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, and the average woman has 2.2 children.
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. Women's use of contraception at first intercourse has risen from 64 percent in the late 1980s to 76 percent in 1995.
From 1987 to 1994, the rate of unintended pregnancy dropped 16 percent. This decline was due most likely to an increase in the use of contraceptives and the improved effectiveness of contraceptive methods. However, 49 percent of pregnancies in 1994 were unintended. Nearly half of all women who experienced an unplanned pregnancy in 1994 had been using some form of contraception.
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 injectable hormones, 1 percent used hormonal implants, and less than 1 percent used the female condom for contraception. Gynecological health is not only an important component of women's health during their reproductive years, but throughout the course of their lives. 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 (STDs). Two-thirds of all STD cases occur among individuals younger than 25 years, and one in four teenagers contracts an STD each year. Women are more susceptible biologically to becoming infected with STDs than are 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. Left undetected, 20-40 percent of women infected with chlamydia and 10-40 percent of those infected with gonorrhea develop pelvic inflammatory disease (PID). In turn, PID leads to infertility in 20 percent of cases, chronic pelvic pain in 18 percent of cases, and ectopic pregnancy in 9 percent of cases. In addition to the direct health problems caused by STD infection, high rates of STD infection in adolescent women contribute to an increased susceptibility to HIV. In 1998, more than half a million new cases (501,128) of chlamydia were reported in American women. That same year, 179,651 new cases of gonorrhea were reported. (Young women ages 15 to 19 had the highest rates of gonorrhea infection.) In addition, 18,179 cases of syphilis were reported. Herpes simplex virus type 2 (HSV-2) infects about one in four women (or 25 percent of this population) and one in five men (or 20 percent of men).
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. 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. Nearly two in five women between the ages of 14 and 50 experience some symptoms of premenstrual syndrome (PMS)-10 percent with symptoms severe enough to disrupt their usual activities.
As many as 10 percent of American women have endometriosis, which can cause chronic pain and infertility. Between 10 and 20 percent of women have uterine fibroids (non-cancerous growths in the uterus). Together, endometriosis and fibroids are associated with half of the more than 580,000 hysterectomies performed in the United States each year. 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.
