Female Veterans

When one hears the term ""veteran"", most would picture older men, Vietnam era, proudly wearing their caps and driving their trucks with stickers which hail their time spent fighting for their country. While many veterans are indeed men, today more and more veterans are from younger generations and even more so are women. Traditionally, women are not seen as fighters, and their time in the service is often understated compared to their male counterparts. Female veterans face just as many if not more risks when they leave the service, retiring and going out into the civilian world.

PTSD, homelessness, and unemployment are just a few of the many challenges all veterans face when trying to integrate back into society along with other healthcare needs they may have, but female veterans have significant differences in relation to their male veteran counterparts. In an article entitled ""Women service members, veterans, and their families: What we know"" authors Mankowski and Everett state that "" women bear a disproportionate share of mental and physical health problems, have less perceived social support, have lower socioeconomic status, utilize healthcare at a higher rate, and experience lower employment status relative to educational levels"". Female veterans have fought hard to gain the acknowledgment and respect they deserve, defying odds, challenging culture norms, and overcoming many physical and mental obstacles throughout their time in service, making them a truly unique, yet vulnerable portion of the population.

Military Experience

Historically, women have always served the military in one form or another. During the Revolutionary War, women followed their husbands to war, serving in camps as cooks, nurses, and doing laundry as long as they were deemed helpful by the commanding officers at that camp. During the Civil War women fill the role of administrators of hospitals and cooks in both Union and Confederate hospitals. In 1898, during the Spanish-American War, Army hospitals in the United States are staffed with 1500 civilian women, and many more serve as spies, support staff, and there are even some who disguise themselves as men in order to fight.

Women have always played a role in the military, but in 1917, during the last two years of World War I, is when women are allowed to join the military. It is during this time that 33,000 women sign up as nurses and support staff officially being recognized as being a part of the military. As time continues, female presence during times of war just continues. In the time of Word War II, Rosie the Riveter encouraged women to pick up the fallen tools of the men overseas fighting, and while this fueled engineering and mechanical jobs for women back home, it also saw a dramatic increase in women serving in the military. It is during this time more than 400,000 women join the military. These women find themselves serving as ambulance drivers, mechanics, pilots, nurses, administrators and many other non-combat roles both in America and abroad. As history marches forward, women continue to pledge their service, mainly as nurses and in non-combat roles, but as time progresses more and more opportunities open up to women. Service academies open up their doors to women, women start flying in combat, and now, in today's society, all positions are now open to women. In an article in The Atlantic published December 3, 2015 Defense Secretary Ash Carter stated ""starting in January, women will be allowed to serve in all front-line combat roles, including in infantry units, in the U.S. Army, Navy, Marine Corps, and Special Operations Command"" (Koren).

Demographics

As the role of women in the military has changed, so too has the number of women who have taken up the call to fight for freedom. Looking at demographics, characteristics for female veterans are quite different than their male counterparts. In general, female veterans tend to be younger, more highly educated, and comprised of a greater number of minorities. The Department of Veterans Affairs, in efforts to track and store data in reference to Veterans has on its website www.va.gov a tool known as VetPop2016. According to the VA website ""Vetpop16 provides the latest official Veteran population by key demographic characteristics such as age/generations, gender, period of service and race/ethnicity at the national, state and Congressional District levels for the next 30 years"". Data is collected and organized by age, gender, branch of service, period served, race, ethnicity, and officer or enlisted. Using this data, it can be seen that as of 9/30/2017 there were 1,882,848 female Veterans across the nation. Of these, 1,342,739 are white, 374,912 are Black of African American, 19,090 are American Indian and Alaska Native, 40,023 are Asian, 8,272 are Hawaiian/Pacific Islander, 34,957 are classified as ""other race"", 62,855 classify themselves as two or more races, and 180,199 are classified as Hispanic or Latino. In an article entitled ""Aiming High: Explaining the Earnings Advantage for Female Veterans"" the authors explain that ""Women now represent 14% of active duty enlisted personnel (up from 2% in 1973) and 16% of officers (up from 4%). These increases mean that the proportion of female veterans has been rising, and it is forecast to increase still further over the next 30 years"" (Padavic, Prokos).

