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. 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. 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 . “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. 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. Race and reproductive health. See also: Weathering hypothesis 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. 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. 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. 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, but in most cases it is used imperfectly. Oral hormonal contraceptives have an 8% 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. 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. 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. Women in the United States have many fears 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 problems. Pregnancy complications in women with PCOS. One in ten women of childbearing age in  the U.S. are affected by Polycystic ovary syndrome (PCOS). Women with this condition are at a higher risk of experiencing complications during pregnancy. PCOS is a medical condition consisting of hyperandrogegism, ovarian dysfunction and polycystic ovarian morphology (PCOM). The hormonal imbalance caused by PCOS can cause the egg to not properly develop or be released as would otherwise normally occur during ovulation in a healthy menstrual cycle. In the past, research of PCOS has been focused on diagnostics, symptoms, and effects such as infertility. Very little research has been done concerning complications than can result when a woman with PCOS  conceives. This is a very important condition to address as it can have major financial impacts on the lives of those diagnosed with PCOS. Currently, in the U.S. it can cost the healthcare system nearly four million dollar to treat women with PCOS, due to the many other conditions that PCOS can cause including: cardiovascular disease; pregnancy-induced hypertension and pre-eclampsia; miscarriage; infertility; and type 2 diabetes mellitus. There has also been some research conducted concerning the outcomes of the health of offspring born to mothers with PCOS. The results have proved inclusive, but they are thought to be  at an increased risk of developing cardiovascular dysfunction and endocrine dysfunction. Assisted reproductive technology. Infertility is an increasingly common issue among women of reproductive age. The CDC estimates 6% of women between the ages of 15 and 44 in the U.S. cannot get pregnant after one year of trying. Along with medicine and surgery, one growing treatment for infertility is assisted reproductive technology (ART). ART describes any method in which both eggs and embryos are manipulated outside the woman’s body, of which in vitro fertilization (IVF) is the most common type. In 2015, 1.7% of all live births  in the U.S. were the result of ART. While this method of conception is becoming more common, it is still a highly complex and debated issue. ART has been associated with many adverse health outcomes including an increased risk of birth defects, and a 1.71 increased risk of preeclampsia among women. Success rates for ART are improving yet vary significantly and are particularly dependent on age. For instance, for women younger than 35 the average success rate of ART in 2015 was 31% compared to 16% for those aged 38–40, and 3% for those over 44 years of age. 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. 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. STDs are defined by the CDC as “infections you can get from having sex with someone who has an infection”. There are more than twenty types of identifiable STDs caused by bacteria, parasites, or viruses. 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. 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. 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 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. Women, with their partners, do not commonly discuss STDs as well. 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. Most women do not even know any information about Chlamydia as an STD besides the fact that it is curable. 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. 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. A study by the Journal for Women’s Health identified a need for a knowledge campaign on STD screening targeting sexually active young women.