Women comprise the fastest-growing subpopulation of the United States military and veteran communities. This fast growth indicates the increasingly diverse nature of the military. However, the pace of growth in this subgroup does not correspond with the improvement of the systems in place to support them. This factor has negatively reflected the military as it gives the impression that women do not quite belong. Recent developments, such as the opening of combat positions for women in 2015, may have improved the perception of women in the military. However, women veterans have largely been overlooked. As a result, female veterans report unique problems, including but not limited to: higher cases of military sexual trauma compared to men, higher cases of single parenthood, and higher cases of unemployment. These factors have a great significance on the mental wellbeing of this subgroup, potentially contributing to cases of post-traumatic stress disorder (PTSD), mood disorders, and substance use disorders. This report will provide an in-depth analysis of women veterans, including their healthcare needs and inter-professional collaboration that could meet their needs.
About the Population
The largest segment of women veterans alive today served in the period following September 11, 2001 (9/11). This group comprises 33% of the women veteran population. The group that served before 9/11 can be broken down as follows: 23% who served during the gulf war of the early 1990s; 13% who served during the Vietnam War; 3% who served during the Korean War; 2% who served during World War 2; and 25% who served exclusively during peacetime (U.S. Department of Veterans Affairs, 2018). A majority of women veterans served as military nurses with others acting as physicians, intelligence officers, air traffic controllers, and clerks, among other positions, excluding active combat. The government acknowledged women’s capacity to serve as combatants in 2013, followed by integration into combat positions in 2015.
As of 2015, women veterans were, on average, older than non-veteran women. This is according to the National Center for Veteran’s analysis and statistics (U.S. Department of Veterans Affairs, 2018). The median age of women veterans of 2015 was 50, while that of non-veteran women was 46. The same statistics indicated that a higher percentage of veteran women were African American, non-Hispanic. The representation of African American non-Hispanic women veterans was 19%, while that of non-veterans was 12%. The representation of women veterans of Caucasian descent was 66%, while that of the non-Hispanic minority was 25%, and that of Hispanic descent was 9.1%. Compared to non-veterans, women veterans were more likely to have ever married, with 84% being either currently married at the time of the study, divorced, widowed, or separated. In comparison, 72% of non-veterans were married at some point during the study. The divorce rates are also higher across this subgroup, with 23% having been divorced, compared to 13% of non-veteran women.
As of 2015, the total population of women veterans exceeded 2 million. Among these, over 400,000 women veterans received compensation for a service-related disability. 6% of these were subject to Individual Unemployability (IU) compensation. IU compensation is provided for veterans who have a service-related disability that prevents them from being actively employed. A separate study by the United States Bureau of Labor Statistics (2013) revealed that 97,000 women veterans were unemployed as of 2013. The high rate of unemployment is partly contributed to by low educational attainment of this subgroup as the highest educational attainment for a majority of veterans is high school.
Healthcare Needs of Women Veterans
Women veterans report healthcare needs that are absent in other subgroups of the population. Service in the risks of the military increase to women’s reproductive health (U.S. Department of Veterans Affairs, 2018). Women veterans also report higher rates of mental health issues as a result of post-traumatic stress disorder, military sexual trauma, and intimate partner violence. In a study focusing on women veterans who served in Afghanistan, it was observed that their mental health was undermined by PTSD following exposure to combat, sexual assault, sexual harassment, among other stressors experienced during deployment and homecoming readjustment (Muirhead, Hall, Jones‐Taylor, Clifford, Felton‐Williams, & Williams, 2017). These issues largely contribute to the statistic, whereby the rate of divorces and separations among women veterans is higher than the general population.
Other than the mental health problems that women veterans experience, some unique physical health problems have also been identified. Foster and Vince (2009) observe that up to 42% of women veterans return with muscular ailments, arthritis, and back problems. 33% of women veterans also return with stomach illnesses, while 29% return with genital and/or urinary system problems. Reports from Veteran Affairs clinics also reveal that women veterans also visit for hormone replacement therapy and infertility services, among other problems that stem from serving in the military. The source of some of these problems is the subject of debate, but it is reported that muscular illnesses, arthritis, and back problems emerge from carrying heavy loads, while genital and urinary problems stem from the lack of adequate personal hygiene. Dire climatic conditions and traumatic brain injury also cause wide-ranging health problems, which eventually contribute to chronic pain.
