National Academies Press: OpenBook

Transforming Human Health: Celebrating 50 Years of Discovery and Progress (2022)

Chapter: Sexual and Reproductive Health: Equitable Care for Women and LGBTQIA Individuals

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Suggested Citation:"Sexual and Reproductive Health: Equitable Care for Women and LGBTQIA Individuals." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×

Sexual and Reproductive Health:

Equitable Care for Women and LGBTQIA Individuals

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September 15, 2015 demonstration at Foley Square, New York City, NY (Shutterstock®)

Significant progress has been made since 1970 in the realms of family planning, reproductive health, and sexually transmitted disease prevention and treatment. However, major disparities persist among groups distinguished by gender, race and ethnicity, and age as well as among members of lesbian, gay, bisexual, transgender, queer (or questioning), intersex, and asexual (LGBTQIA) groups.

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iStock®
Suggested Citation:"Sexual and Reproductive Health: Equitable Care for Women and LGBTQIA Individuals." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×

1970

Federal Support for Family Planning

The Title X Family Planning Program, which was signed into law in 1970, provided federal funds to support basic health care and family planning services for low-income or uninsured families, including wellness exams, cancer screening, U.S. Food and Drug Administration–approved birth control, education about contraception, and testing and treatment for sexually transmitted diseases. Title X is the only federal program specifically dedicated to supporting family planning care and services that benefit women and women’s health.

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iStock®

1970s

Birth Control

The U.S. Food and Drug Administration approved the first birth control pill in 1960, but use dipped significantly in the 1970s due to an elevated risk of blood clots and heart attack. Studies revealed that drugs with lower levels of hormones were just as effective without the harmful side effects, which resulted in the modern birth control pill. The benefits of birth control include a decline in unintended and mistimed births, increased access to education and employment for women, and improved economic security. Contraception has also evolved since the advent of the pill into new, more flexible delivery systems like contraceptive implants, injections, or the vaginal ring. In addition, coverage for contraception has increased through Medicare, the Patient Protection and Affordable Care Act, and other legislation.

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Package of birth control pills (iStock®)

1973

Abortion as a Health Care Service

Roe v. Wade, the landmark 1973 U.S. Supreme Court trial, officially made abortion legal in the United States. Two years later, the Institute of Medicine released a report, Legalized Abortion and the Public Health, concluding that legal abortions “will lead to fewer deaths and a lower rate of medical complications than restrictive legislation and practices.” Access to abortion services has been shown to increase high school and college graduation rates among women, increase their participation in the workforce, and promote planned births of children who go on to have improved educational and economic outcomes. However, in 2022, the U.S. Supreme Court overturned Roe v. Wade, threatening access to safe abortion care for women in many states.

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Demonstrators in Providence, RI (Shutterstock®)
Suggested Citation:"Sexual and Reproductive Health: Equitable Care for Women and LGBTQIA Individuals." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×

1970s

Cervical Cancer, Human Papillomavirus, and a Cancer Vaccine

Human papillomavirus (HPV) is one of the most prevalent sexually transmitted infections, though most people who are infected will experience no symptoms. However, certain strains of HPV are the cause of almost all types of cervical cancer and increase the chance of developing cancers of the mouth, anus, throat, and genitals. In the 1970s, scientists identified the two most common strains of HPV that cause cervical cancer, leading to the development of an HPV vaccine that can prevent HPV infection in up to 70 percent of cases.

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Package of Gardasil HPV vaccine (Shutterstock®)

1973

Sexual Orientation Is Not a Mental Illness

In 1973, the American Psychiatric Association decided that homosexuality would no longer be classified as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders and advocated for legislation to grant “homosexual citizens the same protections now guaranteed to others.” However, transgender individuals are still often treated under the diagnosis of “gender dysphoria” in the manual. Many people believe that being transgender is not a mental disorder, and that it should be officially declassified, as was homosexuality. However, this diagnostic process is complicated by the fact that some transgender individuals wish to receive medical interventions that ensure their bodies match their gender identities, so a “diagnosis” is needed to support the need for medical interventions.

