Reproductive Health Needs of the Military and Veterans

Alicia Y. Christy, MD, MHSCR, FACOG

Richard Burney, MD, MSc

Women veterans and active-duty women are both rapidly expanding populations, with unique reproductive health needs, that differ from their civilian counterparts. There are more than two million Veterans in the United States, and women Veterans comprise the fastest growing group in the Department of Veteran Affairs. In this issue, as in our first special issue, the authors focus on the unique challenges that active-duty women and women Veterans face.

In our previous issue, Dr. Pilgrim and his DoD colleagues provided an overview of the infertility services available in the military healthcare system. In this issue, Drs. Maldonado and Madden examine the unique reproductive needs of active-duty men, and their options for evaluation and treatment in Infertility and the Military Male.

Dr. Ryan and Dr. Edmonds provide an analysis of the science and policy related to infertility care within the Veterans Health Administration. In their review, Infertility Services for Veterans: Policies, Challenges, and Opportunities, the authors discuss challenges and identify opportunities that exist within the Veteran's health administration system.

After 9/11 the number of young women serving in the military grew exponentially, resulting in a significant increase in the number of reproductive-aged women Veterans. Although the research regarding Veterans' pregnancy and obstetric outcomes is growing, it is still limited. Recent programming and research efforts have focused on the unique reproductive risks and needs of this population. In their manuscript, Obstetric Outcomes in U.S. Veterans: Emerging Knowledge, Considerations, and Gaps, Dr. Hugin and her coauthor, Dr. Jonathan Shaw, review what is known about the risk factors and outcomes of women Veterans who receive obstetrical through the Veterans Affairs (VA). The authors focus on one of the largest contemporary studies, based on California birth data, in their examination of the unique health profiles and outcomes of pregnant Veterans.

As the number of reproductive-aged women Veterans has increased, the need for contraceptive care has also expanded. Data from a recent large survey study have suggested that both contraceptive use and unintended pregnancy rates in Veterans Health Administration (VHA) are similar to the general population. Subgroup analysis, however, has identified a need for ongoing efforts to improve the outcomes in vulnerable subpopulations of women Veterans. In Contraceptive Care in the Veterans Health Administration, Dr. Yecies and her coauthor, Dr. Borrero, suggest innovative solutions to address inequities in access to contraceptive care within VHA.

To achieve effective, high-quality, patient-centered care for oncology patients, communication and coordination across multiple disciplines is necessary. VHA must often rely upon community providers to provide cancer care for women Veterans, making it necessary to coordinate care across two or more health care systems. In their contribution, Coordinating Care for Reproductive Health Malignancies in the Veterans' Health Administration: Promising Practices, Ongoing Challenges, and Future Research, Dr. Cordasco and her coauthors identify future opportunities for research, interventions, and potential options for implementing innovative approaches aimed at improving the coordination of VA reproductive cancer care.