# Racial and Ethnic Disparities in Reproductive Health Care and Outcomes Among Female Veterans: A Scoping Review

## TL;DR

This study reviews research on racial and ethnic disparities in reproductive health care and outcomes among female veterans to understand patterns and promote health equity.

## Contribution

The study extends a prior review with updated data and applies Donabedian’s model to categorize disparities in reproductive health outcomes among female veterans.

## Key findings

- Racial/ethnic disparities were more common in clinical and behavioral outcomes than in process measures.
- Most studies focused on VA care and pregnancy-related topics.
- Access to care alone does not eliminate disparities in reproductive health outcomes for female veterans.

## Abstract

Female veterans are the fastest growing group of new Veterans Health Administration (VA) users, and 40% identify as belonging to a racialized group. It is unclear if racial/ethnic disparities in reproductive health care and outcomes observed among nonveterans are present among veterans. The purpose of this scoping review was to characterize patterns of racial/ethnic disparities in reproductive health care and outcomes among female veterans.

A structured PubMed search was performed to extend a prior systematic review (from 2008–2017 to 2018–2023). We included original research on reproductive health care and outcomes in female veterans that also included a measure of association to race or ethnicity. Four hundred thirty-eight articles were identified for potential inclusion. Following PRISMA guidelines, titles and abstracts were screened in duplicate, and full articles were reviewed using a standardized abstraction form. Articles were sorted into six categories by topic (contraception, infertility, pregnancy, reproductive health screenings, gynecology, and menopause) and outcomes characterized as structural (e.g., organization of care), process (e.g., access to services), or clinical/behavioral (e.g., low birthweight) measures per Donabedian’s model.

After title and abstract screening, 53 articles were reviewed in full. Four additional articles were excluded for a final sample of 49 articles. All articles described results from observational studies, which were almost exclusively focused on veterans using VA care (94%, n = 46). Topics with the greatest number of articles included pregnancy (43%, n = 21) and contraception (24%, n = 12). Racial/ethnic disparities were detected more frequently for clinical and behavioral outcome measures than for process measures.

Consistent with literature regarding other types of VA care, racial/ethnic disparities were more prevalent for clinical and behavioral outcome measures versus process measures, highlighting that access is necessary but not sufficient for reaching health equity. Understanding the racial/ethnic health disparities and their relationships with different measures of health care quality is essential for achieving health equity for female veterans.