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Diagnostic and Statistical Manual of Mental Disorders shown on the American Psychiatric Association website
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Demonstrators at a pride parade in 2012 (iStock®)

1980

Toxic Shock Syndrome

After detection of a serious health condition caused by bacterial infection, the Centers for Disease Control and Prevention assembled a Toxic Shock Syndrome Task Force in 1980. The task force determined that women who were using highly absorbent tampons were at much higher risk for contracting the syndrome. The task force’s findings resulted in the redesign and remanufacture of tampons by many suppliers, adjusting the materials used in the tampons and providing a less fertile breeding ground for particularly aggressive bacterial strains.

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Diagnostic culture of Staphylococcus aureus bacteria growing on an agar plate: This is the most common cause of toxic shock syndrome (iStock®)
Suggested Citation:"Sexual and Reproductive Health: Equitable Care for Women and LGBTQIA Individuals." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×

1980

Pharmacological Abortion

Mifepristone, also known as RU-486, is a medication typically used in combination with misoprostol to induce an abortion during pregnancy. This combination is 97 percent effective during the first 63 days of pregnancy and can also be used in the second trimester. First developed in 1980, the medication became commercially available in the United States in 2000. Although mifepristone is included in the World Health Organization’s List of Essential Medicines, its approval and use remain controversial, with many anti-abortion groups continuing to actively campaign for its withdrawal and its distribution in the United States limited to specially qualified licensed physicians. Mifepristone remains the only medication specifically approved by the U.S. Food and Drug Administration for use in pharmacological abortion, and it offers the least invasive and least expensive option for safe and effective pregnancy termination.

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Packaging of mifepristone, also known as RU-486 (Science Photo Library®)

2000s

Human Egg Preservation

Scientists have been able to freeze embryos and sperm for decades, but freezing human eggs has proven more difficult because of ice crystals that can develop during the cooling process. In the 2000s, a new technique called vitrification solved this issue by allowing eggs to be frozen so quickly that ice crystals do not form. As a result of this advance, egg freezing went from an experimental procedure to a clinical practice that transformed assistive reproductive technology, offering a reproductive insurance policy for women who choose to postpone pregnancy, including cancer patients, single women, and those who want or need to delay having children.

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Light micrograph of human ovary showing a Graafian follicle containing a secondary oocyte (Shutterstock®)

Sexual and reproductive health has improved for many groups that have long suffered from discrimination and neglect, but physical and psychological problems remain common. In particular, LGBTQIA individuals still face significant health disparities compared with their heterosexual peers, and these disparities are further exacerbated if the individual is female or a member of a minority racial or ethnic group.

Suggested Citation:"Sexual and Reproductive Health: Equitable Care for Women and LGBTQIA Individuals." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×
Page 66
Suggested Citation:"Sexual and Reproductive Health: Equitable Care for Women and LGBTQIA Individuals." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×
Page 67
Suggested Citation:"Sexual and Reproductive Health: Equitable Care for Women and LGBTQIA Individuals." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×
Page 68
Suggested Citation:"Sexual and Reproductive Health: Equitable Care for Women and LGBTQIA Individuals." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×
Page 69
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The past half-century has been an era of astonishing progress for biomedical science, health, and health care in the United States and worldwide. This volume, commissioned to mark the occasion of the 50th anniversary of the founding of the U.S. National Academy of Medicine (NAM; formerly the Institute of Medicine [IOM]), tells the story of that progress across five major fields: biomedical science and technology, diseases and conditions, public health, U.S. health care, and global health. Since the NAM was founded in 1970, the nation and the world have seen multitudes of remarkable "firsts"—including the dawn of targeted gene therapies, the near eradication of polio, revolutionary treatments for cancers and cardiovascular disease, and many more. NAM members were the architects of many of these breakthroughs, alongside countless dedicated scientists, clinicians, educators, and public health leaders worldwide. The milestones chronicled in this volume are a testament to their remarkable work, which has saved and improved innumerable lives.

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