Background Women Veterans are one of the fastest growing groups of new VA users and are younger and more racially diverse than their male counterparts. Yet services such as obstetric care continue to be purchased from the community due to concerns regarding capacity and quality given the limited demand at any one VA site. Understanding whether or not racial and ethnic disparities in reproductive health care and outcomes are evident among women Veterans is critical for ensuring that VA meets its goal of providing high quality, equitable care to all Veterans. The purpose of this scoping review was to examine the evidence with respective to racial and ethnic disparities in reproductive health care and outcomes among women Veterans.

Methods Databases were queried for articles addressing reproductive health and health care of women Veterans between 2008 and 2023, pertinent to reproductive health care or outcomes of women Veterans that also included outcome frequencies by race or ethnicity or measures of association for race or ethnicity with the outcome of interest. Articles were sorted into six categories based on topic: contraception, infertility, pregnancy, reproductive health screenings, gynecology, menopause. Outcomes were defined as structural, process, or clinical or behavioral outcome measures.

Results Of 438 original articles, 49 articles were included. The topics with the greatest number of articles included pregnancy (43%) and contraception (24%). In terms of types of measures, only two studies included at least one structural measure (7%) and the remainder were split nearly evenly between process measures (53%) and clinical and behavioral outcomes (57%, n=28). In nearly two thirds of the studies racial and ethnic disparities were not the primary focus of the analysis and were reported only as secondary outcomes. In terms of process measures for pregnancy, non-White Veterans were less likely than White Veterans to return to VA primary care postpartum, but results were mixed for other measures. With respect to clinical and behavioral measures, although Black versus White Veterans were consistently found to be more likely to have a low birthweight baby, results were variable regarding preterm birth, breast feeding, prenatal smoking, and perinatal mental health.

Conclusion This scoping review identified numerous racial and ethnic disparities in reproductive health care and outcomes among women Veterans. These findings suggest a need to ensure that Veterans receive culturally competent, patient-centered contraceptive counseling and a need to potentially address social determinants in the context of reproductive health care.