What Are Reproductive and Sexual Health Rights?
In a nutshell, these are your basic human rights to control your sexual and reproductive health. Laws where you live may or may not protect these rights.
Health and human rights advocates have outlined three categories of reproductive rights. They include your rights to:
- Decide when or if you have children and with whom
- Have access to information and services related to sexual and reproductive health
- Make reproductive and sexual health decisions free from discrimination and inequality
Around the world, many people, especially girls and women and those living in poverty, have limited reproductive and sexual health rights. They may not have access to sex education, birth control, pregnancy care, abortion, or counseling.
This often stems from a community’s beliefs and values surrounding sex, particularly women’s sexuality. Some societies may place more pressure on women to have children.
Restricted reproductive rights have long-term effects -- physically, socially, and economically. Without options or proper health care, women and girls are more likely to die during pregnancy and childbirth. Maternal death is the leading cause of death for girls and women ages 15 to 19 around the world, often because their bodies aren’t mature enough to carry a baby.
If you don’t have the right to decide when you have sex and get pregnant, or whether to have a baby, you may have fewer educational and job opportunities.
For many girls, reaching puberty means their communities consider them to be adults. They may get married, become pregnant, and drop out of school to care for their children. This cycle limits a girl’s economic and career potential, leaving her vulnerable to poverty.
What Are Your Rights to Reproductive and Sexual Health Services?
In the United States, the Affordable Care Act (ACA), signed into law in 2010, makes health insurance and some health services more affordable for more people. The ACA also expanded Medicaid to cover certain people with low incomes, although some states haven’t gone along with that.
While some services apply to all health coverage, some may only be available through the insurance plan where you work or the Health Insurance Marketplace managed by your state or the federal government.
It’s been talked about a lot since the Supreme Court of the United States struck down the constitutional right to legal and safe abortion in its Dobbs vs. Jackson Women’s Health Organization decision in June 2022. That ruling leaves it to individual states to regulate abortion access.
More than half of all states are expected to restrict or ban abortions altogether. It’s already illegal in some states, allowed in some under specific circumstances, and a protected right in some.
You may be wondering if your health plan covers abortion. It’s complicated.
But mostly it depends on where you live and who provides your insurance.
If you have Medicaid, federal law says it can cover abortion costs only in cases of rape or incest, or if your life is in danger. But Medicaid uses both state and federal money. So, states can choose to use their Medicaid funds to cover abortions beyond those situations. Some states do that and some don’t.
The state you live in is also key If you have health coverage through the ACA. There are a few states that require it to cover elective abortions, as long as no federal funds are used. But ACA plans and their level of abortion coverage vary from state to state. Some states prohibit ACA insurance plans, and even some private plans, from covering abortions no matter the circumstances.
If you get health insurance through your job, your abortion coverage depends on various things that might include where you live, details of your plan, and whether your company is self-insured or buys insurance for you. Check your plan and company’s rules to learn about your coverage.
Some large employers are offering to pay expenses for workers who have to cross state lines for a legal abortion. But it’s unclear how much risk those companies are taking in doing so.
Abortion remains legal in some states. You can get info on your state’s laws, abortion-related legal help, and resources that may help you pay for an abortion at websites like www.abortionfinder.org.
You cannot be charged for birth control, or related health care visits, by any Marketplace health insurance plan when you see an in-network provider. The ACA covers all birth control approved by the FDA including:
- Barrier birth control
- Hormonal control
- Emergency birth control
- Tubal ligation (sterilization or “having your tubes tied”)
Pregnancy and breastfeeding
If you’re pregnant or recently had a child, you’re entitled to health coverage. The Marketplace and Medicaid meet your health care needs during pregnancy and childbirth, and all qualified health plans must cover care for those who’ve given birth and newborns.
If you breastfeed your baby, there is free help available. Most health insurance plans are required to cover breastfeeding support, counseling, and the cost of a new or rented breast pump. You may need approval from your doctor.
Other sexual health services
The ACA also covers the following sexual health services:
- HIV screening for teens and adults ages 15 to 65
- PrEP medication for high-risk HIV-negative adults
- HPV vaccine
- STI counseling for high-risk adults
- Syphilis screening for high-risk adults
Under the ACA, you can choose any available in-network primary care provider. You don’t need a referral from your primary care doctor to see an OB/GYN.
Barriers to Birth Control Services
Unfortunately, there are reports of insurers denying women birth control coverage under the ACA. Some expect women to prove other birth control methods have failed before paying for their preferred method. Or, they may not cover birth control methods that have the same ingredients but different delivery methods, such as the birth control patch and the pill. One study reviewed 20 insurers across five states and found that only 12 covered costs for the contraceptive ring and only 10 covered all FDA-approved IUDs.
Sometimes, there are pharmacists who won’t fill birth control prescriptions, or offer emergency birth control, because of their religious or other beliefs. In some states, this is their right. If this happens to you, you’ll need to find another pharmacy to get your birth control.
You may also find barriers to birth control at your doctor’s office. Despite what they may say, it’s not necessary to have a pelvic exam or cervical screening before receiving a birth control prescription.
But you may be required to see your doctor two times for a birth control implant such as an IUD -- one time for a consultation and the other time to place the device. This all can happen in one visit.
Keep in mind that it’s not mandatory for health insurance plans to cover vasectomies for men. Also, some employers, such as religious organizations, aren’t required to cover birth control in their health plans. Talk to your employer about which services their plan covers.
What Rights Do Minors Have to Reproductive and Sexual Health Services?
It’s important to note that young people may have different reproductive and sexual health rights than adults. It all depends on where you live and the laws of your state.
In many states, people under 18 are legally allowed to access birth control, pregnancy care, and STI services without the consent of their parents. Other states only allow specific groups of minors to use these services without parental permission, such as those who are married, pregnant, or already have children. A few states don’t have clear-cut laws about parental consent. In these cases, doctors can choose whether or not to offer young people birth control and other sexual health care.
You can find out the laws in your state and any new or pending legislation on the Guttmacher Institute website.