The Veterans Health Administration Reproductive Mental Health Consultation Program: an Innovation to Improve Access to Specialty Care

Abstract: Reproductive mental health needs are prevalent, under-recognized, and under-treated throughout the United States (US). This especially affects the Veterans Health Administration (VHA) as the population of US veterans who are women continues to increase. Between 1980 and 2018, the percent of women veterans more than doubled, from approximately 4 to 9%, and is projected to increase to 17% by 2040. More than 75% of women veterans are of reproductive age, less than 45 years old. This has led to a sizeable increase in reproductive mental health (RMH) needs among women veterans. Among women receiving health care through VHA, the number who gave birth increased more than 14-fold from the year 2000 to 2015. Based on multisite and national data, it is estimated that among pregnant women receiving VHA care, 28% have clinically significant depression (more than double the estimated 12% prevalence of perinatal depression in the general population)5 and 12% have post-traumatic stress disorder (PTSD).6 Untreated antenatal depressive and/or PTSD symptoms are associated with increased risk of obstetric complications and adverse effects on offspring.