By Suzanne Gordon

Copyright prospect

Kayla Williams is a 49-year-old Iraq combat veteran who’s received mental health therapy at a Veterans Affairs (VA) Vet Center. In 2023, when she discovered that her Vet Center therapist had resigned, she switched to a virtual therapy group for women veterans who have experienced military sexual trauma (MST).

Williams knows her way around veterans’ health care. During the Obama administration, she served as the director of the Department of Veterans Affairs’ Center for Women Veterans. She’d always found a supportive atmosphere at the VA, but the therapist running her MST group also left the system. So she decided to seek help from one of the many private-sector therapists who contract with the Veterans Community Care Program, a private sector network established after the enactment of the VA MISSION Act of 2018.

At her first appointment her new therapist asked a routine question: So, what brings you here? Williams gave her usual answer, “Well, I’m dealing with this and that and MST.”

“What’s MST?” the therapist asked.

One out of three women veterans has experienced some form of sexual harassment or assault during military service. Every VA mental health provider is required to take basic MST training and some specialize in this area.

“This immediately destroyed any trust I could have had in the provider,” Williams says. “You’re taking referrals from the VA to care for veterans, and you don’t even bother to have the minimum amount of clinical or cultural competency. You’re essentially asking your patient to train you.” She quickly decided that “I’ll just wait for a VA therapist who understands.”

Williams’s brief encounter with the private sector illustrates the risks women veterans face as the Trump administration continues to cut programs, staff, and funding. The media has focused on how the VA’s cuts to abortion and LGBTQ services will impact women veterans. But the cuts to mental health and medical services are equally detrimental and chip away at the complex model of women’s health care offered by the VA, the largest occupational health care system in the country.

“A system dedicated to veterans has to understand what it means to be a woman veteran and what issues women veterans deal with,” Kyleanne Hunter, the CEO of the Iraq and Afghanistan Veterans of America (IAVA) told the Prospect.

“Anyone who takes care of women veterans,” adds Hunter, who uses Veterans Health Administration (VHA) services, “needs to understand the jobs women had in the military and the injuries and exposures they may have sustained and how that impacts their health.”

Women are the fastest-growing group of veterans because women are the fastest-growing cohort in the military. A 2022 Department of Defense report noted that women made up 17.5 percent of the active-duty military force in 2021. Today women comprise 10 percent of the veteran population and 30 percent of all new patients in the VHA, the health care system run by the Department of Veterans Affairs. By 2042, the VA estimates that women will comprise about 16 percent of veterans.

Over 600,000 women veterans receive care from the VHA, and not surprisingly, their needs are significantly different not only from those of male veterans but from non-veteran women patients. According to a 2018 Disabled American Veterans report on women veterans, 60 percent of women polled about their time in the military said that it had negatively affected their mental and physical health.

Women veterans’ suicide rates are 2.5 times higher than women in the general population, a rate that has accelerated twice as fast as male veterans since 2001. Women with PTSD also have higher-risk pregnancies, higher risk of suicide, cancers, and arthritis, and older women veterans have a higher risk of death from chronic illnesses like diabetes or heart disease than their civilian counterparts.

Arlys Herem, a 76-year-old nurse who served in Vietnam, has been going to the Minneapolis VA Health Care System for years. Recently, Herem, who is a leader in the Veterans for Peace “Save Our VA Campaign,” complained of “particular muscular problems” and was sent to a physical therapist (PT). “When he couldn’t help me, he sent me to a female PT who specialized in pelvic floor PT and pelvic muscle problems. It helped, it was amazing,” Herem says.

The failure of Congress to require the same training, screenings, and military cultural competency tools and skills for both VA and private sector providers could cost women veterans their lives.

Women veterans also suffer from the toxic exposures that prompted passage of the 2022 Promise to Address Comprehensive Toxics Act, which allocates $280 billion over the next decade for health care and disability pay for former service members harmed by toxic substances. VHA providers are taught to recognize, screen for, and treat these exposures. Civilian providers are not. Indeed, the failure of Congress to require the same training, screenings, and military cultural competency tools and skills for both VA and private sector providers could cost women veterans their lives.

Hunter, IAVA’s CEO, is, like most aviators, at higher risk for certain cancers. That’s why, she points out, Congress passed the ACES Act (Aviator Cancer Examination Study Act) in 2025, which mandates that VHA study cancer rates among pilots and air crews. A VA screening found that Hunter had ocular (uveal) melanoma, a very rare cancer. If not caught and treated early, this cancer can be very aggressive, leading to vision loss and blindness. If it metastasizes to other parts of the body, it has a very high mortality rate.

“I was fortunate to be in the VA, where I was actively screened for this cancer,” she says. “I shudder to think what would have happened to me if I had no contact with this kind of specialized care.”

