It’s often not easy for veterans to receive health care at Department of Veterans Affairs (VA) facilities — especially if they are not cisgender men. Not all hospitals have the equipment, or even the space, to properly treat and provide health care to women and LGBTQ+ people. There’s a shortage of specialists. And there’s the way they’re treated by staff or other patients.
Lindsay Church, a 38-year-old trans nonbinary Navy veteran, said they have dealt with a patient advocate that kept misgendering them, a security guard who laughed at them when they voiced safety concerns and once was even harassed by a VA staff member when they tried to use the bathroom. Church was at a facility in Virginia for a radiology appointment in December 2021 when they needed to use the women’s bathroom. Suddenly, a staff member started pounding on the outside wall, yelling: “Is there a man in this bathroom?”
“I was really scared,” said Church, the co-founder and executive director of Minority Veterans of America. “It left a mark on me that I’m not welcome. I don’t even go to the VA unless I’ve used the restroom before I left my house or unless I can find a single stall bathroom somewhere in there, because I don’t feel safe. And I’m not the only one.”
Church founded Minority Veterans in 2017 in response to the Trump administration’s announcement that transgender people would not be allowed to serve in the military and the administration’s Muslim ban, which temporarily barred people from seven countries, most of which were predominantly Muslim, from entering the country. One of the organization’s policy priorities is pushing to close health care access gaps by guaranteeing access to in vitro fertilization and surrogacy programs, abortion and contraception, and gender confirmation surgery through the VA.
Women and LGBTQ+ veterans have historically accounted for a small percentage of patients receiving care at VA facilities, but as their numbers have grown, so has the awareness of gender-based disparities. As of 2017, only about 1 in 3 VA clinics and hospitals had a gynecologist on staff, according to data from Disabled American Veterans, with OBGYN services — including fertility and pregnancy-related care — being even more rare. A 2020 study published in Women’s Health Issues found that there were gendered disparities specifically when it came to chronic disease management, continuity of care, inpatient services and patient experience of care at VA facilities.
Many women and LGBTQ+ veterans have long spoken out about harassment and unique obstacles to care at VA hospitals. A 2019 study found that 1 in 4 women veterans who routinely go to VA primary care clinics reported inappropriate or unwanted comments or behaviors by men veterans or VA employees. Some locations have since created separate clinics or entrances for women, with one hospital in Texas citing harassment as a leading reason for relocating its trauma recovery program for women. A 2017 directive from the Veterans Health Administration called for all VA women’s health centers to have a “separate entrance into the clinical area” and a “separate waiting room” for women whenever possible. In 2019, Congress passed the Deborah Sampson Act, which allocated $20 million for the retrofitting of existing VA facilities to better support women’s care.
In addition, some VA facilities lack resources and don’t provide some basic services: For example, no VA facility in New Jersey currently has a mammogram machine, there’s a shortage of OBGYNs across the board and many women veterans still face stigma when doctors assume they are military wives or dependents.
“These systems and services are often made to make us feel like we don’t belong,” Church said. “They weren’t built with us in mind or they were built to our exclusion.”
In response to requests for comment, the VA said it has stepped up efforts to meet the specific needs of women and LGBTQ+ veterans: It funded in fiscal year 2023 more than 1,000 new women’s health personnel nationally, including primary care providers, gynecologists, mental health providers and care coordinators; it established a call center to connect veterans with services and benefits; and it established at least one LGBTQ+ veteran care coordinator at each of its facilities.
The agency also began a new awareness and training push to end harassment in 2017; in June, it created a new hotline for veterans who want to report sexual harassment or assault after leaving a VA facility.
“Whenever a veteran walks into a VA facility or interacts with us in any way, they should be able to know — without a doubt — that they will be treated with care and respect,” VA Press Secretary Terrence Hayes said in a statement. “That is the standard to which we hold ourselves accountable, and we will never settle for anything less.”
Church said she’s noticed a concerted effort over the years, though sometimes frustratingly slow, to better accommodate LGBTQ+ veterans. For example, VA health care providers and staff are now required to acknowledge patients’ gender identity and sexual orientation and use a veteran’s preferred pronouns. Republican lawmakers, however, fought to strip this year’s defense appropriation bill, which provides more than $831 billion in funding for the 2024 fiscal year, of diversity, equity and inclusion initiatives — which pay for providers’ training, resources and guidance around LGBTQ+ care.
“Dismantling the offices of diversity, equity and inclusion and the trainings is like removing the core basic fundamental thing that we were doing to provide better service,” Church said. “If they’re taken out, we’re going to be at a disadvantage.”
Women are the fastest-growing group in the veteran population, with two million women veterans in the United States today. They make up an increasing share of all VA users, with a projected increase to 18 percent by 2040 from just 4 percent in 2000. Compared to their men counterparts, women veterans are more likely to have lifelong post-traumatic stress disorder, depression, suicidal ideation and other mental health challenges.
The exact number of veterans who identify as LGBTQ+ is not known, because for years the “Don’t Ask, Don’t Tell” policy that kept those numbers intentionally obscured. It wasn’t until December 2021 that the VA started collecting gender identity and sexual orientation information in 2022, including transgender and gender-diverse identifiers in its medical record system.
Lucy Del Gaudio, a 51-year-old Army veteran and chief operations officer of the Pink Berets — an organization that helps military sexual trauma survivors — said that the harassment from men patients and the lack of resources for women has made access difficult for women veterans and sometimes re-triggered them. Del Gaudio said one of her friends, a fellow Army veteran and sexual trauma survivor, had to get an X-ray at a facility in Virginia. There wasn’t a room for privacy, so staff members put her in a hallway, where she was forced to wait in a hospital gown and subsequently harassed by passing patients. Another friend, Del Gaudio added, had her bottom haphazardly propped on a bedpan in an emergency room during a vaginal examination.
