Women's reproductive health in the United States

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.[1] 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.[1] 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.[1]

Issues

Sexual health

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.[2]

“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.[3]"

The United States government recognizes that gender is a factor which plays a significant role in sexual health.[3]

With this being said, there is a war on women's rights in the United States. It is based on politics in the United States and for candidates to be able to get votes or funding for certain area agendas. With this being said, one of the first pushes with making laws tighter for agendas would be the law in Louisiana. This allowed women who have had abortions in the past to be able to sue the doctor who did the procedure for up to ten years past the abortion date. The law stated that they could sue for damages not only done to the women, but also to the emotional damages of the fetus. This was a political move that has gotten the ball rolling for more states to put laws into place against abortions or for abortions depending on the political agenda they are pushing in each state.[4]

Contraception

The U.S. Department of Health and Human Services has identified national reproductive health goals including reducing the level of unintended pregnancy.[5] Out of all the pregnancies reported in the United States, half are unplanned.[3] 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.[5] 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.[5] 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) have 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 Elibility Criteria for Contraceptive Use,2010.[5] The CDC lists methods of birth control under two categories: reversible and permanent.

Reversible methods of birth control[6]
  • 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[6]
  • 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 can be almost 100% effective when used perfectly,[7] but in most cases it is used imperfectly. Oral hormonal contraceptives have an 8% failure rate.[7] 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.[7]

Intrauterine contraception

A large stigma exists among women on the topic of using an intrauterine device (IUD) as a form of contraception. The two types of IUDs that exist for current contraceptive use are Copper T 380A and levonorgestrel-releasing intrauterine system or Mirena. IUDs are underutilized by women in the United States with only 2% of women using IUD as an effective contraception.[7] 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.[7] It is not possible to use IUDs improperly or inconsistently because they must be inserted inside of the uterus. Women in the United States have many fears about the use of IUDs, making them the less popular form of contraception.[7] 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 women has already had children.[7] 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.[7] There is a lack of knowledge about female anatomy and pregnancy prevention, even among women of the United States.

Sexually Transmitted Diseases

A health objective of the United States government through The United States Public Health Service is to reduce the number of cases of sexually transmitted diseases from the 1980s to today.[8] The Centers for Disease Control is responsible for many studies on the topic of STDs as well as the effect of STDs on women and girls.[9] STDs are defined by the CDC as “infections you can get from having sex with someone who has an infection”.[10] There are more than twenty types of identifiable STDs caused by bacteria, parasites, or viruses.[10] Within one year in the United States there are an estimated 12 million cases of sexually transmitted diseases that occur. Of those 12 million cases there are 1.5 million cases of gonorrhea, 500,000 cases of genital herpes, and 110,000 cases of syphilis.[8] Both women and men in the United States are affected by the STD epidemic. However, women have a stronger negative health reaction to some STDs than men. The negative health effects of STDs for women can include pelvic inflammatory disease (PIV), ectopic pregnancy, chronic pelvic pain, infertility, fetal and perinatal infections, complications to pregnancy, fetal loss, cervical cancer, and increased risk of tubal pregnancy, intrauterine growth retardation and preterm delivery.[8][9] Women in the U.S. are less likely to seek out treatment for STDs for a variety of reasons. Some STDs appear asymptomatic in women[8] therefore women are less likely to seek out treatment for STDs than men. Like most health topics, there is a gap that exists in understanding the pathology of diseases in women versus men. Women receive less than adequate information about the prevalence of STDs as well as the symptoms of STDs.

As with contraception in the U.S., a stigma exists which prevents women from learning about all possible STDs and their treatment. A study by the Journal of Women’s Health identified STDs as a topic women would rather not talk about.[9] Women, with their partners, do not commonly discuss STDs as well.[9] The stigma surrounding STDs in the U.S. prevents women from discussing the topic even among healthcare provides, close friends, partners, and family. Younger women do not understand the risk that STDs can pose to them. For example, Chlamydia is one of the most common STDs affecting women and men in the United States. Women do not follow the recommendation that people should be screened for Chlamydia at least once per year.[9] Most women do not even know any information about Chlamydia as an STD besides the fact that it is curable.[9]

STD screening is most effective for identifying STDs in women, but is commonly underutilized by women in the U.S. Healthcare access and access to family planning clinics increases the probability that women will seek out and utilize STD screening.[8] Screening is a form of testing healthy versus symptomatic people against traditional symptoms of STDs to determine STD prevalence. The Planned Parenthood Federation of America has available clinics across the United States for the purpose of screening for STDs as well as other family planning services. Planned Parenthood suggests that sexually active women screen for STDs at least annually.[8] A study by the Journal for Women’s Health identified a need for a knowledge campaign on STD screening targeting sexually active young women.[9]

Resources
  1. Rosser, Sue V. (December 2002). "Overview of Women's Health in the U.S. Since the Mid-1960s". History and Technology. 18 (4): 355–369. doi:10.1080/0734151022000023802. S2CID 144004991. Retrieved 25 October 2014.
  2. World Health Organization (January 2002). "Defining sexual health: report of a technical consultation on sexual health" (PDF): 28–31. Retrieved 25 October 2014. Cite journal requires |journal= (help)
  3. Department of Health and Human Services (May 2012). "CDC/HRSA Advisory Committee on HIV, Viral Hepatitis, and STD Prevention and Treatment" (PDF). Retrieved 25 October 2014. Cite journal requires |journal= (help)
  4. Yeoman, Barry (2001). "The Quiet War on Abortion". Mother Jones. 26 (5): 46–51. ProQuest 213811750.
  5. Yu, Jingbo; Henry Hu (2013). "Inappropriate Use of Combined Hormonal Contraceptives for Birth Control Among Women of Reproductive Age in the United States". Journal of Women's Health. 22 (7): 595–603. doi:10.1089/jwh.2012.3955. PMID 23789583.
  6. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. "Contraception". www.cdc.gov. Retrieved 25 October 2014.
  7. Rubin, Susan E.; Ilana Winrob (2010). "Urban Female Family Medicine Patients' Perception About Intrauterine Contraception". Journal of Women's Health. Mary Ann Liebert, Inc. 19 (4): 735–740. doi:10.1089/jwh.2009.1549. PMID 20201700.
  8. Mosher, William D.; Sevgi O. Aral (October 1991). "Testing for sexually transmitted diseases among women of reproductive age: United States, 1988". Family Planning Perspectives. 23 (5): 216–221. doi:10.2307/2135756. JSTOR 2135756. PMID 1743274.
  9. Friedman, Allison L. (2010). ""Something We'd Rather Not Talk About": Findings from CDC Exploratory Research on Sexually Transmitted Disease Communication with Girls and Women". Journal of Women's Health. 19 (10): 1823–1831. doi:10.1089/jwh.2010.1961. PMID 20929416.
  10. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. "Women's Reproductive Health". www.cdc.gov. Retrieved 25 October 2014.
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