Women war vets may need more aid

By Becky Dodson, Medill News Service, Tuesday, August 28, 2007


WASHINGTON – With more women serving in dangerous combat situations in war-torn Iraq, health-care advocates and specialists worry the Department of Veterans Affairs is not equipped to deal with their post-war problems.


One in seven Americans deployed to Iraq is female, and although women are officially barred from combat roles, the lack of a clear front line has drawn many into the line of fire. And, increasingly, they are vulnerable to combat-related trauma.


"Although women have been in the military for decades, generally they haven't been on the front lines and were not in combat areas," said Sidney Weissman, professor of social psychiatry at Northwestern University's Feinberg School of Medicine. "In Iraq, everything's a combat area, so if you're there, you're a combatant."


Almost 15 percent of America's active duty military is female, and the VA projects that by 2010, more than 14 percent of all veterans will be women, compared with 2 percent a decade ago.


In addition, female veterans of the conflicts in Iraq and Afghanistan seem to rely more on the services of the VA: 37.5 percent of the women discharged from active duty have been to a VA health-care facility at least once, compared with 32 percent of men.


"The number of women entering into the system puts an added burden on the VA," said Marsha Four, chairwoman of the Women Veterans' Committee. "They really don't have the staffing to provide combat-related PTSD treatment or residential programs in a gender-specific environment." 


The VA has 22 health-care facilities nationwide with "dedicated, comprehensive women's center space." But those with children, or those who live in isolated, rural areas, can find it difficult to obtain the care they need.


"Who is going to take care of the children when she is gone?" asked Weissman. "So, we have some real issues for women with families who have been soldiers and are injured and need care. And I don't believe that we've ever had to deal with these issues before."


The untypical warfare in Iraq increases, for both genders, the risk of PTSD -- Post-Traumatic Stress Disorder -- which the VA defines as "an ailment resulting from exposure to an experience involving direct or indirect threat of serious injury or death.


"There's no front, and threats come from a 360-degree angle," said Lizbet Boroughs, deputy director of government relations for the American Psychiatric Association. "Consequently, the biology system is in a fight or flight mode constantly."


Longer tours of duty and multiple deployments are increasing the risks for PTSD.  And screening tools, which have improved since the Vietnam era when PTSD first was recognized as a problem, make it easier to spot the disorder, Boroughs said.


Although the environment in Iraq poses a PTSD risk for both genders, one recent study suggests women may be more vulnerable.


The National Center for Post-Traumatic Stress Disorder reviewed 25 years of research and concluded that women are approximately twice as likely as men to meet the criteria, and more than four times more likely to have chronic PTSD.


The study did not point to one specific reason for the disparity. Some contend that women often are more willing to discuss their experiences; or perhaps women are more likely to experience multiple traumas during their lifetimes.


Female veterans also are more likely to report that they have been victims of sexual crime: 14.5 percent of female veterans of Iraq or Afghanistan compared with only 0.6 percent of males, reported military sexual trauma to the VA. These women have four times the risk of developing PTSD.


With surging numbers of women and heightened vulnerability to certain problems, veteran's advocates worry that the VA isn't prepared to deal with an influx of women needing services.


Betty Moseley Brown, associate director of the Center for Women Veterans, told a congressional committee on July 12 that a "knowledge gap" still exists: There hasn't been a national survey of female veterans in 22 years, so policymakers have limited information to plan for their future health-care needs.

Although VA initiated a "National Survey of Women Veterans" in April, the final report will not be completed until Dec. 31, 2008. The study aims to identify the health-care needs of female veterans of Iraq, as well as previous wars.


Meantime, the VA is trying to address some current problems, including understaffing of its centers.

"Veteran's Affairs hospitals are gearing up with significant enhancements of staffers," Weissman said. "They're rehiring for the number of positions that they closed a year or two ago."


But Valerie K. Cortazzo of Pittsburgh, Women's Services Coordinator for the Iraq War Veterans Organization, says the VA has a lot of work to do.


"There are very few mental health facilities, and so people have to travel really far to get to them," she said. "They're coming from Ohio, they're coming from 200 or 300 miles away, because that is the closest facility where they can get what they need. And I know that Pittsburgh is not an isolated situation."


Although the Pentagon does not release statistics about how many returning veterans have been afflicted with traumatic brain injuries—which some doctors call the "signature" wound of Iraq— women are at risk of roadside explosive devices because they often serve as drivers.


Those who suffer from traumatic brain injuries have to endure long-term rehabilitation and often there may not be a return of function. When women suffer with these types of injuries, Weissman said, a pension alone may not adequately address future issues.


"We are the first country that I know of that sends women who are mothers overseas," he said.  "….So, if you could imagine a mom who is in one of the Humvees which is blown up, bounced around, and who experiences a significant brain injury and who has kids back home and is not going to be adequately able to take care of them … society has to be responsible for the children of that woman."