Healthcare Needs

With the growing female veteran population, comes growing health care needs. Veterans in general can pose great challenges for healthcare providers. The veteran population can not be treated the same as the civilian population and doing so could cause great harm. Veterans may suffer from several psychological problems due to their time in service such as traumatic Brain Injury, Post Traumatic Stress Disorder, anxiety, depression and military sexual trauma. In an article entitled ""Trauma Among Female Veterans"" Zinzow et all states that ""The prevalence of posttraumatic stress disorder (PTSD) among female veterans is higher than the prevalence among civilian women. Female veterans are more likely than male veterans to experience sexual assault. Female veterans are equally or less likely than male veterans to meet criteria for PTSD""(385). Mental and emotional health is going to be vital in treating and caring for the female veteran population. The stress they endured while in the service often times leads to mental health issues that follow them into their civilian life. These mental health issues can branch into personal lives, affecting the veteran's family life as well as professional life. Assessing and diagnosing mental health problems is a key factor in promoting the best quality of life for the female veteran population.

Policies and Laws

P.L. 110-186 titled ""Veterans Health Improvement Act of 2004"" which can be found on the Center for Women Veterans on VA.gov. ""authorizes appropriation assistance to homeless veterans, funds sexual trauma counseling programs, and authorizes funding for centers for research, education and clinical activities on complex multi-trauma associated with complex injuries"" among other things. Other public laws include P.L 111-163 entitled ""Caregivers and Veterans Omnibus Services Act of 2010 which ""provides contract for a comprehensive study on barriers to health care for women Veterans, pilot program to provide group readjustment counseling in retreat settings for newly separated women combat Veterans, mandates inclusion of recently separated women on Advisory Committees for Women Veterans, and requires VHA to carry out a 2 year pilot program to assess feasibility and advisability of offering child care to Veterans"". Other laws and policies listed on the site assist with military related injuries and business training resource programs for women veterans.

Barriers

Ensuring care is received for all health care matters is important, especially regarding female veterans. The Department of Veterans Affairs has many branches throughout the country with satellite branches and clinics dispersed throughout as well, but be that as it may, one of the biggest barriers to access to care. In a study entitled ""Factors Related to Attrition from VA Healthcare Use: Findings from the National Survey of Women Veterans"" in the Journal of General Internal Medicine it is stated that ""Distance from a VA was the most frequently selected reason for discontinuing use, followed by availability of non-VA insurance, perceived higher quality of care outside of VA, and prior negative experience with the VA"" (Hamilton et all). Without access to care, and perceived low quality of care, female veterans are foregoing their VA benefits, and quite possibly foregoing receiving the quality care they need.

Promoting Change

Female veterans can suffer from a wide range of physical, mental, and emotional issues. In order to treat this population, it is important to educate the veteran population, especially the female population about the care available to them. The Department of Veterans Affairs offers comprehensive health care to the veteran population which covers the physical and mental health care needs they require. While many veterans take advantage of these services, there are still many more who are unaware of the services they are eligible for. In the clinical setting it is important for nurses to educate the female veterans about the access to care they are eligible for, and the services this care can provide this population. Ensuring female veterans seek out the physical and mental health care they need is the best way to improve the health outcomes of this population.

Collaboration

In order for female veterans to receive the best quality care, the entire care team needs to be proactive in assessing, planning, and implementing health care goals. Female veterans are susceptible to many of the same physical and mental traumas of their male counterparts. Stress and anxiety from their years in service, physical trauma suffered during times of conflict, and the emotional effects from trying to transition back into civilian life all pose significant challenges for the health care team. The female veteran needs more than just their outward symptoms managed. Physicians need to diagnose and manage the mental pain as well as the physical pain. Mental health providers need to provide proper assessment and medication if necessary to manage the complicated gamut of feelings and stressors that damage the mental well-being of these women. Social workers and case managers need to work closely with this group, ensuring that they have access to support groups and community resources that will help these female veterans on their care journey. Nurses need to constantly assess the needs of this population and confer with the care team accordingly. Actively listening and advocating for the best interest of the patient ensures that the veteran gets the care they need. Every member of the care team needs to understand and respect the challenges faced by the female veteran.

While outwardly, female veterans share the same mental and physical strength as their male counterparts, inwardly they may be facing battles that are all too common across the veteran spectrum. While all veterans may suffer from an array of physical and mental health needs, it is important not to clump these women in with male veterans. Women are a unique portion of the population, women veterans even more so. The physical and emotional tolls they endure to serve their country is equal to that of their male counterparts, but all to often the care they receive in anything but. It is vital for care teams to acknowledge the battles these women endure, respecting the difficulties that these women face, and treating them with the respect and dignity they deserve.

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