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