SOCIOL 3HH3: SOCIOLOGY OF HEALTH
ROOM FOR IMPROVEMENT: Reproductive
Health Needs A Revamp
Name: Alice Xue
Student Number: 1138724
Introduction
For the vast majority of all living species, sexual reproduction is the fundamental source
of their continued survival. However, sexuality for humans is much more complex than this
functionalistic definition would suggest. Sexuality is often considered part of an individual’s
identity and hold significant social value, affecting the way one views themselves and their
interactions with others. For this reason, reproductive health is a very important pillar in
determining the physical, mental and social wellbeing of an individual. The World Health
Organization defined reproductive health as the reproductive processes, functions and system at
all stages of life. UN agencies goes further to claim that sexual and reproductive health includes
“physical, as well as psychological well-being vis-a-vis sexuality” (Joint United Nations
Programme on HIV/AIDS et al 2018). In real life application, reproductive health may include,
but is not limited to, being informed about safe sex practices through well implemented sexual
education programs, having easy and affordable access to birth control options and sexual
healthcare. For women, reproductive healthcare may be particularly important as it not only
pertains to managing pregnancy and childbirth, but is also inseparable from gender equality.
Proper reproductive health allows for crucial decision making in regards to a woman’s body and
future. Institutions such as education, healthcare and government all play important roles in
achieving reproductive health for its citizens. Therefore, it would be in the best interest for social
institutions to implement legislation that advocates for reproductive health and help citizens
attain a happier and healthier standard of living. .
Thesis
This inquiry argues that current institutional legislations surrounding reproductive health
are inadequate. Reproductive health needs to be better established as a topic in social institutions,
such as education and healthcare, in order to promote better sexual agency and a healthier
attitude towards sexuality.
Theoretical Approach
A feminist perspective will be used to understand the impacts of current reproductive
health legislations on sexual agency, particularly for women in health care institutions. The
feminist tradition, at its core, is focused on a humane system of justice that acknowledges that
women are placed at a disadvantage in a patriarchal society (Inderbitzin et al 2015). More
specifically, the effects of these patriarchal institutions will be examined in context of the
structure agency debate; a debate concerning individual choice versus determination by outside
forces and of the need to understand an issue that has such important implications for politics and
social life (Hornosty and Germov 2012). This theoretical approach is important in understanding
the effects of a insufficient sex education curriculum for both male and female adolescents as
well as the implications of gender inequality found in health care. The inquiry will delve into
how these social institutions limit an individual’s ability to make well informed decisions and
fail to provide the required resources to achieve reproductive health.
Education
Abstinence Only Programs
Sex education is one of the few reliable sources for sexuality and sexual health for youth.
However, there is no standardized sex education policy in the US, leading to curriculums that are
factually lacking and often riddled with misinformation, hindering an adolescent’s development
of a healthy attitude towards sexuality. There are three main types of programs found in the
American sex education system; abstinence-only, abstinence-plus, and comprehensive sex
education (Lindberg et Al 2016). Abstinence centered education focus on providing instruction
on saying no to sex without providing information on birth control. A study done by Advocates
for Youth state, “many of the curricula commonly used in abstinence-only programs distort
information about the effectiveness of contraceptives, misrepresent the risks of abortion, blur
religion and science, treat gender stereotypes as scientific fact, and contain basic scientific
errors" (Blanton 2018). These curriculums may also enforce the idea that an individual may “lose
part of their worth everytime they sleep with someone”, a message that is particularly directed at
the female gender. This idea feeds into the sexual double standard that women are more harshly
judged for their number of sexual partners compared to their male counterparts (Kreager and
Staff 2009). This kind of sex education spreads misinformation and assigns morality to sexual
behaviour. By presenting subjective belief systems as objective facts, adolescents are impaired in
their decision making when it comes to their sexuality.
Comprehensive Programs
Still, abstinence only programs are more prominent in American schools even though
comprehensive programs are proven to be more effective and promote better decision making in
adolescents (Lindberg et Al 2016). Comprehensive program curriculums commonly include
topics on sexual health topics suchs as human sexuality, HIV or STD prevention and pregnancy
prevention through birth control options. But even the comprehensive programs take a traditional
disease model when approaching the topic of sexual activity, resorting to fear tactics to scare
adolescents away from the consequences of being sexually active. This kind of educational
program is grossly lacking from a dynamic relationship perspective as it fails to address
adolescents’ social and emotional concerns regard sex and could lead to more serious adverse
outcomes after having sex (Brady and Halpern-Felsher 2007). Being sexually active
encompasses far more than the biological risks of pregnancy and sexually transmitted diseases,
the social and emotional consequences can cause equal if not greater impact on the psychological
well being of adolescents. By forgoing such an important component, adolescents are not able to
proper assess situations and may not act in their best interest out of ignorance. It would be far
more beneficial for sex education curriculums to address these social and psychological factors,
which encourage for a better understanding of sexuality and promote well informed decisions.
