WASHINGTON — The VA has come a long way, baby, when it comes to treating female veterans. But it still isn't quite ready to deal with the needs of the historic ranks of women who've fought in Iraq and Afghanistan.

Women veterans aren't getting the same quality of outpatient care as men in about one-third of the 139 Department of Veterans Affairs facilities that offer it, said an internal review by the agency on Friday.

It did say strides are being made, such as creating on-site mammography services and establishing women's clinics at most VA medical centers. The department also is attempting to recruit more clinicians with training in women's care.

That's clearly needed, the report said, along with more equipment to meet women's health needs.

Women make up about 5 percent of the VA's population, but that is expected to nearly double in the next two years.

Things are changing for women at the VA, says Delphine Metcalf-Foster, 65, an Army veteran from the Persian Gulf War.

She laughs when she recalls the first day she stepped into a VA waiting room in 1991 and the physician called out for "Mr. Metcalf."

"I knew he was talking about me, but I wouldn't move," said Metcalf-Foster, a member of the nonprofit Disabled American Veterans in Vallejo, Calif. "Of course, they weren't used to women there."

Despite that, Metcalf-Foster said, she thinks the VA has listened to the concerns of women like her and has adapted as more women have sought care.

Silva Royer, 64, a Vietnam-era veteran who volunteers at the VA center in Biloxi, Miss., said she would like to see the VA reach out to more women veterans and encourage them to take advantage of the health care — particularly mental health help — to which they are entitled.

"I still think they still look at the VA as, that's where my grandpa went," Royer said.

Paul Rieckhoff, founder of the Iraq and Afghanistan Veterans of America, said women veterans have complained about the lack of women's restrooms and private changing areas in some VA centers. Others have complained about the scarcity of women-only group counseling options.

"There's a definite feeling of isolation," Rieckhoff said. "There's a definite feeling that they're a minority and that big Army and big VA are still trying to understand their issues."

Any discrepancies in care are unacceptable and the agency is aggressively addressing the issue, said Dr. William E. Duncan, associate deputy undersecretary at the Department of Veterans Affairs.

"We're striving to understand the reason for these health disparities and to eliminate differences in veterans health care based on personal characteristics," Duncan said.

Overall, women make up about 14 percent of the U.S. Armed Forces. Of the 1.7 million troops who have deployed in support of the wars in Iraq and Afghanistan, more than 190,000 — or about 11 percent — are women.

The VA's review noted that other studies have found better surgical outcomes and decreased mortality for women at VA hospitals compared to women who receive care under the Medicare Advantage Program or under private care. And, performance of breast and cervical cancer screening exceeds that of commercial and some government plans.

Data were not available to compare the inpatient quality of care between men and women.

Sen. Patty Murray, D-Wash., who is on the Senate Veterans Affairs Committee, said in a statement that the findings confirm what she has been hearing from women veterans for years.

She encouraged passage of legislation that would, among other things, force the agency to do comprehensive studies of women veterans' care and conduct a pilot program providing child care for veterans seeking mental health care.

Among the other findings of new report:

• Older and younger veterans appear to be receiving the same quality of care;

• About 86 percent of homeless veterans seen by VA received primary care, mental health care and/or substance abuse services;

• About 98 percent of appointments were completed within 30 days in primary care clinics and about 97 percent were completed during that period at specialty clinics;

• Overall quality of care appears to be good when reviewed using commonly accepted health care benchmarks;

• Minority veterans surveyed were generally less satisfied with inpatient and outpatient care than white veterans, but it wasn't clear if the quality of care offered was different. A more comprehensive study of care for minority veterans is expected to be complete this summer.