Sexual Behavior

McGinnis attributes 1% of premature deaths to sexual behavior, primarily via hepatitis B, HIV/AIDS, and cervical cancer. The first two are directly trans- mitted through sex, and the last is most often caused by human papillomavirus, a sexually transmitted virus. McGinnis also includes in this category infant mortality after unplanned and unwanted pregnancies.

No “manufacturer of illness” benefits from convincing people to engage in sexual activity without protecting themselves against disease or pregnancy, but social conditions can encourage such behavior. First, those forced by economic necessity to turn to prostitution to support themselves, whether male or female, often find that they can’t suggest safer sex to clients without losing business or risking violence. Similarly, those whose intimate relationships are not based on mutual respect and equality sometimes find that suggesting safer sex to their ro- mantic partners results in violence or abandonment. Finally, those who have learned to have little hope for the future—a senti- ment particularly common.

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Other sexually active individuals, however, do fear sexually transmitted diseases (STDs) and pregnancy but lack knowledge about safer sexual prac- tices or access to birth control. Only half of U.S. states require that schools teach sex education. In addition, half of all states require that abstinence be stressed if sex education is taught, even though research overwhelmingly suggests it doesn’t work. Such education delays individuals’ first sexual intercourse by only around three months while significantly reducing the odds that condoms will be used.

Meanwhile, access to birth control and abortion has declined. Cuts in pub- lic funding for contraceptive services have reduced options for teenagers and low-income women, the groups most at risk for unplanned pregnancies and infant mortality. Similarly, the federal government will pay for abortions for women on Medicaid (the government-funded health insurance program for poor persons) only if the woman’s life is endangered. Meanwhile, cutbacks in government funding for abortions, strict new laws and regulations, and harass- ment or even violence against abortion providers have reduced the number and geographic distribution of abortion providers. Moreover, few medical schools now teach students how to perform abortions, making it the only medical pro- cedure that doctors can refuse to learn. Currently, 39% of U.S. women live in counties without any abortion provider. Other restrictions such as requiring waiting periods or parental consent before abortions also limit access, especially for poor and young women. Yet despite these restrictions, abortion remains common: An estimated one-third of all U.S. women will have an abortion at some time during their lives. As a result, preserving the safety of abortion services is an important health issue.


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