Women's reproductive health in the United States refers to the set of physical, mental, and social issues related to the health of women in the United States. It includes the rights of women in the United States to adequate sexual health, available contraception methods, and treatment for sexually transmitted diseases. The prevalence of women's health issues in American culture is inspired by second-wave feminism in the United States. As a result of this movement, women of the United States began to question the largely male-dominated health care system and demanded a right to information on issues regarding their physiology and anatomy. The U.S. government has made significant strides to propose solutions, like creating the Women's Health Initiative through the Office of Research on Women's Health in 1991. However, many issues still exist related to the accessibility of reproductive healthcare as well as the stigma and controversy attached to sexual health, contraception, and sexually transmitted diseases.
The Department of Health and Human Services has developed a definition for sexual health in the United States based on the World Health Organization's definition of sexual health.
"Sexual health is a state of well-being in relation to sexuality across the life span that involves physical, emotional, mental, social and spiritual dimensions. Sexual health is an intrinsic element of human health and is based on positive, equitable, and respectful approach to sexuality, relationships, and reproduction, that is free of coercion, fear, discrimination, stigma, shame, and violence.
The United States government recognizes that gender is a factor which plays a significant role in sexual health.
Partially influenced by second-wave feminism, women in the U.S. challenged the male dominated healthcare system while also demanding better information and autonomy over their bodies. Initiatives such as the Women’s Health Initiative have improved awareness and research, however, significant barriers still remain. Those barriers include limited access to reproductive services, stigma surrounding sexual health, contraception, and STIs.
Race and reproductive health
In the United States, reproductive health disparities exist between white and minority women. Historical abuses and experimentation on Black women by medical professionals has led to greater distrust of the medical community.Sutton, Madeline Y.; Anachebe, Ngozi F.; Lee, Regina; Skanes, Heather (2021-02). "Racial and Ethnic Disparities in Reproductive Health Services and Outcomes, 2020". Obstetrics & Gynecology. 137 (2): 225–233. doi:10.1097/AOG.0000000000004224. ISSN 0029-7844. PMC 7813444. PMID 33416284. Additionally, current racial biases held by medical personnel affect medical care of Black and minority women. Compared to white women, the rate of HIV infection is disproportionately high in Black and Hispanic women. These groups account for 75% of infection among women. There is also a gap in contraceptive use between white and Black women. These disparities are partly due to lack of health insurance and financial costs. Comprehensive gynecological care can also help reduce the rates of HIV in minority women and increase contraceptive use. The lack of reproductive health is a contributing factor in higher rates of maternal mortality in the United States among minority women, especially among Black women. Black women are 3.3 times more likely than white women to die from pregnancy-related causes. This is partly due to lack of insurance before pregnancy and higher rates of chronic conditions, such as obesity and diabetes. Furthermore, there are disparities in the use and success of ART among racial and socio-economic groups given the high costs, limited access, and varied utilization. A review of all U.S. studies that considered race and ethnicity when reporting success rates for ART, found white women consistently had the highest success rates, followed by Hispanic and Asian women, and African American women. An African American women does not receive the same treatment as a white women due to the age they were diagnosed at, the household income, and the specific treatment facility.
Contraception The U.S. Department of Health and Human Services has identified national reproductive health goals including reducing the level of unintended pregnancy. Out of all the pregnancies reported in the United States, half are unplanned. Of the 62 million women in the U.S. who are able to have children, seven out of ten of these women are sexually active but do not want to become pregnant. Contraception is a major issue of women's reproductive health. 86% of sexually active women practice some form of contraception and 30% of these women use a hormonal form of contraception. Women in the U.S. have more freedoms in deciding their use of contraceptives among other global nations, comparatively.
The Centers for Disease Control (CDC) has significant pull over the decision-making process women must make when choosing different types of contraception. Women of the U.S. still rely on their healthcare providers for the majority of information they receive about contraceptive use. In order to help healthcare providers provide appropriate family planning care, the CDC published the US Medical Eligibility Criteria for Contraceptive Use, 2010. The CDC lists methods of birth control under two categories: reversible and permanent.