Analysis of Policies or Laws That Impact Women Veterans
The federal government falls short of recognizing women veterans and providing mechanisms for providing special benefits based on their unique needs. At the state level, however, various states have established a female veterans program to oversee resource and service distribution. Some states issue special vehicle license plates recognizing women veterans. The profits generated from the sale of these plates are used to fund programs for women veterans. Other states dedicate special days and months to recognize women veterans as a gesture to appreciate them for their service.
One of the most comprehensive laws dedicated to women veterans is Indiana’s Senate Bill 354 – Hoosier Women Veterans Program. This policy is aimed at meeting various objectives for female veterans, including raising awareness of the state and federal benefits available to women veterans. The program also seeks to improve service delivery by assessing the needs of women veterans and reviewing the programs in place to meet these needs. This program is aimed at ensuring that women veterans enjoy the services to which they are entitled.
Resources Available to Women Veterans
The national government provides a wide range of resources for veterans to address special needs, such as employment, housing and homelessness, health, and social support. Some of the programs in place include Homeless Veteran Stand Downs, VA Vocational Rehabilitation and Employment Home, and VA MST Services. Each of these services provides unique opportunities for veterans by consolidating funds provided by non-profit organizations to assist in-need veterans. Women veterans have particularly targeted with Veteran Affairs (VA) healthcare, which is designed to assist women in overcoming challenges stemming from military sexual trauma, maternity care, and general healthcare. Other than the VA program, there are limited platforms designed especially for women veterans, which exacerbates their healthcare needs.
Barriers to Resource Utilization
Study findings by Washington, Bean-Mayberry, Riopelle, & Yano (2011) indicated that up to 20% of women veterans experience delayed healthcare delivery. A majority of women veterans who experience delayed healthcare delivery are in younger age groups (particularly those aged between 18 and 34). The key reasons given by women veterans for delayed care included the inability to get permission from their current employers, transportation difficulties, and unaffordable healthcare. Washington et al. (2011) observed that a majority of women who experienced barriers to healthcare were uninsured. It was also observed that women veterans were either unaware of or had little confidence in the Veteran Health Administration. Moreover, women who reported prior military sexual assault had a higher likelihood of seeking healthcare, with some believing that Veteran Health Administration personnel were not gender-sensitive.
These study findings were confirmed by Washington et al. (2015), who observed that women veterans have special needs in regard to privacy and sex-specific care. Washington et al. (2015) further observed that women veterans were either reluctant or unable to access Veterans Affairs healthcare due to lack of knowledge of the services provided; the perception that the services offered were not optimal for meeting their health requirements; and that these services were not convenient. The authors recommended meeting gaps in knowledge of Veterans Affairs healthcare use and benefits, particularly among younger women veterans.
The Role of the Nursing Profession in Promoting the Healthcare Outcomes of Women Veterans
Considering that women are the fastest-growing veteran population in the United States, the nursing profession should prioritize their needs by designing special measures to identify and meet their special healthcare needs. Women veterans are not only reluctant to seek healthcare but also have limited opportunities to access quality healthcare. Reluctance to seek healthcare is contributed by the perception that services offered in VA clinics are not optimized for women and the inconvenience of poor accessibility of the services. Some are also unaware of VA resources, and some lack the opportunities to visit VA clinics. Based on these factors, nurses must identify women veterans during hospital visits by enquiring from patients whether they have served in the military. This is an important first step for answering important clinical questions, aiding in designing comprehensive care plans, and enabling women veterans to gain access to vital resources for addressing underlying mental and physical health problems.
Although individual nurses have a duty to ensure that they provide specialized care to women veterans based on their unique needs, the nursing profession at large has an even more significant duty to ensure that care is consolidated towards bettering health outcomes for this group. VA providers experience unique challenges in attempting to provide care for women veterans because women veterans constitute 7% of VA users and because their mental health burdens supersede those of male veterans. Logistical and fiscal challenges have undermined the capacity to provide care for this population, necessitating stakeholders in the healthcare industry to prioritize resource distribution to the care of women veterans. Moreover, a patient-centered approach needs to be used in the effort to make the care accessible, continuous and coordinated. VA clinics need to have specially trained teams that focus on female veterans. Care teams would need to provide social support services tailored towards helping women to deal with mental health problems and overcome the risk of substance abuse. These care teams would also provide gender-specific care to help women veterans with special emphasis on reproductive health. Finally, the teams would provide coordinated care to treat acute and chronic illnesses that stem from military injuries.
