The US Department of Veterans Affairs (VA) provides health care to about 600,000 women veterans—half are of child-bearing age. Pregnancies in women veterans using VA care have increased by more than 80% since 2014, from 6950 in 2014 to 12,524 in 2022.
Until recently, VA maternity care coordinators would help women navigate health care from the beginning of pregnancy to 8 weeks postpartum. But “[e]vidence shows that new mothers often need support and care coordination long after 8 weeks postpartum, which is why VA is taking action to support veteran mothers for much longer after they give birth,” said Under Secretary for Health Shereef Elnahal, MD. As of October 1, 2023, the maternity support is now extended to 12 months postpartum.
The full range of maternity care services includes primary care, examinations, tests, ultrasounds, newborn care, and screening for social determinants of health, mental health risk factors, and relationship health and safety. Maternity care coordinators also connect veterans with care after delivery and ensure access to follow-up screenings.
The VA says expanding access to maternity care coordinators is part of the work it’s doing to implement the White House Blueprint for Addressing the Maternal Health Crisis , released last year . The US maternal mortality rate is the highest of any developed nation in the world and more than double the rate of peer countries, the report says. According to the Centers for Disease Control and Prevention (CDC), f rom 2018 to 2021, the maternal death rate in the US increased from 17.4 to 32.9 per 100,000 live births .
Moreover, “[t]housands of women experience unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to their health,” the White House report says, “such as heart issues, the need for blood transfusions, eclampsia, and blood infections.” Disturbingly, more than 80% of pregnancy-related deaths are preventable. Black and American Indian/Alaska Native women, regardless of income or education, are most likely to experience poor outcomes. Women who live in rural America—where there are many maternal care “deserts”—are about 60% more likely to die, the White House report says.
Quality care requires “care organized for and provided to all women in a manner that maintains their dignity, privacy, and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labor and childbirth,” say CDC researchers who surveyed 2407 women about their maternity care experiences. One in 5 respondents reported instances of mistreatment. Roughly one-third of Black, Hispanic, and multiracial women reported, for instance, receiving no response to requests for help, being shouted at or scolded, not having their physical privacy protected, and being threatened with withholding treatment or made to accept unwanted treatment.
The White House Blueprint delineates several goals. One is to ”ensure those giving birth are heard and are decisionmakers in accountable systems of care…to improve quality of care, hold providers accountable, and prioritize patient needs and their experience before, during, and after pregnancy.”
The Blueprint advises, for instance, expanding the Hear Her campaign to include culturally relevant materials to raise awareness of urgent maternal warning signs and improve communication between patients and clinicians. It also urges addressing social determinants of maternal health, supporting projects to expand maternal mental health access, increasing access to digital tools, and expanding models that train maternal health care practitoners and students on how to address implicit bias and racism and screen for social determinants of health.