Contraceptive Care in the Veterans Health Administration

Abstract

In recent years, the number of women Veterans obtaining care in the Veterans Affairs (VA) Healthcare System has grown, expanding the need for provision of contraceptive care. Women Veterans are a diverse group of women with complex sociodemographic and medical backgrounds, and meeting their needs presents a unique challenge for VA. Efforts including the establishment of comprehensive women's health clinics and training practitioners in women's health have greatly improved healthcare services for women Veterans over the last few decades. Recent data from a large cross-sectional survey study suggest that contraceptive use in VA is similar to the general population and that rates of unintended pregnancy, while still significant, are not higher than that in the general population. Subgroup analyses of this survey data, however, suggest that ongoing efforts are needed to improve outcomes in vulnerable subpopulations of women Veterans, particularly ethnic/racial minorities and Veterans with complex medical backgrounds. Policy changes such as the elimination of copayments for contraceptive prescriptions and the dispensing of more months of contraceptive supply are evidence-based starting points for improvements, in addition to leveraging VA's integrated system and research infrastructure to improve patient-centered counseling and contraceptive access.

Development and Pilot Testing of a Patient-Centered Web-Based Reproductive Decision Support Tool for Primary Care

“…10 Over the past 20 years, VA has invested in building reproductive health services, including training PCPs in reproductive health, 11 creating comprehensive women's health clinics, 12 and ensuring availability of all FDAapproved contraceptive methods. 13 Despite this, only 38% of reproductive-aged Veterans who could become pregnant report that they discussed contraception or optimizing health prior to pregnancy with their PCP in the past year. 14 This counseling is particularly critical for Veterans, who face elevated risks of adverse pregnancy and birth outcomes due to a high prevalence of chronic medical 15,16 and mental health conditions 17 as well as psychosocial stressors including sexual trauma histories, 18 intimate partner violence, 19 and homelessness.…”