Racial and Ethnic Disparities in Reproductive Health Care and Outcomes Among Female Veterans: A Scoping Review

Introduction: Female veterans are the fastest growing group of new Veterans Health Administration (VA) users, and 40% identify as belonging to a racialized group. It is unclear if racial/ethnic disparities in reproductive health care and outcomes observed among nonveterans are present among veterans...

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Main Authors: Katrina S. Nietsch, Samantha L. Estevez, Nichole Goodsmith, Kristin O. Haeger, Jill Inderstrodt, Sabra S. Inslicht, Katherine A. Kosman, Qiyan Mu, Yael I. Nillni, Deirdre Quinn, Adriana Rodriguez, Lauren Siff, Krysttel C. Stryczek, Erica V. Tartaglione, Jodie G. Katon
Format: Article
Language:English
Published: Mary Ann Liebert 2025-02-01
Series:Health Equity
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Online Access:https://www.liebertpub.com/doi/10.1089/heq.2024.0168
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author Katrina S. Nietsch
Samantha L. Estevez
Nichole Goodsmith
Kristin O. Haeger
Jill Inderstrodt
Sabra S. Inslicht
Katherine A. Kosman
Qiyan Mu
Yael I. Nillni
Deirdre Quinn
Adriana Rodriguez
Lauren Siff
Krysttel C. Stryczek
Erica V. Tartaglione
Jodie G. Katon
author_facet Katrina S. Nietsch
Samantha L. Estevez
Nichole Goodsmith
Kristin O. Haeger
Jill Inderstrodt
Sabra S. Inslicht
Katherine A. Kosman
Qiyan Mu
Yael I. Nillni
Deirdre Quinn
Adriana Rodriguez
Lauren Siff
Krysttel C. Stryczek
Erica V. Tartaglione
Jodie G. Katon
author_sort Katrina S. Nietsch
collection DOAJ
description Introduction: Female veterans are the fastest growing group of new Veterans Health Administration (VA) users, and 40% identify as belonging to a racialized group. It is unclear if racial/ethnic disparities in reproductive health care and outcomes observed among nonveterans are present among veterans. The purpose of this scoping review was to characterize patterns of racial/ethnic disparities in reproductive health care and outcomes among female veterans. Methods: A structured PubMed search was performed to extend a prior systematic review (from 2008–2017 to 2018–2023). We included original research on reproductive health care and outcomes in female veterans that also included a measure of association to race or ethnicity. Four hundred thirty-eight articles were identified for potential inclusion. Following PRISMA guidelines, titles and abstracts were screened in duplicate, and full articles were reviewed using a standardized abstraction form. Articles were sorted into six categories by topic (contraception, infertility, pregnancy, reproductive health screenings, gynecology, and menopause) and outcomes characterized as structural (e.g., organization of care), process (e.g., access to services), or clinical/behavioral (e.g., low birthweight) measures per Donabedian’s model. Results: After title and abstract screening, 53 articles were reviewed in full. Four additional articles were excluded for a final sample of 49 articles. All articles described results from observational studies, which were almost exclusively focused on veterans using VA care (94%, n = 46). Topics with the greatest number of articles included pregnancy (43%, n = 21) and contraception (24%, n = 12). Racial/ethnic disparities were detected more frequently for clinical and behavioral outcome measures than for process measures. Conclusion: Consistent with literature regarding other types of VA care, racial/ethnic disparities were more prevalent for clinical and behavioral outcome measures versus process measures, highlighting that access is necessary but not sufficient for reaching health equity. Understanding the racial/ethnic health disparities and their relationships with different measures of health care quality is essential for achieving health equity for female veterans.