“There’s not adequate space for women because they’re not sometimes prepared for us to be there,” Del Gaudio said. “It’s sad that it’s 2023, and women still have to face these discrepancies when they go to get the health care that they so rightly deserve.”
Where Del Gaudio lives, in New Jersey, she said there is an extensive list of discrepancies between how men and women veterans’ health needs are met through the VA. First and foremost, there hasn’t been a mammogram machine in any of the state’s VA hospitals, forcing women veterans to get outside referrals. It’s a “very lengthy process,” she said.
“We also don’t have full-time, gender-specific clinics,” said Del Gaudio, who was sexually assaulted during her service in the 1990s. “We do not have women’s clinics. We have to be treated with our male counterparts, and for some women, that’s very difficult. If you are a survivor of military sexual trauma and you still have issues based on your trauma, it can be a very difficult thing to even go to your appointments.”
In addition, Del Gaudio said there are not enough OBGYNs, so it’s often hard to schedule timely appointments. And for those who are mothers, it’s even harder to access necessary child care during those appointments.
Many advocates and veterans, like Del Gaudio, have long called for change.
“I sit on the work group for sexual assault and sexual harassment at the VA, and we try to make recommendations but they aren’t making these changes fast,” Del Gaudio said before acknowledging that she has noticed some positive changes.
Over the past year, the VA began offering abortion counseling and medically-necessary abortions and expanded breast cancer screenings and mammograms for toxic-exposed veterans as part of the PACT Act, the largest expansion of veterans’ benefits in decades. As part of that, more centers are beginning to receive the resources needed to carry that out: A hospital in eastern Oklahoma just opened the VA’s first in-house mammography unit in the state. In 2021, the VA has also clarified its policy that all LGBTQ+ service members who were given anything other than honorable discharges — based on their sexual orientation, gender identity or HIV status — are eligible for VA benefits.
Still, Del Gaudio said the VA needs to do more to encourage more women veterans to come back to its facilities. One way it could do this, she said, is by expanding reproductive care access for veterans, providing doulas for those who have been sexually assaulted or harassed and continuing to shift the culture to make women feel more welcome at its facilities.
“We just need more, more clinics and more visibility,” Del Gaudio. “We still are not looked at the way we should be looked at as women veterans. There’s still an emphasis on men and an older generation that doesn’t seem to value our service.”
Shannon Davila, an Air Force veteran and nurse who currently works with health care providers that serve veterans, said she thinks the VA is on the right track but “just hitting the tip of the iceberg.”
“There’s a lack of military cultural competence for a lot of health professionals,” Davila said. “I went through nursing school, and I don’t believe we ever talked about veteran health ever.”
Davila said she’s not been on active duty for over two decades, and in all that time, not a single provider has ever asked her if she wanted to discuss her service as it relates to her health. Because many veterans are referred to care facilities outside the VA, Davila said it’s important that all health care professionals better understand how service can impact a patient.
“Men, perhaps of a certain age group, tend to wear their service more outwardly,” Davila said. “A lot of times they’ll wear the hats or the t-shirts or put the stickers on their cars. Women tend to be a little more internal, protecting their privacy. And in more extreme cases, women have had bad experiences that they are suppressing or have a lot of shame associated with it. But providers really need to address all health issues that stem from a veteran’s service, whether it be emotional or physical, in order to take holistic care of a patient.”
Because of the way they have been dismissed, overlooked or harassed, many women and LGBTQ+ veterans, like Church, opt not to go to the VA when other options are available. According to the VA, women are less likely than their counterparts to go to the VA for care. Only 44 percent of women veterans are enrolled in VA health care, compared to about 62 percent of all veterans. And about 43 percent of the women who use VA health services belong to a racial or ethnic minority group.
“When you think about who is most likely to be using VA care because they have no other options, it’s folks with lower socioeconomic earnings,” Church said. “You’re looking at minority veterans. You’re looking at veterans that live in the margins.”
Church said when she founded Minority Veterans, it started as five people in their living room. It’s now grown to more than 3,000 members around the world.
“In our communities, people have just stopped going to the VA because trust has been broken,” Church said. “A lot of people that have already been harmed in the military are then harassed when they go to seek care at the VA. People just stop going.”
Church said shortly after they got married in 2020, they’ve been able to use their wife’s secondary insurance except when it comes to their service-related surgeries. In total, Church has undergone 11 surgeries on their sternum and spine, the insertion of breast implants and is currently in the midst of removing those implants after one ruptured.
“It’s wild how bad it is honestly,” Church said. “Women and LGBTQ people and racial and ethnic minorities are some of the most likely people to be sexually assaulted in the military, then to have to go to VA and get catcalled and harassed and have to defend their existence in a space that’s supposed to be there for them. … I feel like I have to put on armor just to walk into the VA. The last time I went, I felt myself getting small because it’s just the way it makes you feel. My wife looked at me, and she goes: ‘You need to be big.’”
Church said they don’t think things will really change until more people are aware of the problem.
“The reality of the situation is that equitable policy through the VA is not going to happen without a fight,” Church said. “We need folks that don’t live in the veteran community to be in that fight as well because we need people that aren’t considered to be self-interested in this conversation to push the needle as much as we do.”
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