Lack of LGBTQ Curriculums
Additionally, sex education curriculums are largely heteronormative, disregarding
alternative sexual identities and alternative definitions of sex. This may be particularly
distressing to individuals that identify as part of the LGBTQ demographic, an already
marginalized group, whose experiences and identities are not being adequately addressed as part
of the curriculum. According to a Human Rights Campaign survey conducted in 2015, only 12%
of millennials recall learning about same-sex relationships as part of their sex education
curriculum (Blanton 2018). Certain abstinence only curriculums may even promote fear of same
sex attraction, creating a hostile environment for LGBTQ youth. Queer youth need a safe and
reliable source of information regarding their sexual health, positive representation of LGBTQ
individuals and guidance in understanding their gender identity or sexual orientation. The
absence of these topics may cause queer youth to frequently seek information online or from
peers. However, much of the sexual health information online is neither age-appropriate nor
medically accurate, and peers may be misinformed. This may result in detrimental impacts to the
physical and psychological well being of LGBTQ youth. Future sex education curriculums
would greatly benefit from including topics that address queer sexuality and positively influence
the development of sexual identity among the LGBTQ demographic.
Thus, given the lack of information in sex education curriculums, it would be very
difficult for an adolescent to develop a healthy and well informed attitude towards their own
developing sexuality. While it could be argued that parents may take on the role of educating
their children on sexuality, it is unlikely that they would be able to provide accurate and unbiased
information on the topic given the historical lack of well implemented sex education
curriculums. The parents themselves are also unlikely to have been formally educated on the
topic of sexuality (Brown et al. 2014). Additionally, the existing social taboos around discussion
of sex does not encourage a safe and comfortable environment for children to ask questions and
engage in open conversation. The remaining sources of information that adolescents commonly
turn to are what is told to them by peers and what is shown in mass media. Both of these sources
are littered with misinformation and ignorance towards a sensitive topic which may increase the
likelihood of poor decision making when faced with a sexual scenario and negatively impact an
individual’s future attitudes and mindset regarding sexuality. The Government of Canada
website reports that comprehensive sexuality education can contribute to a reduction in rates of
adolescent pregnancy and rates of HIV (Government of Canada 2018). Both pregnancy and
disease during adolescence can inhibit workforce participation later in life. Therefore, a
comprehensive sexual education program should be implemented as part of the health curriculum
at schools in order to encourage well informed decision making in sexual matters and provide
better opportunities in the future.
Health Care
Access to Birth Control
Having access to safe, affordable birth control options is a big contributor to women’s
sexual health and agency. However, female contraceptive options that are commercially
available still lack accessibility for all social classes and come at the cost of adverse health
effects. Legislative regulations in healthcare make it especially difficult for citizens of lower
classes to obtain contraceptives methods and offer few options in the event of a unplanned
pregnancy. This holds especially true for women who wish to have sexual agency without
becoming pregnant as female contraceptives are controlled by medical institutions, costly
without insurance and come with a slew of side effects. Male condoms only offer 84%
effectiveness with perfect use and require cooperation from sexual partners (Planned Parenthood
2019), so female contraception is a better option for sexually active women who desire more
control and higher reliability. Additionally, virtually all of the aforementioned contraceptive
methods require prescription through a medical consultation and is not always covered by
insurance. Without insurance coverage, contraceptive options range from $50/month to initial
costs of $1300, this is in addition to any fees required for regular consultations, check ups and
prescriptions (Planned Parenthood, 2019). This is simply not feasible for women who are
unemployed or employed without insurance coverage; this concern is compounded for women in
lower social classes, who are also less likely to receive proper sex education and are more
vulnerable to unplanned pregnancies (Chandra-Mouli et al. 2014). Access to family planning
enables women to choose the timing and spacing of their pregnancies. Fewer pregnancies lead to
greater workforce participation for women. With each additional child born to a woman between
the ages of 25 and 39, it is estimated that labor participation decreases 10%-15% (Government of
Canada 2018). For lower income classes, lower labor participation exacerbates the lack of
financial resources and better employment opportunities, which in turn feeds into their inability
to attain access better health care. This is especially true for the vulnerable demographic of
working class teenage mothers. Adolescent pregnancy can have negative social and economic
effects on girls, their families, and their communities. Often, girls who become pregnant have to
drop out of school, and girls with little or no education have fewer skills and opportunities to find
a job (Government of Canada 2018). The current institutional system has no place for the single,
pregnant teenager; and without some form of significant social and financial support from a
partner or family, will find themselves trapped in a vicious cycle of poverty and poor health.