Before putting these teams in place, stakeholders in the nursing profession need to consider some of the implications for implementation. Doing so would lead to better planning and better, more equitable resource distribution across VA clinics. Individuals selected to work in the patient-aligned care teams would need specialized training on various gender-specific examinations, such as the Papanicolaou test for special screening procedures (Yano, Haskell, & Hayes, 2014). It would also be necessary to improve women veterans’ convenience of access to vital services outside VA clinics. Improving convenience would call for improved access to community-based services for basic and advanced gender-specific services. There is also an urgent need to improve the availability of screening equipment in VA clinics. Improving availability would, in turn, lead to more timely cervical screenings for women veterans.
Interprofessional Collaboration to Meet Healthcare Needs of Women Veterans
In the effort to optimize the quality of care for women veterans, it is essential to consider a care model involving multiple professions. The recommended collaborative framework would include holistic approaches, counseling services, community outreach programs, and wellness groups. Holistic approaches would include massage therapy and acupuncture, among other services. Counseling services would be issued to the individual and couples as well as families of veterans as part of mental health improvement therapy (Madaus & Kellaghan, 2000). Community outreach programs would be designed to improve awareness of VA clinics and other community-based services available to women veterans. Finally, wellness groups would be designed to provide women veterans with health education and deal with stress and anxiety. Making this collaborative framework a reality would necessitate coordination among stakeholders in different professions. Government agencies might be required to intervene by creating a platform for different stakeholders to work together.
Women veterans encounter special challenges during their military placement. They encounter higher cases of military sexual trauma compared to men, leading to heightened cases of PTSD. They also experience adverse physical health outcomes resulting from carrying heavy loads and a lack of adequate personal hygiene. Women veterans also report higher cases of single parenthood and higher unemployment cases, further exacerbating their mental health problems. In order to assist this group, it is necessary to improve the legal frameworks in place while bettering resource allocation for women veterans. The nursing profession also has a special role to play in bettering health outcomes for this subgroup. Going forward, VA clinics ought to have specially trained teams that focus on female veterans. Interprofessional intervention is also necessitated by the need to improve health outcomes for women veterans based on diverse services, such as counseling, holistic care, community outreach, and wellness groups.
Department of Veterans Affairs, U. S. (2018). National center for veteran’s analysis and statistics. Available at: https://www.dvs.virginia.gov/wp-content/uploads/2017/05/VAMCWomen_Veterans_Feb-2017_Final.pdf
Foster, L. K., & Vince, S. (2009). California’s women veterans: The challenges and needs of those who served. CA: California Research Bureau.
Madaus, D. L. S. G. F., & Kellaghan, T. (2000). Evaluation models: Viewpoints on educational and human services evaluation (Vol. 49). Springer Science & Business Media.
Muirhead, L., Hall, P., Jones‐Taylor, C., Clifford, G. D., Felton‐Williams, T., & Williams, K. (2017). Critical questions: Advancing the health of female Veterans. Journal of the American Association of Nurse Practitioners, 29(10), 571-580.
U.S. Bureau of Statistics. (2013). Unemployment Rates for Women Veterans and Non-Veterans by Age, 2013 Annual Averages. Available at: https://www.bls.gov/spotlight/2014/women-vets/home.htm
Washington, D. L., Bean-Mayberry, B., Riopelle, D., & Yano, E. M. (2011). Access to care for women veterans: Delayed healthcare and unmet need. Journal of general internal medicine, 26(2), 655.
Washington, D. L., Farmer, M. M., Mor, S. S., Canning, M., & Yano, E. M. (2015). Assessment of the healthcare needs and barriers to VA use experienced by women veterans: findings from the national survey of women Veterans. Medical Care, 53, S23-S31.
Yano, E. M., Haskell, S., & Hayes, P. (2014). Delivery of gender-sensitive comprehensive primary care to women veterans: implications for VA patient-aligned care teams. Journal of General Internal Medicine, 29(2), 703-707.