The VHA has multiple programs to address issues unique to women, such as the Women Veterans Health Strategic Health Care Group, the Women Veterans Call Center, and the Center for Women Veterans. These groups have tried to make the VA more welcoming to women veterans and to educate staff and patients about their needs.

In early 2024, the VA Office of Research and Development established the Women’s Health Research Integration Workgroup. The group now collaborates with the Department of Defense to improve women’s health outcomes as they leave active duty.

The VA has also addressed the fact that too many research studies do not include women as subjects, a problem long noted in research studies on non-VA patients. VA researchers now include women veterans in their landmark Million Veteran Program, which has established the largest genetic data bank in the world and studies how genes impact health. VA women’s health research also includes efforts to understand barriers that prevent women from seeking care.

MST is one of these barriers. It’s exceedingly difficult for women veterans to describe and heal from sexual abuse and assault that they suffered during their tours of duty. “During basic training the message was hammered in that, male or female, you trusted your buddies. They had your back, you had theirs,” says Briana Holman, an Air Force veteran who was twice assaulted by those so-called “buddies.”

The military’s failure to respond to the problem plays a major role in prolonging the recovery from MST. According to one estimate, 47 percent of women said they feared retaliation from co-workers if they reported an assault, and 48 percent said they got little help from the military legal counselors. Williams, the former VA official, believes that if they do not feel welcomed and comfortable, women veterans suffering from MST are more likely to exit the VA health care system—or never seek care at all.

The military’s failure to respond to the problem plays a major role in prolonging the recovery from MST.

To address women’s unique issues, the major VA medical centers have women veterans program managers and field directors. They deliver essential health services, including abortion counseling and abortion services, which, in the event of an emergency, can preserve a woman’s fertility—and her life.

If a VA center does not have the personnel or equipment to perform mammograms or deliver babies, women are referred to private sector providers at the VA’s expense. For women who do not want to interact with male patients, the VA locates women’s clinics in separate spaces.

In 2003, during the Iraq War, Joanna Sweatt, a 47-year-old Marine Corps veteran, worked as a member of an air station construction team. The VA has treated Sweatt, who served for almost ten years, for three episodes of MST as well as premenopausal symptoms. She says the Phoenix VA Health Care System, where she receives treatment, has made great progress over the past decade. “If you can believe it, we used to be sent to a gloomy basement space, and now we have a beautiful women’s clinic,” says Sweatt, now the national organizing director for the Common Defense, a veterans advocacy group.

The Trump administration’s cuts to VHA research, teaching, staffing, and in-house care will push more women veterans into the private sector, jeopardizing the targeted services women now receive at the VA. Current Veterans Community Care Program contractors are not required to have any training in military cultural competency or military-related health conditions, like ocular melanoma or MST.

“A section in the MISSION Act requires the VA to develop competency standards for non-VA providers offering care to veterans with MST and other conditions for which the VA has special expertise,” Russell Lemle, a Veterans Healthcare Policy Institute senior policy analyst, told the Prospect. “The VA developed a 30-minute core training in MST. But under Trump, the VA waived it as a mandatory requirement for community providers. The [Government Accountability Office] recently issued a report that documents that less than 1 percent of [Veterans Community Care Program] mental health providers have taken the training. It was only 30 minutes of their time, and they still wouldn’t do it.”

The reluctance of private sector providers to gain the necessary expertise to deliver high quality care for veterans is perhaps understandable in this country’s profit-driven health care system. The 9 million VHA patients represent only about 3 percent of America’s adult population of 248 million and 3 percent of potential patients. Women VHA patients represent about 0.23 percent of potential private sector patients.

Most health care professionals are inundated with recommendations about individuals’ needs. A 2022 study found that most doctors would need an impossible 26.7 hours per day to follow national guidelines on delivering appropriate preventive, chronic, and acute care to an average load of patients.

As one study documented, the camaraderie that women value will also be lost as more veterans are scattered over a fragmented private-sector system. For Williams, being in a therapy group with women veterans “was profoundly valuable and validating to realize how shared some of those experiences are—it was like, ‘Oh, there’s not something uniquely wrong with me.’”

Williams wonders how groups of women vets could even be assembled outside of the VA system. In rural America, these veterans may not be able to obtain basic obstetrical services, much less mental health care that is in short supply. A July 2025 Health Affairs article spotlighted the dramatic decline in hospitals providing obstetrical services across the nation, with “12 states experiencing 25 percent or more losses of obstetric services among hospitals in rural counties.”

In a September article in The Guardian, Hunter, the IAVA leader, backed VA staff members, who risked their jobs by signing a letter to VA Secretary Doug Collins and members of Congress protesting the president’s staffing cuts and other policy changes.

“The VA was designed as a public health institution placing the veteran at the center of care and decision-making,” Hunter said. “That care is a promise America makes when someone raises their right hand.” And that commitment must extend equally to all military members—men and women alike.