Alternatively, easy and affordable access to contraceptive options combined with proper sex
education will decrease pregnancies, allowing for more labour participation and financial
stability. This will serve to increase a woman’s independence and grant access to both better
employment and healthcare opportunities.
Side Effects of Contraceptives
The most common female contraception methods offered to women such as oral
contraceptives, intrauterine devices (IUD) and hormonal patches are known to cause adverse
health effects, including: irregular bleeding; amenorrhea; weight gain; headache; skin changes;
nervousness; stomach pain; nausea; libido changes; dizziness; weakness; depression (Barr 2015).
However, many side effects are withheld from websites that are specifically designed to provide
information regarding available contraception options. Bedsider.org, a research based non profit,
non partisan organization designed to provide a birth control support network for women,
features an article titled “ Side effects: The good, the bad, and the temporary” in an attempt to
outline the side effects of common birth control options. However, the negative side effects listed
are glossed over or presented in a “you may experience this certain side effect but there is no
clear relationship” tone (Bedsider 2018). One look at the comment section for this article shows
many women frustrated with this kind of disregard, voicing that negative side effects have been
downplayed. A user under the name Peg shares her experiences with oral contraceptives, saying
“I have had a horrible time with birth control - depression, anxiety, loss of libido from the Pill
has really done some damage in my life. Does everyone experience these side effects? No. But
that doesn't mean they don't exist and are not important.” Another user by the name of Opal also
echoes this sentiment, commenting; “My sister and I both suffered crippling depression when we
tried the Pill back in college, and we both struggled with it for months before we figured out
what the problem was. If the potential mood-altering side effects of the Pill were more widely
reported, we might both have solved our problem a lot sooner! I've looked at the individual
entry for the Pill and that information is not there. Please don't talk down to women or try to
sweep this stuff under the rug” (Bedsider 2018). In fact, a quick google search online shows
countless women sharing similar experiences with contraceptives, many who experienced severe
negative side effects that were not listed on the label and whose concerns brushed off by medical
professionals as unfounded by evidence. Unfortunately, the reality of medical professionals
minimizing women’s pain compared to their male counterparts is a well documented
phenomenon (Hoffman and Tarzian 2003) and the impacts of this inequality spans far wider than
just reproductive health. But in the context of contraceptive options, if the concerns around
current contraceptive options are not heard, there is no push to come up with new ones. These
side effects are severe enough to drastically decrease one’s quality of life and it can be
emotionally and financially exhausting to test out options in hopes of finding one that is well
tolerated. The lack of institutional support in women’s reproductive health also limits sexual
agency, as the responsibility of preventing and dealing with pregnancy is almost solely assigned
to women. Women may choose to avoid casual sexual encounters in order to create the best
chances of avoiding these repercussions, creating an unequal balance of power in sexual agency
between the sexes. Reproductive health should invest further resources into developing
commercially available male contraception methods that is non surgical in nature, lessening this
inequality by dividing up the responsibility of pregnancy prevention.
Therefore, having access to contraception that is effective, inexpensive and with minimal
negative health impacts, is an important factor in establishing gender equality. With the ability to
choose and plan pregnancies, women can have better employment opportunities and improved
overall agency in making choices regarding their body and future.
Conclusion
In conclusion, social institutions such as education and healthcare should revise their
reproductive health legislations to more effectively ensure health and equality among its citizens.
The current sex education system is outdated and hinders the development of healthy sexuality.
A comprehensive sex education curriculum should be implemented in schools, the program
include factually correct information regarding safe sex, address the social and emotional
consequences of being sexually active and be inclusive of alternative sexual orientations and
identities. Sex education programs should be a reliable source of information for youth, build the
foundation to making well informed choices that lead to happier and more successful lives in
adulthood. Reproductive healthcare would also benefit from providing easy and affordable
access to birth control options for women of all social classes. More research should be
conducted for contraceptive options, the concerns of side effects need to be taken seriously by
healthcare professionals in order to provide improved contraceptive alternatives that minimize
adverse impacts on the health of users. Having the ability to plan pregnancies gives women
greater autonomy in their life, leading to higher financial independence and promotes gender
equality. The reader should note that this paper is written under certain contextual limitations in
order to better narrow down the scope of understanding. The educational aspects discussed are
Western centric, focusing on the sex education curriculums in North America and not
comprehensive of other education systems. The healthcare portion of this paper places heavy
focus on the heterosexual definition and understanding of sex and does not fully consider
alternative sexualities or alternative definitions of sex. Further research should be conducted on
already existing sex education programs that are well implemented successful in promoting good
decision making and healthy attitudes towards sexuality. In healthcare, male contraception
options should be explored as a way to share the responsibility of pregnancy prevention and even
the balance of power between sexes. Social institutions could be a driving force in improving the
reproductive health of citizens and should definitely work towards implementing better practices
in its legislation.
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