Social Determinants of Women’s Reproductive Health

1. Social Determinants of Women’s Reproductive Health Wendy Hellerstedt, MPH, PhD Epidemiology, University of Minnesota

2. Inequities in Women’s Reproductive Health • May reflect gender inequity within race, age, etc.

3. U.S. Pregnancy, Childbearing and Abortion Statistics • Average of 3.2 pregnancies per woman • Average of 1.8 (57%) pregnancies result in wanted births • 85% of adolescent pregnancies are unintended • On average, black women (4.6) have more pregnancies than white women (2.7)

4. Consequences of Sexually Transmitted Infections (STIs) • Systemic infections • Infertility • Ectopic pregnancy • Spontaneous pregnancy loss • Preterm pregnancy risk

5. Prevalence of STIs • Chlamydia: 322 cases/100,000 • HIV: 3750- new cases among women each year • Human papillomavirus (HPV): as many as 50% of young women infected • Bacterial vaginosis: perhaps 16% of pregnant women are affected • Pelvic inflammatory disease (PID): 175/100,000 women are hospitalized every year

6. STI Rates • 2/3 of new cases are in persons 25 or younger • Black women have higher STI rates than white women • Low income women have higher STI rates than middle- and upper-income women

7. AIDS and women • 4th leading cause of death for black women (ages 25-44) • AIDS rate for black females: 59/100,000 • AIDS rate for American Indians, Asians, and whites: 2-5/100,000

8. Gender Roles and Health • Two sources of imbalance • Societal level – Historical and sociopolictial forces segregate power and ascribe social norms that maintain discriminatory roles • Institutional level – Imbalances maintained by social institutes via practices like unequal pay, discriminatory admissions or hiring, and degradation of individuals through the media

9. Gender Imbalances and the Division of Labor • Allocation of women and men to certain occupations • Can occur in the workplace, family, social institutions

10. Gender Imbalances & Employment • Women earn about 78 cents for every dollar earned by a man in a comparable position • Women represent: • 99% of secretaries • 97% of child care workers • 20% of lawyers • 25% of physicians

11. Issues of Working Women • Child-care issues • Support systems for balancing multiple roles • Exposures that can effect pregnancy or fertility • Worksite-based prenatal and reproductive health counseling

12. Work and Women’s Health • Good health • Many studies report work positively associated with self-esteem, perceived health, and physical functioning • Poor health factors • High-demand and low-control jobs • Lack of employment • Absence of family responsibilities • Time constraints • Conflicting responsibilities • Non –supportive work environments

13. Household Structure & Income

14. Gender Imbalances in Interpersonal Power • Individual's control over and vulnerability to environmental and behavioral risk affects health outcomes • Political institutions, language, etc. convey societal acceptance of gender inequalities in control and authority

15. E.g., Domestic violence • Risks of domestic violence • Injury • Chronic pain • Disability • Substance use • Depression • Unintended pregnancy • Increased STI risk • Adverse pregnancy outcomes

16. Violence and Pregnancy • Estimated that the prevalence of violence during pregnancy ranges from .9-20.1% • Violence may be more prevalent than diabetes

17. Conclusion • Gender inequity affects women AND men • Importance to keep gender inequities in mind when providing reproductive health care for both men AND women