Five-year Trends in Women Veterans' Use of VA Maternity Benefits, 2008–2012



      An increasing number of young women veterans are returning from war and military service and are seeking reproductive health care from the Veterans Health Administration (VHA). Many of these women seek maternity benefits from the VHA, and yet little is known regarding the number of women veterans utilizing VHA maternity benefits nor the characteristics of pregnant veterans using these benefits. In May 2010, VHA maternity benefits were expanded to include 7 days of infant care, which may serve to entice more women to use VHA maternity benefits. Understanding the changing trends in women veterans seeking maternity benefits will help the VHA to improve the quality of reproductive care over time.


      The goal of this study was to examine the trends in delivery claims among women veterans receiving VHA maternity benefits over a 5-year period and the characteristics of pregnant veterans utilizing VHA benefits.


      We undertook a retrospective, national cohort study of pregnant veterans enrolled in VHA care with inpatient deliveries between fiscal years (FY) 2008 and 2012.


      We included pregnant veterans using VHA maternity benefits for delivery.

      Main Measures

      Measures included annualized numbers and rates of inpatient deliveries and delivery-related costs, as well as cesarean section rates as a quality indicator.

      Key Results

      During the 5-year study period, there was a significant increase in the number of deliveries to women veterans using VHA maternity benefits. The overall delivery rate increased by 44% over the study period from 12.4 to 17.8 deliveries per 1,000 women veterans. A majority of women using VHA maternity benefits were age 30 or older and had a service-connected disability. From FY 2008 to 2012, the VHA paid more than $46 million in delivery claims to community providers for deliveries to women veterans ($4,993/veteran).


      Over a 5-year period, the volume of women veterans using VHA maternity benefits increased by 44%. Given this sizeable increase, the VHA must increase its capacity to care for pregnant veterans and ensure care coordination systems are in place to address the needs of pregnant veterans with service-connected disabilities.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Agency for Healthcare Research and Quality. (2012). Caesarean section: Proportion of women delivering babies in acute care hospitals by caesarean section. National Quality Measures Clearinghouse. Retrieved July 9, 2012, from:

        • Bean-Mayberry B.
        • Yano E.M.
        • Washington D.L.
        • Goldzweig C.
        • Batuman F.
        • Huang C.
        • et al.
        Systematic review of women veterans' health: Update on successes and gaps.
        Women’s Health Issues. 2011; 21: S84-S97
        • Bennett I.M.
        • Coco A.
        • Anderson J.
        • Horst M.
        • Gambler A.S.
        • Barr W.B.
        • et al.
        Improving maternal care with a continuous quality improvement strategy: A report from the Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network.
        Journal of American Board of Family Medicine. 2009; 22: 380-386
        • Borrero S.
        • Mor M.
        • Zhao X.
        • McNeil M.
        • Ibrahim S.
        • Hayes P.
        Contraceptive care in the VA healthcare system.
        Contraception. 2012; 85: 580-588
        • Brown D.W.
        Smoking prevalence among US veterans.
        Journal of General Internal Medicine. 2010; 25: 147-149
        • Chireau M.
        • Salz T.
        • Brown H.
        • Bastian L.
        Outcomes, costs, and utilization of pregnancy-related care.
        Federal Practitioner. 2006; : 20-30
      2. Department of Veteran's Affairs. (2004). Women Veterans Health Program Newsletter, 40, 14–16.

