Women veterans comprise about 18.5% of the military population and are projected to increase over the next two decades, even as the number of men and total veterans decline. But there is little data available to address severe pregnancy complications related to service.
"There are a number of things disproportionately impacting those who served, including PTSD, military sexual trauma, intimate partner violence, and other mental and behavioral health conditions," said Rachel Gandell Tetlow, director of federal affairs at the American College of Obstetricians and Gynecologists.
According to an ACOG report, women veterans are twice as likely to experience PTSD as their civilian counterparts and 1 in 4 women report PTSD from sexual violence experienced during service. This can lead to diminished physical health and a reluctance to seek preventive reproductive care. Other studies show women veterans have a uniquely high risk for infertility and preeclampsia when compared with the civilian population, and their newborns are more likely to be admitted to the neonatal intensive-care unit.
Congress has put veteran women's maternal care at the forefront of its Black Maternal Health "Momnibus" package to address maternal mortality. The total bill package will ultimately include other bills addressing high maternal mortality rates among Black women, Indigenous women, and other women of color.
The House of Representatives passed the Protecting Moms Who Served Act on May 13, which focuses on strengthening maternity care programs for active duty and veterans through partnerships with the Veterans Affairs Department and community care coordinators, since the VA does not provide maternity care.
Rep. Lauren Underwood (D-Ill.), who sponsored the Momnibus, said lawmakers decided to go with a bill-by-bill approach to try to "broaden their appeal" in the House and Senate. Sens. Tammy Duckworth (D-Ill.) and Susan Collins (R-Maine) are sponsoring that chamber's version of the bill.
The House bill would require the Government Accountability Office to collect data on the effectiveness of the VA's partnerships as well as demographic information on women veterans to help pinpoint disparities in care and poor health outcomes. Women with VA, private insurance, Tricare, Medicaid and those uninsured will be included in the study.
"There is not as robust a research base as there has been for male veterans and we're doing the best that we can, but a huge part of this bill is that there's so much for us to learn," Tetlow said.
Women veterans covered by the VA were significantly more likely to suffer from preeclampsia, gestational diabetes or have their infants admitted to the NICU than mothers on other payers, according to a study by Health Services Research. Medicaid beneficiaries have a higher rate of preterm births, which puts them at a higher risk of complications, but they experienced them less often than veterans.
When compared with the civilian population, VA-covered women veterans were 40% more likely to suffer from preeclampsia, showing the physical and emotional trauma of deployment may contribute to adverse reproductive health outcomes since those at the VA were twice as likely to have seen combat.
As of 2018, 19% of the almost 2 million women veterans are Black. From 2000 through 2012 they made up 14% of the total VA-enrolled births, significantly higher than the civilian population, where they accounted for 5% of births.
"Even if we do not have the specific data about veterans, we do know about the system," said Jamille Fields Allsbrook, director of the Women's Initiative at the Center for American Progress. "We also know there's a peer coordination problem within the VA. I don't think we need to wait to show all these veterans are dying to solve the systemic problem."
The VA declined to comment on the legislation.