Addressing Disparities in Reproductive and Sexual Health Care in the U.S.

12.30.2008

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The U.S. spends at least twice as much per capita on healthcare than almost every other western industrialized country.  Yet, the U.S. has some of the widest disparities in health outcomes. This is particularly true in the field of reproductive and sexual health.  Women of color fare worse than white women in every major health indicator from maternal mortality to the incidence of cervical cancer.  The 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.  

The U.S. has ratified two international human rights treaties that prohibit racial discrimination: the International Covenant on Civil and Political Rights and the International Convention on the Elimination of Racial Discrimination (ICERD).  The treaties prohibit polices or practices that have the purpose or effect of discriminating on the basis of race or national origin and require that countries work towards eliminating racial discrimination in all its forms.  These treaties create an international legal obligation that the US address and eliminate persistent racial disparities in reproductive health outcomes and reproductive healthcare access.

In February 2008, the U.S. reported on its progress in eliminating racial discrimination to the UN Committee that oversees governments' compliance with ICERD.  Center President Nancy Northup presented evidence to the Committee on dramatic disparities in reproductive health between women of color and white women in the U.S.  She noted that African American women die in childbirth at a rate three to four times that of white women, and that African American women and Latinas account for over three-quarters of reported female HIV/AIDS diagnoses even though they represent only one quarter of the U.S. female population.

The Center also authored a "shadow letter" to the Committee, which discussed how U.S. policies exacerbate and even help to create disparities rather than reducing them.  The lack of universally available and affordable health insurance, coupled with restrictions on access to government safety-net programs, are key barriers to reproductive healthcare for poor and low-income women.  Women of color are disproportionately burdened by government restrictions on access to reproductive healthcare because they are more likely to be low-income and therefore to rely upon government insurance programs.

The CERD Committee expressed concern that "wide racial disparities continue to exist in the field of sexual and reproductive health" in the United States, and it recommended that the U.S. government undertake a number of policy steps to improve access to comprehensive reproductive healthcare. 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.

The Center has used these recommendations to advocate on Capitol Hill and in the states for policy changes that better ensure the human right to non-discrimination in sexual and reproductive healthcare.