March 2017

In this Issue: VA Healthcare for Women Veterans
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VA Maternity Care Coordination

Feature Article

A substantial proportion of new women Veterans are of reproductive age, with more than 90% of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans age 45 years or younger. As a result, VA has substantially increased its attention to reproductive healthcare, including pregnancy-related care. Recent evidence suggests the number of women Veterans delivering babies using VA maternity benefits has nearly doubled in the past five years. Further, because nearly all maternity care is provided by community obstetrical providers through the non-VA care program, virtually nothing is known about how women Veterans access and use maternity care services, how their maternity care is coordinated, or how ongoing VA care (e.g., primary care, specialty care, and mental healthcare) is managed during and after pregnancy.

This ongoing study seeks to characterize women Veterans' maternity care experiences with accessing this care, including any barriers and facilitators they experience in care coordination across VA and non-VA facilities. Investigators recruited pregnant Veterans from 13 VA facilities across the country, conducting surveys at approximately 20 weeks of pregnancy and again at 12 weeks postpartum. Information is being analyzed regarding perceptions of maternity care coordination, as well as pregnancy experiences, co-existing physical and mental health conditions during pregnancy, social support, and postpartum health of both mother and baby. Concurrently, investigators conducted interviews with women's primary care, gynecologic, mental health providers, Women Veteran Program Managers (WVPMs), Maternity Care Coordinators and fee basis/community obstetricians to better understand the process of maternity care coordination to identify barriers to ideal care coordination.

To date, 231 pregnant Veterans have enrolled in the study and completed the pregnancy interview, and 125 of these women have completed the postpartum interview. Thus far, findings show:

• Pregnant Veterans experience substantial mental health burdens during pregnancy, with nearly half of all pregnant Veterans having a diagnosis of depression or PTSD. However, few women seek mental healthcare during their pregnancy, due either to the inability to find a community mental health provider or perceptions that VA mental health care is not available during their pregnancy.
• Forty-nine percent of women had a diagnosis of depression, while 34% had a diagnosis of PTSD.
  • Fewer than 30% of women had plans to continue to see their VA mental health provider during pregnancy despite diagnosis of depression or PTSD.
• Thirty-two percent of women Veterans were unable to access prenatal care as soon as they would have liked due to an inability to find a non-VA provider willing to accept VA maternity benefits.
• Fifty-three percent of pregnant Veterans had experienced military sexual trauma during their military deployments, and 31% of these women had experienced force or the threat of force for sex during military service.
• Following delivery, only 8% of women reported receiving mental healthcare during pregnancy from either a VA or community provider.

Impact: Care coordination between VA and non-VA providers for pregnant Veterans is important given the burden of depression and PTSD during pregnancy. The VA must prioritize care coordination strategies to ensure that Veterans are receiving comprehensive care across VA and non-VA health care systems.

Principal Investigator: Kristin Mattocks, PhD, MPH, Principal Investigator with the Women Veterans Healthcare CREATE and part of the VA Central Western Massachusetts Healthcare System.

VA Maternity Care Coordination project abstract