Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4036 — "Just Talk to Me About It:" How Women Veterans' Experiences of Stigma in Health Care Shape Reproductive Counseling Needs

Lead/Presenter: Lisa Callegari, COIN - Seattle/Denver
All Authors: Callegari LS (HSR&D, Seattle/Denver COIN) Szarka J (HSR&D, Seattle/Denver COIN) Tartaglione E (HSR&D, Seattle/Denver COIN) Magnusson S (HSR&D, Seattle/Denver COIN) Nelson KM (HSR&D, Seattle/Denver COIN) Arterburn DE (Group Health Research Institute) Zephyrin L (VA Women's Health Services) Borrero S (HSR&D, Pittsburgh/Philadelphia COIN)

Objectives:
Women Veterans' unique military experiences and health profiles increase their risk of adverse reproductive health outcomes, and may influence their needs related to provider-patient communication. Our objective was to understand women Veterans' experiences of reproductive health care in the military and VA, and how these experiences shape their current reproductive counseling needs.

Methods:
We conducted 32 in-depth, semi-structured qualitative interviews by telephone with women Veterans ages 18-44 who used VHA primary care in the past two years (21 from Puget Sound and 11 from Pittsburgh). Interviews explored experiences of counseling related to pregnancy intentions, planning, and contraception in the military and VHA. Transcripts were analyzed using simultaneous deductive and inductive content analysis, and key themes were identified.

Results:
Nearly all study participants reported experiencing gender-based stigma and discrimination in their reproductive health care interactions in military and/or VHA. Perceived dismissal of their concerns, pressure and judgment from providers, and structural factors such as lack of continuity with providers have impeded their ability to receive the care they need. Some participants, however, also reported positive experiences of feeling respected, receiving comprehensive information about pros and cons of options, and having their perspectives and concerns elicited. Key counseling needs that emerged included that providers (1) initiate and validate discussions about pregnancy plans and contraception ("talk to me about it"), (2) form a partnership with patients as advocates ("someone on my side"), and (3) discuss all options and elicit women's preferences and values, allowing women to retain ultimate control over decisions.

Implications:
Women Veterans report experiences of stigma, discrimination, dismissal, and judgement in reproductive health counseling interactions with providers. VHA providers can successfully counterbalance these negative experiences through high quality communication, including forming therapeutic relationships with women and engaging in shared decision making.

Impacts:
Providers and policy makers in the community as well as in VHA can ensure delivery of high quality care by recognizing the ongoing impact of women's military experiences on their reproductive health care needs. Communication tools tailored to Veterans that empower women and facilitate patient-centered interactions could improve quality of reproductive health care in VHA.