Study Shows One-third of Reproductive-Age Women Veterans Perceive Gender-based Discrimination in VA Healthcare System
BACKGROUND:
VA serves more than 450,000 women, representing 5% of the total VA patient population. Evidence indicates that some women Veterans delay or avoid care within the VA healthcare system because they have had prior negative gender-based experiences when seeking VA care. This study examined the prevalence of perceived gender-based discrimination – and factors with which it is associated – among reproductive-aged women Veterans seeking VA healthcare. Using data from the "Examining Contraceptive Use and Unmet Need among Women Veterans" (ECUUN) study, investigators assessed how patient demographics and variables that may uniquely affect women Veterans' experiences with the VA healthcare system (e.g., deployment experiences, history of military sexual trauma, and having a women's health clinic at one's VA) are associated with perceived gender-based discrimination. The ECUUN study used a telephone-based survey with a nationally representative sample of 2,302 women Veterans of reproductive age; surveys were completed between April 2014 and January 2016.
FINDINGS:
- Among 2,294 women Veterans, 34% (n=773) perceived gender-based discrimination when receiving VA care. However, the mean perceived discrimination score was 7.8 on a 24-point scale, indicating a relatively low frequency of perceived discrimination in VA among those who do encounter it.
- Of the women Veterans perceiving gender-based discrimination in VA, odds were higher among women with medical or mental illness, or with a history of military sexual trauma.
- Odds of perceiving gender-based discrimination were lower among women who received most of their care from the same VA primary care provider – or whose VA had a women’s health clinic.
- Of note, compared to non-Hispanic White women, Hispanic and non-Hispanic African American women perceived less gender-based discrimination.
IMPLICATIONS:
- The roles of women’s health clinics and care continuity with VA primary care providers in reducing perceptions of gender-based discrimination among women Veterans should be examined further.
- Efforts to enhance patient experiences to prevent exposure to gender-based discrimination may be needed among women with more health concerns and/or a history of military sexual trauma.
LIMITATIONS:
- This study did not assess the specific context or timing of experiences of discrimination, nor did it determine the existence of objective discriminatory practices within VA.
- This study assessed perceived gender-based discrimination using a measure intended to capture experiences with members of the healthcare system (e.g., staff, doctors, and nurses). The extent to which participants experienced gender-based harassment from other patients is unclear.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 12-124). Drs. Hausmann, Borrero, Zhao, and Mor are part of HSR&D’s Center for Health Equity Research and Promotion (CHERP), Pittsburgh and Philadelphia, PA.
MacDonald S, Judge-Golden C, Borrero S, Zhao X, Mor M, and Hausmann L. Experiences of Perceived Gender-Based Discrimination among Women Veterans: Data from the ECUUN Study. Medical Care. May 2020;58(5):483-90.
