Adria Horn was breastfeeding her infant daughter at Togus VA Medical Center several years ago when someone approached to ask whether she was waiting for a patient. The implication was clear: Horn, a West Point graduate who deployed five times in 10 years, didn’t fit the image of a veteran.

That kind of cultural barrier “is what women veterans face in a VA system that has catered to, by necessity, mostly male medical issues,” said Horn, who now serves as director of the state Bureau of Veterans’ Services.

The number of female veterans in the United States and in Maine is growing, and as the oldest generation of men who served dies and more women move into combat roles newly opened to them, women will make up a larger portion of the veteran population in the years ahead.

Yet the organizations meant to support veterans, including the Veterans Affairs health care system, the VFW and the American Legion, haven’t kept pace with the change in demographics, advocates say. They weren’t designed to serve women, and the culture that surrounds them can deter women from seeking the help they need or the benefits they are entitled to.

Nationally, there are about 2 million veterans who are women. In Maine, that number is just over 9,000, accounting for about 8 percent of the state’s veteran population. By 2045, women could become nearly 18 percent of Maine veterans, according to federal projections.

The VA and other groups are making a concerted effort here and nationally to better serve women, and members of a younger generation are pushing those organizations to better serve them and their peers.

As recently as 2010, patients admitted to Togus used shared bathrooms and group showers. Renovations changed that. In 2012, the regional VA system hired a care coordinator and social worker to help pregnant veterans get the care they need during and after pregnancy. And in 2014, the hospital opened a women’s primary care clinic that has seen steady growth, said LaRhonda Harris, manager of the Women Veterans Program for VA Maine.

Providers around the state at the VA’s community-based outpatient clinics are trained in women’s health, Harris said, and she provides training to all new employees about serving women.

Adria Horn, director of the Maine Bureau of Veterans Services, says all veterans need good physical and mental health care.

Female veterans have some specific needs. They are, for example, more than three times more likely than male veterans to ever experience post-traumatic stress disorder and more than twice as likely to experience major depressive disorders, according to a study published in August by the National Center for Biotechnology Information, U.S. National Library of Medicine, analyzing self-reported data from 3,157 veterans. And they are much more likely to report experiencing military sexual trauma.

But Horn avoids framing the conversation around the particular challenges that women face. All veterans need good physical and mental health care, she said. The goal should be to serve all veterans well – women included.

Kayla Williams, director of the Center for Women Veterans, at the U.S. Department of Veterans Affairs, echoed that point.

“When we put in solutions to some of the challenges that disproportionally affect women veterans, they help other veterans as well,” said Williams, who served as an Arabic linguist and intelligence specialist with the Army from 2000 to 2005.

A small example: The VA made a push to install changing tables at its facilities. “Dads use those, too,” she said.

NOT JUST ‘THE BAR AND WAR STORIES’

Think of a VFW post, and the image that comes to mind may be a dark, smoky bar occupied by a few men wearing caps identifying their years of service.

Amy Meuchel of Standish said she was at first reluctant to join the VFW because she thought it was “about the bar and the war stories.” She was elected this year as the first female commander of VFW District 10, with posts from Fryeburg to Portland.

Today, when she meets other veterans at the University of Southern Maine, where she’s studying for a degree in social work, she encourages them to get involved by talking about the VFW as a networking opportunity and a chance to do important advocacy work. She points to the organization’s role in expanding the GI Bill.

“No one does more for veterans,” she said.

But Adrian Cole, public relations officer for the Maine VFW, said his organization and others can do more to serve younger generations of veterans today. Cole believes the VA isn’t meeting the mental health needs of veterans in Maine, and especially for women. He points to long waits for inpatient care and regional reductions in support groups. The VFW should be pushing more aggressively for improvements, he said. To do that, it needs more post-9/11 veterans to become involved and to take on leadership roles.

“Recruitment is key,” he said. “This is a pinnacle moment for veterans in the United States to demand oversight of our institutions.”

Frustrated by what she saw as the failure of veteran institutions to address the issue of homeless female veterans, Martha Everatt-St. Pierre four years ago began the process of opening a privately funded transitional housing facility for female veterans in Augusta, the first of its kind in northern New England.

Veteran homeless shelters historically have been unwelcoming places for women, particularly those with children or those who have had experienced trauma. Housing voucher programs have proved more effective. But the risk of homelessness among female veterans is growing, according to federal projections.

There is no clear accounting of the number of homeless or at-risk female veterans in Maine.

“Male veterans are getting housed,” Everatt-St. Pierre said. “Male veterans are getting funded. Female veterans are just not noticed. They’re not counted.”

The Betsy Ann Ross House of Hope opened its first two bedrooms for occupancy last month. When renovations are complete, the house will have eight rooms where women can live for up to two years.

MAINE’S UNIQUE CHALLENGES

The state’s rural character compounds the challenges of serving female veterans in Maine. The VA has increased the number of services it offers in regional clinics and is offering more telemedicine, but veterans still have to go to Togus for certain specialties.

“If you have a job and you have children, that makes it really a challenge,” Horn said.

Geography can be an obstacle to even finding female veterans. Harris travels around the state, accepting almost every event invitation she receives, hoping to meet female veterans and enroll them in the VA.

“You never know where you’re going to find a woman veteran,” she said.

Joy Asuncion of Belfast, who served in the Navy for 20 years, has found them on Facebook. She created a closed Facebook group of Maine female veterans, now with more than 450 members. The group fields questions about benefits, supports members who are deployed and provides resources for suicide prevention. Members have identified people who are homeless and helped them connect to services, she said.

Williams, of the U.S. Center for Women Veterans, worries most about reaching older female veterans who might not be connected online and who for years were told – implicitly or explicitly – that they weren’t “real veterans.” But, she said, she believes the country is at “a real inflection point.”

“People are talking about issues that were much more hidden during my service and immediately after my homecoming,” she said. “I’m very hopeful that we are at a point where we can drive some genuine culture change, build some momentum and move things forward to a point where my office doesn’t need to exist.”

Chelsea Conaboy is a freelance writer and editor and former features editor at the Press Herald. She can be contacted at:

cconaboy@gmail.com

Twitter: @cconaboy