission is to provide outstanding healthcare to women veterans. We expect our efforts at the VA will also achieve another goal:  It will raise the standard of care for all women.”

Women Veterans Health Care Poster

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Don’t Call Me ‘Mister’: Report Says VA Needs Cultural Change in Women’s Care

The draft strategic plan also calls for the VHA, VBA and NCA to “ensure they have sufficient ability to accommodate women veterans who request access to staff of specific gender.” For women with MST, as well as some of those seeking obstetric or gynecological care, having the opportunity to choose and consistently see a female physician or other medical professional provides great comfort, particularly in a space or facility set aside for women, according to the report.

As women veterans from the North Midwest gather at the Veterans Affairs Medicial Center in Minneapolis last fall, Ruth Hedlund, a member of Women Accepted for Volunteer Emergency Services (Waves) National, enjoys lunch with a friend. The mission of the Minnesota Women Veterans program is to ensure women veterans have equitable access to federal and state benefits and services. Photo courtesy of Minnesota National Guard.

OB/GYN Services

A number of comments encouraged the VA to beef up OB/GYN services so that women could get appointments more quickly, particularly for pregnancy issues. This need has become more acute as the number of young women veterans has risen.

“In 2000, the age distribution of women showed two main peaks, the tallest one at age 44 and the second at age 76,” said Haskell. “By 2009, this pattern had shifted, with a much higher peak at age 47 and a second at age 85 — and a new one at age 27.”

For those younger women, reproductive-health services are critical. “We need to have an OB/GYN clinic instead of farming them out, with an ultrasound for pregnancies,” wrote poster JS. “It looks bad when we have to fee-for-service for these things, like we are not committed to them.” Others commented, however, that being assigned to an existing women’s clinic had reduced their quality of care, because the clinic was not run by a physician of either gender.

The draft strategic plan presents a women veteran-centric approach that goes beyond providing traditional women’s healthcare services and treats the whole woman more effectively. The Women Veterans Task Force notes that women who seek care through the VHA today are less likely to receive preventive-care services such as colorectal cancer screening, depression screening and immunizations and are more likely to be prescribed inappropriate drugs than men. Gender-based disparities also are seen in management of hypertension, hypercholesterolemia and diabetes.
To address these issues, the VA has trained more than 1,200 healthcare providers in basic and advanced topics in women’s health through mini-residencies and developed three models for comprehensive women’s healthcare. Those models include stand-alone women’s clinics, as well as co-located women’s clinics and integrated primary-care clinics. Women would receive all of their prevention, medical and routine gynecologic care from a single primary-care provider at a women’s clinic. A network of medical directors and program managers who coordinate care for women Veterans is in place in all 153 medical centers in the VA Health Care System.


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