A new federal report reveals that the number of pregnant American veterans experiencing severe complications has doubled over the last decades. The Government Accountability Office (GAO) analyzed 40,000 hospitalizations related to pregnancy, childbirth and postpartum depression that were paid for by the U.S. Department of Veterans Affairs (VA).
In 2020, the rate of severe complications rose to 184 cases per 10,000 admissions, up from 93 per 10,000 in 2011. Researchers noticed significant increases in the number of emergent admissions, infections, kidney failure, aneurysms, and blood loss. During the same period, 13 former service personnel died from such complications.
This is nothing new. As far back as 2018, VA officials knew that pregnant veterans using VA-sponsored services were significantly more likely to experience adverse complications like cesarean births, preeclampsia and admissions to the neonatal intensive care unit than patients under Medicaid or private insurance.
The recent GAO report may reveal the VA’s deficiencies in tracking prior data and gaining a clear picture of the growing needs among female service personnel.
The Department of Veterans Affairs, whose patient population is predominantly male, has not historically focused on women’s healthcare. Many of these services, like other medical specialties, have been contracted to other providers in better positions to meet the needs of female patients, specifically those associated with maternity care.
While this arrangement is understandable for efficiency and quality, the VA’s poor job of collecting data and following up on unmet needs is a severe issue.
This “out of sight, out of mind” mentality has opened the door for a wave of preventable pregnancy-related complications. The GAO recommended more research and preventative screenings during pregnancy and postpartum.
In addition, the study revealed widespread neglect of mental health during pregnancy. There has long been a recognized connection between mental health and pregnancy-related complications. Post Traumatic Stress Disorder can significantly increase a mother’s risk of complications, including a 35% increase in the rate of preterm birth and a 30% increase in cases of preeclampsia.
Along these lines, the GAO report recommends expanding the questions healthcare providers ask patients to address anxiety and PTSD. In response, VA officials are creating a dashboard to track pregnant veterans’ health outcomes and provide targeted care. In addition, the VA is pushing for better demographic data that looks at economic, geographic, and racial disparities associated with pregnancy complications.
While mental health among pregnant patients is a significant risk factor, racial disparities also account for complications. The GAO report revealed that black patients were over 30% more likely to have maternal complications than white patients.
This is similar to a 2021 study of 659 deliveries revealing that black patients were twice as likely to need a cesarean section as white patients who used VA services. This parallels the Centers for Disease Control and Prevention’s 2020 data, which documents that maternal mortality rates among Black patients nationwide were 55.3 per 100,000 live births. In contrast, white and Hispanic mothers were 19.1 and 18.2 respectively.
These numbers have been rising steadily since 2017, when the nation saw an average rate of 17.2. This increase should enrage women’s rights groups and the pro-life lobby, as the vast majority of these deaths are preventable through good prenatal and postpartum care. The resources are simply not being applied or tracked by officials.
All this reveals that the Department of Veterans Affairs has long neglected the needs of its female patients.
While contracting specialty services for female veterans to ensure the best quality care can be appropriate, failing to ensure excellent care is provided is not. The authors of the GAO report are correct.
This problem has existed for a very long time. It is time for Congress and the VA to step up to ensure female veterans receive appropriate care.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
