Over the past decade, the number of women Veterans using VHA care has nearly doubled. A substantial proportion of these women Veterans are of reproductive age, with over 90% of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) women Veterans age 45 or less. Recent evidence suggests the number of women Veterans delivering babies using VHA maternity benefits has nearly doubled in the past five years, and yet little information exists regarding how these women access and utilize maternity care. These pregnant Veterans may be at risk for poor maternal and child health outcomes as a result of complex medical and mental health problems they may be experiencing during their pregnancies. Therefore, coordinating maternity care with ongoing VHA care for pregnant Veterans is crucial. The immediate objective of this study is to inform the considerable debate about the best ways to coordinate maternity care for women veterans by characterizing maternity care coordination across VA facilities. The long-term objective of this work is to promote high-quality maternity care for women veterans through ongoing design, evaluation, and improvement of maternity care delivery and coordination. This project represents the first attempt in the VHA to systematically examine maternity care coordination for pregnant Veterans.
This proposal is directly relevant to VA HSR&D Priority Area for research on Women's Health. In 1996 Public Law 104-262 expanded the healthcare services provided to eligible women Veterans by paying for the full range of maternity care services. Recently, in 2010, VHA benefits have been expanded to the first seven days of newborn care. Currently, nearly all maternity care is provided by community obstetrical providers through the VHA fee basis care program. Despite the 10,000 births to women Veterans over the past five years, there is little known of how women across VHA sites nationally access and experience community based obstetric care, nor how VHA facilities coordinate this care for pregnant Veterans. Given the increasing numbers of pregnant Veterans utilizing VHA care, it is essential to have a deeper understanding of how pregnant Veterans utilize maternity care in conjunction with ongoing VA care. Upon completion of this project, we will have made contributions to the knowledge of coordinated maternity care for women Veterans and be poised to assist policymakers in decisions shaping maternity care protocols and procedures for the VHA.