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  • Human Rights Research Center

Sexual and Reproductive Health: A Public Health Perspective - Part 3

September 7, 2023

Part 3: The American Relationship with Sexual and Reproductive Health

United States of America: “The Land of the Free.” But what does free mean? Freedom, as defined by the Merriam-Webster Dictionary, is “the absence of necessity, coercion, or constraint in choice or action,”[9] with absence being the keyword. The toils of sexual and reproductive health rights (SRHR) have consistently been controversial both within and outside the country. With almost 340 million people covering six time zones and eight different political parties, one can only imagine the considerable perspectives and discussions on this topic [3][8].

According to a US timeline of reproductive rights [7], since the 1800s, laws and legislation regulated reproductive health rights. Prior to 1821, abortions were generally accessible, which ironically changed as the country became more medically advanced. The reproductive health rights movement continued into the 1900s when abortion was banned nationwide. Due to Margaret Sanger, in 1916, birth control was introduced, and “The Pill” gained the Food and Drug Administration (FDA) approval in 1960. The famous case of Roe v. Wade in 1973 was a historic landmark, ruling that a women’s right to abortion was considered a constitutional right. But, almost 50 years later in 2022, this decision was overturned in Dobbs v. Jackson Women’s Health Organization leaving regulation of abortion to individual states. Many believe this decision was a step backward for sexual and reproductive health (SRH) and women’s rights in the US. Looking deeper, there is another interpretation of the decision to overturn Roe v. Wade: religion.

With almost 50% of Americans identifying as Protestant and over 20% as Roman Catholic [3], it can be inferred that religion is one of the primary foundations of the United States and its people. Interestingly, a Pew Research Center survey noted that the percentage of Americans who claim no particular religion has risen from 17% to 26% since 2009. And yet, religious issues are gaining even more significance at this juncture in US history, especially within the Republican Party with 5 out of 9 Supreme Court justices appointed by Republican presidents [4].

SRH education has taken a hit as well. Frank conversations about sexual health within the United States are rare and seen as uncomfortable, controversial, and unnecessary, even with the outcry of educators and scientists providing evidence that sexual health education is important for health and well-being challenges that young people face [11]. Young people (16-24) account for almost half of the 20 million contracted STIs and 1 in 4 of the 50,000 HIV diagnoses each year [11]. Racism influences the use of reproductive health services, as Black women between 15-44 years have higher rates of unintended pregnancy and abortion than their White counterparts and are subject to unconscious stereotypes held by their physicians, which lead to mistreatment and delayed reproductive health screenings [13]. These attitudes are just one of many reasons why maternal mortality in the US is 32.9 deaths per 100,000 live births and Black women at 69.9 deaths per 100,000, which is the highest rate of all high-income nations and over 3x the rate of the second highest country, New Zealand [6][15].

“In 1985, anti-abortion protesters demonstrate in front of the Georgia State Capitol in Atlanta on the anniversary of the Roe v. Wade decision. In 2022, abortion rights demonstrators protest in Washington, DC, as the US Supreme Court was poised to strike down the half-century-old Roe v. Wade precedent.” [Image source:]

Women’s health in general is also obstructed by something we all know: patriarchy. The inferiority of women comes from the earliest days of medicine, as much of history documents how women were excluded from medical and science knowledge production, leading to a healthcare system made for and by men. As a result, 20% of women feel ignored or dismissed about their symptoms, and 45% are labeled as chronic complainers [5][12]. What’s peculiar is that women utilize more healthcare services than men; on a familial level, women control 80% of healthcare decisions in the home and are 76% more likely to have visited a doctor [12]. These gender-distinct notions have manifested with the UN’s Sustainable Development Goals, as the United States still has significant challenges with both SDG 5 Gender Equality and SDG 3 Good Health and Well-Being [14].

All said and done, there are some reinforcements and improvements in sexual and reproductive health. In 2022, California’s Governor Gavin Newsom approved Proposition 1 to protect and ensure women’s rights to reproductive freedoms, including abortion and contraception [10]. President Biden and his administration made a statement to resolutely commit to the empowerment and protection of women and girls “by expanding the base of partners implementing US health assistance and increasing” critical health services, family planning information and services, and more [2]. The US has also become the “largest donor to both maternal health and voluntary family planning programs,” supporting maternal/child health, and the prevention and response to gender-based violence1. Though a great step toward a more transparent and supportive SRH, the US still has substantial work to do within this field and so far, is only doing an okay job. Unless there is a drastic social and cultural change and acceptance of the need for sexual and reproductive rights, this country will continue to fall behind.


Download the accompanying infographic below or view it on our website here.

SRH USA Infographic
Download PDF • 2.16MB



[1] The Biden-Harris Administration’s Commitment to Advancing Sexual and Reproductive Health and Rights Globally. US Department of Health and Human Services. (2023, June 26).,%2C%20children%2C%20families%20and%20communities

[2] Blinken, A. J. (2021, January 29). Prioritizing Sexual and Reproductive Health and Reproductive Rights in U.S. Foreign Policy . U.S. Department of State.

[3] Central Intelligence Agency. (2023, August 15). United States. Central Intelligence Agency.

[4] Elving, R. (2022, May 14). Roe draft is a reminder that religion’s role in politics is older than the republic. NPR.

[5] Jackson, G. (2019, November 13). The female problem: How male bias in medical trials ruined women’s health. The Guardian.

[6] Katella, K. (2023, May 22). Maternal mortality is on the rise: 8 things to know. Yale Medicine.

[7] Kennedy, L. (2023, July 13). Reproductive Rights in the US: Timeline. History.

[10] Office of Governor Gavin Newsom. (2022, December 21). Historic California constitutional amendment reinforcing protections for reproductive freedom goes into effect. CA.GOV.

[11] Schalet, A. T., Santelli, J. S., Russell, S. T., Halpern, C. T., Miller, S. A., Pickering, S. S., Goldberg, S. K., & Hoenig, J. M. (2014). Invited commentary: Broadening the evidence for adolescent sexual and reproductive health and education in the United States. Journal of Youth and Adolescence, 43(10), 1595–1610.

[12] Tecco, H., & Cheek, J. (2022, January 18). Women’s health is more than female anatomy and our reproductive system-it’s about unraveling centuries of inequities due to living in a patriarchal healthcare system. - Blog: Health Supplement. Harvard Business School.

[13] Thompson, T. M., Young, Y.-Y., Bass, T. M., Baker, S., Njoku, O., Norwood, J., & Simpson, M. (2022). Racism runs through it: Examining the sexual and reproductive health experience of black women in the South. Health Affairs, 41(2), 195–202.

[14] SDG Index. (2023). United States. Sustainable Development Report 2023.

[15] White, B., Livingston, T., & Babla, D. (2022, July 8). Maternal health in the US: Where we stand compared to other nations. Medium.


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