Reversible methods of birth control Copper T intrauterine device (IUD) or levonorgestrel intrauterine system (LNG IUD) Hormonal methods Implant Injection Combined oral contraceptives Progestin-only pill Patch Hormonal vaginal contraceptive ring Emergency contraception Barrier methods Diaphragm or cervical cap Male condom Female condom Spermicides Fertility awareness-based methods Family planning Fertility awareness Abstinence
Permanent methods of birth control Female sterilization Transcervical sterilization
Hormonal contraception Hormonal contraception is the most popular method of contraception among women in the United States. Women under the age of thirty more commonly use hormonal oral contraception as their preferred method. Hormonal contraceptives are highly effective when used under perfect conditions, however in many cases there can be third factors which can lead to an increase in the failure rate. The popularity of oral hormonal contraceptives among women changes over the course of a year with 32% of women deciding to discontinue use of an oral hormonal contraceptive after one year of typical use. The reason for discontinuation frequently lies within side effects that women receive after prolonged use of oral hormonal contraceptives that can often drastically alter a woman's health both physically and mentally.
Intrauterine contraception There are two types of IUDs that exist for current contraceptive use: Copper T 380A and levonorgestrel-releasing intrauterine system or Mirena. The effectiveness of a contraceptive is described in terms of perfect use and typical use. An IUD is different than most forms of contraception, as it is 100% effective in both cases of use. It is not possible to use IUDs improperly or inconsistently because they must be inserted inside of the uterus. Due to the under researched nature of the procedure, some women in the United States have worried about the use of IUDs, making them a less popular form of contraception. For many women in the U.S., IUDs are only an option when other traditional contraception methods have been used (hormonal birth control, barrier methods, etc.) or when a woman has already had children. The fear surrounding use of an IUD stems from a lack of proper education on all available contraception options available to women in the U.S.. Women have cited being afraid of the quality of the device itself, placing the device inside their bodies voluntarily, and the time required to hold the device in place. There is a lack of knowledge about female anatomy and pregnancy prevention, even among women of the United States.
Fertility awareness based models Fertility awareness based methods consist of non-hormonal or invasive contraceptive methods. These take the form of only having sex when a woman isn't fertile, thus avoiding having sex during ovulation. Women can monitor her menstrual cycle pattern using calendar-based methods or symptoms-based methods. The most effective calendar-based method is the Standard Days Method, a method in which the woman doesn't have sexual intercourse on days 8-19 of her cycle. One symptoms-based method is the TwoDay Method, a method where the woman checks for secretions twice a day and if she has had vaginal secretions that day or the day prior, she can potentially get pregnant. A second symptoms-based method is the Sympto-thermal method, which combines a woman's observations of her vaginal secretions with the use of an electric hormonal fertility monitor which detects urine hormones. One benefit of using fertility awareness based method is that there are no side effects or health issues as no drugs or implants are used.
Reproductive mental health
Women's reproductive mental health focuses on mental health issues that are experienced on account of or exacerbated by transitions in female reproductive cycles. This field is a subset of women's mental health, which includes mental health issues faced by women at all points in their life. Reproductive mental health specifically focuses on reproductive transitions in female life. These include puberty, menstruation, pregnancy, infertility, perimenopause and menopause, abortion, and more. These transitions, brought on by hormonal changes, can trigger emotional and physical symptoms in some women. While the severity ranges from person to person, it was reported that over 75% of women with regular menstrual cycles report unpleasant physical or psychological symptoms, premenstrually. Reproductive psychiatry is the subset that is focused on treating these issues. These clinicians are trained experts in the diagnosis and treatment of mood and anxiety symptoms that occur throughout these cycles in female reproduction. This field is growing as the current gap in mental health specifically focused on women and their reproductive cycles is realised and people see how impactful studying these issues can be.
Sexual health and contraception Sexual health includes sexual development and reproductive health, the ability to have strong interpersonal relationships, appreciate one's body, interact appropriately with both genders, and express love, affection, and intimacy in ways consistent with one's own values. Sexual health also includes intercourse that is "consensual, non-exploitative, honest, pleasurable, and protected against unintended pregnancy and STDs" according to the 2008 World Health Organization (WHO) consensus statement. For most young people, sexual interest begins at the time of puberty and there is evidence that those who get sexual health information from their parents are more likely to initiate sexual activity later than those who get it from their peers although some young people prefer to get information from professionals.
Contraception is used to prevent pregnancy. It is the means by which people can family plan so that they have their optimal number of children with their desired spacing. According to WHO, contraceptives help lower maternal ill-health and the number of deaths related to pregnancy. It also reduces unsafe abortions and reduces HIV transmission between the mother and children. According to the CDC, couples need to consider safety, effectiveness, availability, and acceptability when choosing their form of contraception. Some forms of contraception like the use of male condoms also help lessen the transmission of HIV and other STDs while other forms of contraception like intra-uterine devices (IUDs) do not.