Trista Matascastillo remembers arriving at the Minneapolis VA Medical Center in 2010 for an exam and thinking the hospital didn't quite get the needs of female veterans.
The exam room, for instance, opened onto the patient waiting area, she said. She had to ask that the door be closed.
It was a tiny detail, one Matascastillo said staff fixed quickly. But the 16-year veteran keeps the story close by now that she is part of an effort to help the center improve care for women.
"Our biological needs are different. Our health care needs are different. Our mental health care needs are different and so systems designed for men, we don't fit into," said Matascastillo, head of the Minneapolis VA Women's Initiative. While improved, the system still falls short, she added.
More than 200,000 women nationwide — 30,000 in Minnesota — have served since 2001; 20 percent of the nation's military recruits are female, according to a recent report from the group Disabled American Veterans (pdf) that highlights growing concern the VA hasn't adjusted fast enough to the needs of females, who are the fastest growing group of veterans enrolling in VA health care.
The report showed a lack of gynecologists on staff at many VA hospitals and not enough mental health professionals who can address military sexual trauma.
Minnesota DFL U.S. Rep. Tim Walz and other lawmakers recently called for an inspection into how Department of Veterans Affairs' policies address the needs of women veterans, citing the need for improvement in privacy standards for women and gender-specific care.
The Minneapolis VA Women's Initiative, launched in 2008, found other barriers to women receiving care.
Distance was among the biggest issues, Matascastillo said. If a female veteran — or male veteran — lives in a rural area, she or he may have to travel hours to get to the nearest VA.
Some women choose not to go at all so they can take care of family and stay closer to home instead, she added. "You can wait for six hours to get your appointments in for a day and women have different responsibilities."
Three VA Health Care Systems serve veterans in Minnesota, with hospital facilities in Minneapolis, St. Cloud and Fargo. The VA also has 14 community-based outpatient clinics across Minnesota. Along with resources at the Minnesota Department of Veteran Affairs, each Minnesota county has a veteran's service officer who helps connect veterans with their benefits.
"Our idea of what a veteran is hasn't progressed to what we really look like nowadays," said Morgan Hennessy, who served two years in Iraq with the Minnesota Red Bulls.
While Morgan said her physical needs were met by the VA when she returned, the Minneapolis woman recalled a visit to a VA Hospital accompanied by her sister's boyfriend. Morgan said people around her assumed he was the veteran, not her.
Hennessy, who is studying to become a clinical psychologist, has a passion for mental health services. She once wrote to former Minnesota Gov. Tim Pawlenty, asking for more psychologists working in the field with soldiers while they are deployed to help curb growing suicide rates among soldiers.
While mental health care is readily available through the VA, Hennessy said it can be hard to wait for an appointment to see someone.
"I know when I was going through a hard time, I really wanted to be seen once a week and the most that they could see me was every three weeks. So that was kind of difficult," Morgan said.
Those who work to connect female veterans to services say it can be a challenge to get them to accept the help they've earned serving their country.
"I think that it's typical for women veterans at times not to necessarily wear their service on their sleeve," said Ashley Laganiere, the Minnesota Department of Veteran Affairs' coordinator for women veterans.
Laganiere, 30, a veteran from Farmington who earned her VA medical benefits serving with the Minnesota National Guard, comes from a proud family line of veterans, though she is the first veteran in her family to ask a doctor at the VA for fertility advice.
The VA can't provide Laganiere with fertility treatments, but her VA doctor has referred her to an outside clinic. VA benefits pay for the appointments and a large portion of the cost of fertility medications.
Twenty years ago, the Minneapolis VA Hospital became among the first VA Health Care Systems in the country to open a women's clinic.
Erin Krebs, who is the Women's Health Medical Director at the Minneapolis VA, said a big part of her job is to plan for continued growth in the number of women veterans seeking treatment at the VA and its outlying clinics. Krebs said the number of women users has nearly doubled in the last decade alone and veterans coming home from current conflicts are younger with different needs.
"In terms of women's health, having younger women in their 20s and 30s who are thinking about child-bearing and family planning and all these things, really changes the kind of services that we're giving," Krebs said.
But the issue of providing unique services for women veterans can be a numbers game.
With fewer female veterans than male veterans overall, Krebs said it takes time to convince decision-makers to spend money on more female-specific services.
But change is happening.
Last summer the Minneapolis VA opened a mammography imaging suite and continues to grow its medical staff treating women, including a gynecologist and maternity care advisor. Krebs said she also works to improve women's health services across the VA system.
"It's a big system and it's a big ship to turn around. That's something that we need to do," Krebs said. "It's not just women's health care. It's all of the changes that have come as a result of these most recent conflicts and all of these new veterans."
Resources for women veterans
• The Minnesota Department of Veteran Affairs offers women veterans outreach programs. The next event takes place May 16 in Brainerd.
• The Women Veterans Initiative is a group of women, mostly veterans, working to improve the well-being of all women veterans through programs and better access to services.
MPR News newsroom coordinator Manda Lillie contributed to this report.