        • Department of Veteran's Affairs: Veteran's Health Administration
        VHA handbook 1330.01: Healthcare services for women veterans.
        Author, Washington, DC2010
        • Dubay L.,&
        • Kenney G.
        Expanding public health insurance to parents: Effects on children's coverage under Medicaid.
        Health Services Research. 2003; 38: 1283-1301
        • Frayne S.
        • Chiu V.
        • Iqbal S.
        • Berg E.
        • Laungani K.
        • Cronkite R.
        • et al.
        Medical care needs of returning veterans with PTSD: Their other burden.
        Journal of General Internal Medicine. 2011; 26: 33-39
        • Frayne S.M.
        • Phibbs C.S.
        • Friedman S.A.
        • Berg E.
        • Ananth L.
        • Iqbal S.
        • et al.
        Sourcebook: Women veterans in the Veterans Health Administration. Volume 1. Sociodemographic Characteristics and Utilization of VHA Care. Women's Evaluation Initiative, Women's Veteran Health Strategic Health Care Group.
        Department of Veterans Affairs, Washington, DC2010
        • Frayne S.M.
        • Skinner K.M.
        • Sullivan L.M.
        • Tripp T.J.
        • Hankin C.S.
        • Kressin N.R.
        • et al
        Medical profile of women Veterans Administration outpatients who report a history of sexual assault occurring while in the military.
        Journal of Women's Health & Gender-Based Medicine. 1999; 8: 835-845
        • Friedman S.A.
        • Phibbs C.S.
        • Schmitt S.K.
        • Hayes P.M.
        • Herrera L.
        • Frayne S.M.
        New women veterans in the VHA: A longitudinal profile.
        Women's Health Issues. 2011; 21: S103-S111
        • Guendelman S.
        • Pearl M.
        Children's ability to access and use health care.
        Health Affairs. 2004; 23: 235-244
        • Haskell S.
        • Mattocks K.
        • Goulet J.
        • Krebs E.
        • Skanderson M.
        • Leslie D.
        • et al.
        The burden of illness in the first year home: Do male and female VA users differ in health conditions and healthcare utilization?.
        Women's Health Issues. 2011; 21: 92-97
        • Haskell S.
        • Ning Y.
        • Krebs E.
        • Goulet J.
        • Mattocks K.
        • Kerns R.
        • et al.
        Prevalence of painful musculoskeletal conditions in female and male veterans in 7 years after return from deployment in Operation Enduring Freedom/Operation Iraqi Freedom.
        Clinical Journal of Pain. 2012; 28: 163-167
        • Himmelstein D.
        • Lasser K.
        • McCormick D.
        • Bor D.
        • Boyd W.
        • Woolhandler S.
        Lack of health coverage among US veterans from 1987 to 2004.
        American Journal of Public Health. 2007; 97: 2199-2203
        • Kang H.K.
        • Mahan C.M.
        • Lee K.Y.
        • Magee C.A.
        • Mather S.H.
        • Matanoski G.
        Pregnancy outcomes among U.S. women Vietnam veterans.
        American Journal of Industrial Medicine. 2000; 38: 447-454
        • Katon J.
        • Rose D.
        • Bean-Mayberry B.
        • Zephyrin L.
        • Washington D.
        • Yano E.
        VA location and structural factors associated with onsite availability of reproductive health services.
        Journal of General Internal Medicine. 2013; 28: S591-S597
        • Katon J.
        • Washington D.
        • Cordasco K.
        • Reiber G.
        • Yano E.
        • Zephyrin L.
        Use of Veterans Health Administration prenatal care and resuming VA care following delivery.
        Academy Health Special Session on Gender and Health, Baltimore, MD2013
        • Martin J.
        • Hamilton B.
        • Ventura S.
        • Osterman M.
        • Wilson E.
        • Mathews T.J.
        Births: Final data for 2010. National vital statistics report.
        volume 6:1. Centers for Disease Control and Prevention, Bethesda2012
        • Lu M.C.
        • Kotelchuck M.
        • Hogan V.K.
        • Johnson K.
        • Reyes C.
        Innovative strategies to reduce disparities in the quality of prenatal care in underresourced settings.
        Medical Care Research and Review. 2010; 67: 198S-230S
        • Mattocks K.
        • Borrero S.
        • Haskell S.
        • Brandt C.
        • Justice A.
        • Yano E.
        Unmet reproductive health needs among women Veterans in care at the Veterans Administration.
        Women's Health Issues. 2011; 21: 124-129
        • Mattocks K.
        • Sadler A.
        • Yano E.
        • Krebs E.
        • Zephyrin L.
        • Brandt C.
        • et al.
        Sexual victimization, health status, and VA healthcare utilization among lesbian and bisexual OEF/OIF veterans.
        Journal of General Internal Medicine. 2013; 274: 604-608
        • Mattocks K.M.
        • Skanderson M.
        • Goulet J.L.
        • Brandt C.
        • Womack J.
        • Krebs E.
        • et al.
        Pregnancy and mental health among women veterans returning from Iraq and Afghanistan.
        Journal of Women's Health. 2010; 19: 2159-2166
      3. Public Law (PL) 111-163 Section 206 of the Caregivers and Veteran Omnibus Health Services Act. (2010). Retrieved from:

