"Every Person Is Going to Have Different Needs and Different Expectations": Reproductive Health Care Experiences of LGBTQ+ Veterans Assigned Female at Birth Within the Veterans Health Administration.

BACKGROUND: Research outside of the Veterans Health Administration (VHA) suggests that sexual and gender minority (LGBTQ+) people assigned female at birth face barriers to accessing needed reproductive health care and receive poorer-quality care in reproductive health settings such as OB/GYN offices and fertility clinics. Little is known about the experiences of LGBTQ+ veterans receiving reproductive health care within the VHA. OBJECTIVE: We aimed to understand LGBTQ+ VHA users' reproductive health care experiences and preferences using in-depth semistructured qualitative interviews. METHODS: We purposively sampled cisgender women, transgender men, and nonbinary veterans to explore variation in experiences by self-reported gender identity. Participants were 18-50 years old, assigned female sex at birth, and identified as LGBTQ+. Interviews were conducted via telephone using a structured interview guide and analyzed in team meetings using deductive and inductive content analysis concurrently with interviews. RESULTS: We conducted interviews with 20 veterans. Participants emphasized the importance of providers demonstrating respect for their identities and avoiding assumptions about their health needs based on their appearance. Many participants highlighted pelvic exams as a barrier to reproductive health care due to past sexual trauma, concerns about pain management in gynecologic procedures, and/or gender dysphoria. Reproductive health care delivery within designated "Women's Clinics" in VHA felt exclusionary to transgender participants. According to participants, restrictions on VHA coverage for in vitro fertilization and gender-affirming surgeries signaled devaluation of LGBTQ+ people. Finally, participants offered recommendations for improving reproductive health care delivery for LGBTQ+ veterans. CONCLUSIONS: LGBTQ+ veterans reported positive and negative experiences receiving reproductive health care within the VHA and identified provider behaviors and VHA policies as targets for future quality improvement efforts.