Addressing Disparities in Reproductive and Sexual Health Care in the U.S.
The U.S. spends at least twice as much per capita on healthcare than almost every other western industrialized country, but has some of the widest disparities in health outcomes. Racial disparities are particularly pronounced in reproductive and sexual health. Women of color fare worse than white women in every aspect of reproductive health. For example:
- African American women die in pregnancy or childbirth at a rate of three to four times the rate of white women – and this has been true for fifty years. No single factor fully explains this racial disparity, but the Centers for Disease Control and Prevention have recognized that access to prenatal care can reduce maternal mortality and other negative pregnancy outcomes. Most pregnancy-related deaths occur after a live birth, and women who do not receive prenatal care are three to four times more likely to die after a live birth than women who attend even one prenatal appointment.
- Nearly all minority groups contract STIs at much higher rates than the majority white population. Together, African American women and Latinas account for 80% of reported female HIV/AIDS diagnoses, even though they represent only 25% of the U.S. female population. And while women of color are much more likely to die of cervical cancer than are white women, with the exception of African American women, they are less likely to receive regular Pap smears, a crucial screening mechanism.
- Low-income Latinas are nearly twice as likely as low-income white women to have an unintended pregnancy. Almost half of all unintended pregnancies in the U.S. end in abortion; African American women, who are three times as likely as white women to experience an unintended pregnancy, are also three times as likely as white women to obtain abortion services.
Poor health outcomes for women of color do not just reveal bad policy – they are evidence that the U.S. is failing to meet its human rights obligations to provide equal access to reproductive healthcare. CRR is raising this issue with human rights entities and experts at the United Nations, as well as on Capitol Hill, to push for recognition that the persistence of racial disparities in reproductive and sexual health is a human rights violation.
In 2008, CRR brought up racial disparities in reproductive and sexual health when the Committee on the Elimination of Racial Discrimination reviewed the United States’ compliance with the Convention on the Elimination of Racial Discrimination. CRR submitted a shadow letter highlighting the ways in which U.S. policy exacerbates racial disparities, with particular reference to the policies that disproportionately burden access to health care for women of color. Additionally, CRR President Nancy Northup testified before the CERD Committee about the dramatic disparities in reproductive health between women of color and white women in the U.S. as evidence that these U.S. policies violate the human rights of women of color.
The CERD Committee recognized pervasive racial disparities in women’s sexual and reproductive health as a human rights concern and called on the U.S. to improve women’s access to reproductive and sexual healthcare, including contraception and sexuality education. Specifically, the Committee urged the U.S. to:
- Improve access to maternal health care, including pre- and post-natal care, through the reduction of Medicaid eligibility barriers;
- Facilitate access to family planning methods; and
- Provide adequate sexuality education aimed at the prevention of sexually transmitted infections and unintended pregnancies.
Building off of this success, CRR raised the issue of racial disparities during the U.N. Human Rights Council’s review of United States compliance with its human rights obligations in 2010-2011. The first-ever Universal Periodic Review of the U.S. encompassed not only the U.S.’s obligations under treaties it has ratified, but also its adherence to human rights principles articulated in the Universal Declaration of Human Rights and the United Nations Charter, among other things. Together with several sister organizations, CRR submitted a shadow report to the United Nations, and helped make sure that the issue was raised at “listening sessions” held by the federal government in the months leading up to the Human Rights Council’s review session. CRR was gratified that members of the Human Rights Council asked the U.S. government about racial disparities in reproductive and sexual health, and will continue to advocate at the international, federal and state levels to ensure that governments respect, protect, and fulfill the reproductive rights of women on a basis of equality.