Advocating for minority Veterans in the United States: Principles for equitable public policy
Abstract: In advocating for minority Veterans in the United States, a primary issue has been confronting policy approaches that seek to maintain existing institutional structures and processes and add minority Veterans in after the fact. This approach foregrounds the needs and experiences of majority Veterans in designing and implementing policy at the expense of the unique needs of minority Veterans, creating barriers and perpetuating harms through initiatives that are often well intentioned. Drawing on work with the U.S. Senate and House Veterans’ Aff airs Committees of the 115th, 116th, and 117th Congresses, as well as with the U.S. Department of Veterans Affairs, the authors present principles for equitable Veteran public policy grounded in intersectionality theory. In addition to presenting these principles, the authors discuss the ways they communicate their framework to, and negotiate with, policy-makers in the context of advocating for minority Veterans. The authors’ work addresses the tension inherent in certain formulations of intersectionality theory that treat identity categories as stable and universal. In complicating this notion of identity and the way it is operationalized in Veteran policy, the authors demonstrate how a renewed notion of identity categories, grounded in intersectionality theory, can guide policy work to benefit minority Veterans.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.