Illuminating the Critical Importance of Research Supporting Women Veterans.

Abstract

Women have served in the US military since the Revolutionary War, without formal recognition until 1901. Some of those women, like Deborah Sampson and Cathay Williams, disguised themselves as men to serve while thousands of others served as themselves in critical roles such as battlefield medicine and intelligence. In 1863, Harriet Tubman became the first woman known to command combat troops during the Combahee Ferry Raid. In 1865, Dr Mary Walker received the Medal of Honor, the only woman to receive it to-date, for her efforts to provide life-saving care to Civil War soldiers. Hundreds of thousands of their successors answered the call to serve in World War I and World War II, and their invaluable contributions finally received the recognition they were due on June 12, 1948, when President Harry Truman signed the Women’s Armed Services Integration Act into law to recognize women as permanent members of the military. Today, women comprise the fastest growing demographic of both the military and veteran populations. They make up >16% of the active duty force and almost 20% of the National Guard and Reserve force. There are 2 million women veterans living in the US and their numbers are expected to grow to 18% of the total veteran population by 2040. Accordingly, the number of women using the Department of Veterans Affairs (VA) health care system has tripled since 2001 and, over the last 5 years, women have accounted for >30% of the increase in veterans served by the VA health care system. Despite their rising numbers and influence, women face unique barriers to the care, benefits, and services that their service entitles them to as veterans. While men tend to have strong communities of support both in and out of the military, women tend to be isolated as servicemembers and as veterans. Compared with men veterans, women veterans wait longer for care and express less trust in VA. Women also face much higher rates of sexual harassment, assault, and abuse than men both in and out of the military, with 1 in 4 servicewomen reporting experiencing military sexual trauma while in the military and 1 in 4 women veterans reporting experiencing sexual harassment while seeking VA care. These realities have concerning implications for the overall health of women veterans and, in particular, for their mental health. In 2019, VA testified that there has been a 154% increase in the number of women veterans accessing mental health care over the last decade. VA research into women veterans’ mental health care has shown that they are twice as likely to develop posttraumatic stress disorder as men veterans, more likely than their nonveteran peers to have preexisting health conditions like depression, and are twice as likely to die by suicide than nonveteran women. Preventing suicide among women veterans, eradicating disparities in care for women veterans, and ensuring that the institutions that serve women veterans are able to keep pace with their rapid population growth and provide safe, equitable access to the care, benefits, and services that women veterans have earned should be among our country’s top public policy priorities. That is what led us and our colleagues on the House Committee on Veterans’ Affairs to prioritize veteran suicide prevention and create the bipartisan Women Veterans Task Force in 2019 at the start of the 116th Congress. The Task Force is the first of its kind to focus exclusively on women veterans. Since it was created, the Task Force has held roundtable discussions with lawmakers, government officials, veteran service organizations, think tanks, nonprofit groups, researchers, individual veterans, and other stakeholders—many of whom are women veterans themselves—on topics that are important to women veterans. Those topics include advocacy; research; access to care and benefits; mental health; military sexual trauma; sexual harassment; reproductive care; and infertility. Working under the auspices of the Committee, the Task Force has also participated in Congressional oversight hearings on many of those same issues and helped to advance legislation to address mental health, suicide prevention, and the inequities that women veterans face within VA and in society at large. There are indications that this work is paying off, with VA recently reporting significant increases in trust scores among women. However, there is still much work left to do. Research underlies much of the work both the Committee and the Task Force have done so far. Medical and prosthetic research is 1 of the 4 statutory missions of the Veterans Health Administration (VHA) and VHA’s world-class research efforts are performed by a nationwide network of in-house investigators as well as by VA’s many academic affiliates and private and public sector partners. Their work has led to discoveries and innovations that have improved the quality of life for veterans and others around the globe. Many of the disparities in care for women veterans that we cited previously were uncovered by VA-sponsored research. For example, VA-sponsored research uncovered significant unmet need for infertility care and evaluation among women Veterans using VA health care, with only 52% of those with trouble conceiving undergoing infertility evaluation and only 65% of these receiving any treatment.1 VA-sponsored research also found that 1 in 4 women veterans experiences sexual or gender harassment in VA health care settings, resulting in many delaying or missing care.2 In addition, a partnership between VA’s National Center for PTSD-Women’s Health Sciences Division and Boston University has led to the creation and expansion of the WoVeN (Women Veterans Network) program, which provides a structured, evidence-based program for women veterans to build connections. This program deploys several of the 7 strategies established by the Centers for Disease Control (CDC) for suicide prevention, including creating protective environments, promoting connectedness, and teaching coping and problem-solving skills.3 Continued research will be critical to illuminating the path forward by helping to identify evidence-based practices to support women veterans at-risk of suicide and reduce and ultimately eliminate inequities and disparities in care for women. As the veteran community becomes increasingly diverse with respect to sex, race, and geography, research will need to similarly diversify within VA to ensure it continues to meet the needs of today’s veteran population, can recognize those who are vulnerable, and target effective treatment, intervention and other support to them. To do so, researchers must continue to dedicate their focus on the needs and interests of women veterans and oversample women veteran—including minority women veterans—in VA research studies and surveys. Given that 14 of the 20 servicemembers, veterans, and members of the National Guard and Reserve who die by suicide each day have not sought VA care in the 2 years before their death, research will also need to be dedicated both to those veterans that regularly use the VA health care system and those that, to-date, primarily or exclusively rely on non-VA providers. We are glad to see just such a focus in this volume. We look forward to using the results of the many important studies on these pages to inform our work as lawmakers to improve the quality of life for all the brave women who have served and sacrificed in defense of freedom, democracy, and the American way of life.