Comprehensive Healthcare: Why Is the Inclusion of Reproductive Health Controversial for Women but Not Men?

Abstract

Whether comprehensive healthcare for women includes birth control, abortion, or even reproductive healthcare remains controversial in the United States. Women have long been faced with health insurance options that could exclude pregnancy, even when it was not a preexisting condition. Multiple arguments have recently been made as to why birth control should not be mandated coverage for women. Comprehensive care for women that broadly includes reproductive care is not yet the standard of care, despite recognition of the gaps and the many consequences for women’s health. The past four decades have brought a series of national efforts to address gaps inwomen’s healthcare, including thewomen’s lay health movement, the rapid expansion of women as providers in all health science fields, the rise of many advocacy groups for the care of women, and the institutionalization of women’s health with national Offices of Women’s Health throughout the Department of Health and Human Services. Each of these efforts was expected to close thegaps.Yet care remains fragmented, aspectsof women’s healthcare are the subject of much public debate, and considerable gender differences in quality of care persist. Interestingly, men’s sexual and reproductive health has not elicited the same scrutiny. There are few restrictions on drugs to treat sexual dysfunction for men with pharmaceutical coverage. In fact, sildenafil (Viagra) is covered even under Medicare. One could make many of the same social arguments regarding sildenafil as have been recently suggested regarding birth control coverage. Both reliable birth control and sildenafil can contribute to sexual activity that might not otherwise take place (although that is arguably the point). In fact, research suggests that men using sildenafil have a higher rate of sexually transmitted diseases than do other men (Jena et al., 2010).