Reproductive health

Women's reproductive capacity plays an important role in shaping their lives and health experiences. Over 80 percent of all American women have had a child by the age of 45 [1], and the average woman has 2.2 children [42].

While motherhood is a defining feature of adult life for many women, most spend the greater part of their reproductive years trying to avoid pregnancy. Sixty-four percent of women ages 15 to 44 use some form of contraception, up from 56 percent in 1982 and 60 percent in 1988 [43]. Women's use of contraception at first intercourse has risen from 64 percent in the late 1980s to 76 percent in 19951. From 1987 to 1994, the rate of unintended pregnancy dropped 16 percent, due most likely to increased contraceptive use and improved effectiveness of contraceptive methods [44]. Nonetheless, 49 percent of pregnancies in 1994 were unintended, and nearly half of all women who experienced an unplanned pregnancy in 1994 had been using some form of contraception [43].

The most commonly used contraceptive is female sterilization (10.7 million women), followed by birth control pills (10.4 million), the male condom (7.9 million) and male sterilization (4.2 million). In 1995, 2 percent of women used hormone injectable, 1 percent used hormonal implants, and less than 1 percent used the female condom for contraception1.

Gynecological health is not only an important component of women's health during the reproductive years, but throughout the life course. The average woman spends a third of her life beyond menopause. While many older women mistakenly believe that regular gynecological exams are no longer necessary, this is precisely the point in life when they are at higher risk for cancers of the reproductive system, and other gynecological problems such as uterine prolapse.

Younger women are particularly at risk for reproductive health problems associated with sexually transmitted diseases (STD). Two-thirds of all STD cases occur among individuals younger than 25 years, and 1 in 4 teenagers contracts an STD each year [45]. Women are biologically more susceptible to STD infection than men, and younger women are more at risk than their older counterparts due to differences in their cervical anatomy. Women are less likely than men to experience symptoms of STD infection. For example, chlamydia- the nation's most prevalent curable infectious disease-produces symptoms in 50 percent of men compared to only 25 percent of women [46]. Left undetected, 20-40 percent of women infected with chlamydia and 10-40 percent of those infected with gonorrhea develop pelvic inflammatory disease (PID), which in turn leads to infertility in 20 percent of cases, chronic pelvic pain in 18 percent, and ectopic pregnancy in 9 percent of cases [47]. In addition to direct health problems caused by STD infection, high rates of STD infection in adolescent women contribute to increased susceptibility to HIV.

In 1998, there were 501,128 new cases of chlamydia in American women; 179,651 cases of gonorrhea (with rates highest among young women ages 15 to 19); and 18,179 cases of syphilis. Herpes simplex virus type 2 (HSV-2) infects about 1 in 4 women and 1 in 5 men [47].

Gynecological problems are common among women of reproductive age. More than 4.5 million women ages 18 to 50 report at least one chronic gynecological condition each year [48]. Half of all women who menstruate experience some pain during menstruation, and 10 percent of them suffer from pain so severe (dysmenorrhea) that it interferes with their daily routine [49]. Nearly 2 out of 5 women ages 14 to 50 experience some symptoms of premenstrual syndrome (PMS) -10 percent with symptoms severe enough to disrupt their usual activities [50], [51]. As many as 10 percent of American women have endometriosis, which can cause chronic pain and infertility [52]. Between 10 and 20 percent of women have uterine fibroids (non-cancerous growths in the uterus) [53]. Together, endometriosis and fibroids are associated with half of the more than 580,000 hysterectomies performed in the United States each year [54]. Other causes include cancer, excessive bleeding or pain, and uterine prolapse. One woman in three over the age of 60 has had a hysterectomy, and it is the second most commonly performed surgical procedure in the nation [53].