        • Sadler A.G.
        • Booth B.M.
        • Cook B.L.
        • Torner J.C.
        • Doeb-belingm B.N.
        The military environment: Risk factors for women's non-fatal assaults.
        Journal of Occupational and Environmental Medicine. 2001; 43: 325-334
        • Seal K.H.
        • Metzler T.J.
        • Gima K.S.
        • Bertenthal D.
        • Maguen S.
        • Marmar C.R.
        Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008.
        American Journal of Public Health. 2009; 99: 1651-1658
        • Seng J.S.
        A conceptual framework for research on lifetime violence, posttraumatic stress, and child-bearing.
        Journal of Midwifery and Women's Health. 2002; 47: 337-346
        • Skovholt C.
        • Lia-Hoagberg B.
        • Mullet S.
        • Siiteri R.
        • Vanman R.
        • Josten L.
        • et al.
        The Minnesota prenatal care coordination project: Successes and obstacles.
        Public Health Reports. 1994; 109: 775-781
        • Sommers B.D.
        Insuring children or insuring families: Do parental and sibling coverage lead to improved retention of children in Medicaid?.
        Journal of Health Economics. 2006; 25: 1154-1169
        • Schwartz E.B.
        • Mattocks K.
        • Brandt C.
        • Borrero S.
        • Zephyrin L.
        • Bathmupali H.
        • et al.
        Receipt of counseling about risk of medication-induced birth defects by female Veterans of reproductive age.
        Journal of General Internal Medicine. 2013; 274: 598-604
        • Weir S.
        • Posner H.E.
        • Zhang J.
        • Willis G.
        • Baxter J.D.
        • Clark R.E.
        Predictors of prenatal and postpartum care adequacy in a Medicaid managed care population.
        Women's Health Issues. 2011; 21: 277-285
        • Weitlauf J.C.
        • Finney J.W.
        • Ruzek J.I.
        • Lee T.T.
        • Thrailkill A.
        • Jones S.
        • et al.
        Distress and pain during pelvic examinations: Effect of sexual violence.
        Obstetrics and Gynecology. 2008; 112: 1343-1350
        • Yoon J.
        • Scott J.
        • Phibbs C.
        • Frayne S.
        Trends in rates and attributable costs of conditions among female VA patients, 2000 and 2008.
        Women's Health Issues. 2012; 22: e337-e344


      Kristin M. Mattocks, PhD, MPH, is Associate Chief of Staff for Research and Education at VA Central Western Massachusetts Healthcare System and Assistant Professor of Quantitative Health Sciences and Psychiatry at the University of Massachusetts Medical School.


      Susan Frayne, MD, MPH, is an associate professor of medicine at the VA Palo Alto Health Care System and a Stanford Health Policy Associate.


      Ciaran S. Phibbs, PhD, is a Research Economist at the VA Health Economics Resource Center, an Investigator at the HSR&D Center for Innovation to Implementation, Associate Director of the Women's Health Evaluation Initiative, and Associate Director of the Geriatrics and Extended Care Data and Analysis Center, at the VA Palo Alto Health Care System. He is also an Associate Professor of Pediatrics (Neonatology) at the Stanford University School of Medicine and a recognized expert in perinatal epidemiology.


      Elizabeth M Yano, PhD, MSPH, is Director of the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy at the VA Greater Los Angeles Healthcare System and Professor of Health Policy and Management at the UCLA Fielding School of Public Health. She is a VA Senior Research Career Scientist awardee and nationally recognized expert in women Veterans' research.


      Laurie Zephyrin, MD, MPH, MBA is the Director of Reproductive Health at the Department of Veterans Affairs. She is also a Clinical Assistant Professor of Obstetrics and Gynecology at New York University School of Medicine.


      Holly Shryock is a Senior Data Analyst for the Chief Business Office for Purchased Care. She has worked with the Non-VA Purchased Care Program and Non-VA Purchased Care data for over a decade and currently oversees national Non-VA Care data and corresponding analysis.


      Sally Haskell, MD, is the Deputy Chief Consultant for Women’s Health Service and Director of Comprehensive Women's Health for the Veterans Health Administration. She is a General Internist, Women's Health Services Researcher, and Associate Professor of Medicine Yale School of Medicine. She is Co-Principal Investigator on the Women Veteran's Cohort Study, and Director of the VA Connecticut Advanced Fellowship in Women's Health.


      Jodie Katon, MS, PhD, is a Research Health Scientist at VA Puget Sound Health Care System. She also serves as Senior Epidemiology Consultant for the VA Office of Women's Health Services.


      J. Cherry Sullivan, MPH, is a Research Health Science Specialist at VA Central Western Massachusetts Healthcare System. She also serves as an adjunct instructor in the School of Public Health and Health Sciences at the University of Massachusetts, Amherst.


      Linda Weinreb, MD, is Vice Chair of the Department of Family Medicine and Community Health, Professor of Family Medicine and Community Health, and Pediatrics at the University of Massachusetts Medical School. Dr. Weinreb also serves as the Joy McCann Endowed Professor for Women in Medicine.


      Christine Ulbricht, MPH, is a PhD candidate in the Graduate School of Biomedical Sciences' Clinical & Population Health Research program at the University of Massachusetts Medical School, Worcester.


      Lori A. Bastian MD, MPH, is a Senior Research Associate at VA Connecticut Healthcare System in health services research. She is also a Professor, Division Chief of General Internal Medicine, and Associate Dean for Career Development at the University of Connecticut Health Center.