Improving reproductive health outcomes in a community requires more than preventing sexually transmitted infections and promoting healthy pregnancies. It also involves developing supportive social systems that improve people’s ability to have safer sex, healthier births and access to high-quality reproductive healthcare.
The social determinants of health (often abbreviated as SDOH) are the conditions under which people live and work. They affect all aspects of people’s health, including their reproductive health.
“Understanding how SDOH impact reproductive health can help scholars, public health professionals and policymakers focus on salient points of intervention,” writes Dr. Emily Hendrick, teaching assistant professor in the Master of Public Health in Public Health Practice program at the University of Nevada, Reno.
Discover the social determinants of reproductive health and the framework’s usefulness in illuminating the factors that explain why some people have better reproductive health than others, and what public health professionals and policymakers can do to improve reproductive health outcomes in communities.
What Are the Social Determinants of Reproductive Health?
Scientists and advocates alike use the SDOH framework to understand reproductive health behaviors and outcomes. Experts continue to develop the SDOH framework, but the U.S. Department of Health and Human Services groups the SDOH into the following domains:
- Economic stability
- Education access and quality
- Health care access and quality
- Neighborhood and built environment
- Social and community context
Each of these domains can have a significant impact on individuals’ reproductive health.
Reproductive health, according to the World Health Organization (WHO), encompasses “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” as it relates to the reproductive system. It’s important to note that social well-being matters in addition to physical and mental health, as a person’s social environment shapes their reproductive health behaviors as well as their access to quality care.
“Some of the social determinants of reproductive health include the laws, proximity to health care services and balance of power among individuals where one lives,” Hendrick explains. She adds that social networks (friends and family), access to reproductive health information and the quality of individual care a person experiences in health care settings also fall under the SDOH umbrella.
How Laws and Policies Shape Reproductive Health Care Access
Hendrick points out that people across the U.S. experience disparities in access to timely and quality reproductive health care in part due to where they live — and more specifically, the laws and policies that regulate reproductive health care in their region.
The Guttmacher Institute, an evidence-based research and advocacy organization committed to advancing global sexual and reproductive health and rights, documents some of the many reproductive health issues affected by state, local and federal policies, including:
- Emergency contraception and abortion services
- Access to and insurance coverage for contraceptives
- Parental notification and consent for reproductive health care for minors
Hendrick points out that two people may experience different access to reproductive health care services because of the state and local laws regarding reproductive health care where they live.
“While some individuals live within walking distance to contraception and abortion services,” she explains, “others living in states with more restrictive laws and policies may need to travel hundreds of miles for the same services.”
Some residents of these states will be disproportionately affected by restrictive laws and policies because a person’s ability to travel out of state for reproductive health care is influenced by social determinants such as their:
- Economic status
- Employment conditions
- Family support
- Access to child care (for patients who are parents or guardians)
- Access to transportation
Gender, Power and Community: How Social Life Affects Health and Reproduction
Beyond official laws and regulations, the social contexts in which people live and work also can affect their reproductive health. Societal gender norms and power structures that oppress women, for example, can result in negative health outcomes.
“Imbalanced power dynamics across genders is associated with women’s increased risk of HIV infection and experiencing sexual violence,” explains Hendrick, citing a 2020 literature review published in the journal Trauma, Violence, & Abuse. Researchers found this association based on 15 distinct studies of young, heterosexual couples in sub-Saharan Africa — suggesting a correlation between sexual relationship power and reproductive health.
In addition, an individual’s social network (e.g., their friends, family, partners and co-workers) shape not only their attitudes and opinions about sexual and reproductive health but their behaviors and health outcomes, too. For example, the attitudes of one’s teenage friends toward contraception use, adolescent sex and adolescent pregnancy were found to correlate significantly with one’s own reproductive health outcomes later in life, according to a 2022 study published in Contraception.
“The attitudes of our friends regarding the timing of childbearing and contraception use in adolescence predicts our own contraception use and timing of childbearing,” Hendrick explains.
In addition, Hendrick’s own review of research, published in 2020 in Adolescent Research Review, points to supportive older women’s family members as important influences for adolescent women making contraception decisions. Findings across studies show that maternal support matters for teens trying to obtain their contraception methods of choice.
How Bias in the Health Care Setting Impacts Reproductive Health
Another important SDOH is the treatment patients receive in health care settings. The care provided to individuals within a reproductive health care setting has important implications for their reproductive health outcomes.
For example, some sexual minority women — which includes those who identify as queer, bisexual or other nonheterosexual identities — have higher unintended pregnancy rates than their heterosexual peers who only have sex with men, according to studies published in Perspectives on Sexual and Reproductive Health and Women’s Health Issues. Research suggests that this may be due in part to the fact that:
- Sexual minority women are less likely to receive contraception counseling at reproductive health care appointments, including appointments for pregnancy tests, according to a study published in the Journal of Women’s Health.
- More generally, sexual minority women report that providers inadequately discuss sexual identity and sexual behavior in some reproductive health care settings, according to research published in Obstetrics and Gynecology.
Further, maternal morbidity and mortality rates are higher for Black women than white women in the United States, according to reports published by the U.S. Commission on Civil Rights. This disparity has been attributed to both practical barriers to accessing timely reproductive health care, such as less access to health insurance, as well as implicit bias within health care settings that prevents Black women from receiving equitable care, according to research published in the Journal of Women’s Health.
Study the Social Determinants of Health at the University of Nevada, Reno
Positive reproductive health outcomes are the result of access to high-quality care and social support. Public health leaders understand that by influencing the social determinants of reproductive health in a community, they can help improve individuals’ reproductive health throughout their lives.
Interested in promoting reproductive health? The online Master of Public Health in Public Health Practice from the University of Nevada, Reno is designed to strengthen your knowledge of current issues in public health such as the social determinants of health. Take courses with experts in public health who care about your success, like Dr. Emily Hendrick. Learn how the MPH program can prepare you to make a difference in public health.