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spelling doaj-art-4688e352e6c346339eeba2f8b40774512025-08-20T01:49:55ZengMary Ann LiebertHealth Equity2473-12422025-02-019120322810.1089/heq.2024.0168Racial and Ethnic Disparities in Reproductive Health Care and Outcomes Among Female Veterans: A Scoping ReviewKatrina S. Nietsch0Samantha L. Estevez1Nichole Goodsmith2Kristin O. Haeger3Jill Inderstrodt4Sabra S. Inslicht5Katherine A. Kosman6Qiyan Mu7Yael I. Nillni8Deirdre Quinn9Adriana Rodriguez10Lauren Siff11Krysttel C. Stryczek12Erica V. Tartaglione13Jodie G. Katon14Icahn School of Medicine at Mount Sinai, New York City, New York, USA.Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.Center for the Study of Health Care Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California, USA.US Department of Veterans Affairs, VA Office of Women’s Health, Washington, District of Columbia, USA.Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA.San Francisco VA Health Care System, San Francisco, California, USA.VA Boston Health Care System, Boston, Massachusetts, USA.Research & Simulation Division, Nursing Education, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA.National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA.Center for Health Equity Research & Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.Center for the Study of Health Care Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California, USA.Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.Center of Innovation for the Study of Veteran-Centric and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA.Center of Innovation for the Study of Veteran-Centric and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA.Center for the Study of Health Care Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California, USA.Introduction: Female veterans are the fastest growing group of new Veterans Health Administration (VA) users, and 40% identify as belonging to a racialized group. It is unclear if racial/ethnic disparities in reproductive health care and outcomes observed among nonveterans are present among veterans. The purpose of this scoping review was to characterize patterns of racial/ethnic disparities in reproductive health care and outcomes among female veterans. Methods: A structured PubMed search was performed to extend a prior systematic review (from 2008–2017 to 2018–2023). We included original research on reproductive health care and outcomes in female veterans that also included a measure of association to race or ethnicity. Four hundred thirty-eight articles were identified for potential inclusion. Following PRISMA guidelines, titles and abstracts were screened in duplicate, and full articles were reviewed using a standardized abstraction form. Articles were sorted into six categories by topic (contraception, infertility, pregnancy, reproductive health screenings, gynecology, and menopause) and outcomes characterized as structural (e.g., organization of care), process (e.g., access to services), or clinical/behavioral (e.g., low birthweight) measures per Donabedian’s model. Results: After title and abstract screening, 53 articles were reviewed in full. Four additional articles were excluded for a final sample of 49 articles. All articles described results from observational studies, which were almost exclusively focused on veterans using VA care (94%, n = 46). Topics with the greatest number of articles included pregnancy (43%, n = 21) and contraception (24%, n = 12). Racial/ethnic disparities were detected more frequently for clinical and behavioral outcome measures than for process measures. Conclusion: Consistent with literature regarding other types of VA care, racial/ethnic disparities were more prevalent for clinical and behavioral outcome measures versus process measures, highlighting that access is necessary but not sufficient for reaching health equity. Understanding the racial/ethnic health disparities and their relationships with different measures of health care quality is essential for achieving health equity for female veterans.https://www.liebertpub.com/doi/10.1089/heq.2024.0168reproductive healthwomen veteransracial disparitieshealth equityfemale veterans
spellingShingle Katrina S. Nietsch
Samantha L. Estevez
Nichole Goodsmith
Kristin O. Haeger
Jill Inderstrodt
Sabra S. Inslicht
Katherine A. Kosman
Qiyan Mu
Yael I. Nillni
Deirdre Quinn
Adriana Rodriguez
Lauren Siff
Krysttel C. Stryczek
Erica V. Tartaglione
Jodie G. Katon
Racial and Ethnic Disparities in Reproductive Health Care and Outcomes Among Female Veterans: A Scoping Review
Health Equity
reproductive health
women veterans
racial disparities
health equity
female veterans
title Racial and Ethnic Disparities in Reproductive Health Care and Outcomes Among Female Veterans: A Scoping Review
title_full Racial and Ethnic Disparities in Reproductive Health Care and Outcomes Among Female Veterans: A Scoping Review
title_fullStr Racial and Ethnic Disparities in Reproductive Health Care and Outcomes Among Female Veterans: A Scoping Review
title_full_unstemmed Racial and Ethnic Disparities in Reproductive Health Care and Outcomes Among Female Veterans: A Scoping Review
title_short Racial and Ethnic Disparities in Reproductive Health Care and Outcomes Among Female Veterans: A Scoping Review
title_sort racial and ethnic disparities in reproductive health care and outcomes among female veterans a scoping review
topic reproductive health
women veterans
racial disparities
health equity
female veterans
url https://www.liebertpub.com/doi/10.1089/heq.2024.0168
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