US Falls Short On Racial Disparities in Health

It's not every day that the United States is reprimanded on the international stage for racial discrimination. And it's certainly not every day that part of the charges includes discrimination against women of color in the area of reproductive health care. But one day before International Women's Day, a United Nations committee expressed concern about "wide racial disparities" in sexual and reproductive health in the United States. The Committee was responding to pervasive and dramatic disparities between the reproductive health of women of color and white women. Its comments reflect a triumph for reproductive health activists in the struggle to have the reproductive health needs of minority women taken seriously.

The Committee's conclusions were issued at the close of a two-week session in Geneva, Switzerland, during which it reviewed the U.S.'s compliance with the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD), a human rights treaty which requires that countries take pro-active measures to address racial inequalities. It was no surprise that during the session the U.S. was grilled about the persistence of racial segregation in public schools, the dismantling of affirmative action, and racial discrimination in the criminal justice system. But the session also provided a unique opportunity to focus on the less publicized but equally pervasive issue of racial discrimination in reproductive health care.

Not surprisingly, the U.S. initially refused to even acknowledge the stark differences in access to quality care between white women and women of color — despite indicators like shockingly high numbers of women of color dying during childbirth and record numbers being infected with HIV/AIDS. Instead, it was U.S. activists who shed light on the overwhelming evidence of systematic racial discrimination in the U.S. in reproductive health care.

Nancy Northup, the president of the Center for Reproductive Rights, testified before the Committee on February 18 and addressed how women of color have significantly poorer sexual and reproductive health than the majority white population. While that's not a newsflash to many of us, the data can be alarming:

  • African-American women are nearly four times more likely to die in childbirth than white women, 23 times more likely to be infected with HIV/AIDS and 14 times more likely to die from the disease.
  • American-Indian/Alaskan Native women are over 5 times more likely than white women to have chlamydia and over 7 times more likely to contract syphilis.
  • The unplanned pregnancy rate among Latinas is twice the national average; and Latinas are much more likely to contract human papillomavirus, the infection that leads to cervical cancer.

These disparities speak to the significant barriers women of color face in obtaining reproductive health services. Across the board, racial and ethnic minority women are less likely than white women to have adequate prenatal care, a full range of contraceptive choices, or a timely and affordable abortion. Even more disheartening — U.S. policies have not only failed to narrow the disparities, but have exacerbated them.

  • More young African-American females and Latinas than white women are given abstinence-only instruction in school, instead of comprehensive sex education. This means they aren't taught about contraceptive use to prevent pregnancy or protect against HIV and other sexually transmitted infections (STIs). Abstinence-only programs have proven ineffective, and in some cases counter-productive, but every year the government has increased their funding dramatically, now totaling $176 million annually.
  • Although the U.S. has the resources to reduce maternal deaths and has acknowledged the importance of prenatal care to prevent them, it has adopted policies which force women to delay pregnancy-related care or forego it altogether. Unreasonable requirements for Medicaid like the 5-year bar on benefits for legal residents prevent many immigrant women from receiving even basic services.

Not only did the Committee recognize the need for the U.S. to take action to address racial disparities, it rejected the government's argument that the poor health outcomes arose from behavioral choices rather than government policy choices that fail to address American citizens' human right to adequate reproductive health care. In order to address these needs, the Committee recommended that the U.S.: (1) improve access to pre- and post-natal care, including by eliminating eligibility barriers to Medicaid, (2) facilitate access to contraceptive and family planning methods, (3) provide adequate sexual education aimed at the prevention of unintended pregnancies and STIs.

It's fitting that these recommendations came on the eve of International Women's Day, the nearly century-old commemoration of the worldwide battle to ensure equal rights for women on issues like work, voting and abortion. The Committee's comments are a victory for reproductive health advocates and women of color. Now it's time for the U.S. to stop making excuses and to adopt health care policies to ensure that the basic rights of women of color to reproductive health care.

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  • rachel-roth

    Kudos to the human rights community in the U.S. for getting these issues on the international agenda. Remember the 2004 vice presidential debate in which the candidates were not able to discuss the impact of HIV on African American women, because, in Cheney's case at least, he was not even aware of the numbers?


    The shadow reporting process is an important opportunity to raise awareness and to create a record of evidence that can be used in other organizing efforts.


    For anyone who wants to read the Committee's conclusions or the NGO shadow report, I've posted links here:


    And check out SisterSong on the web for more information about women of color and reproductive health. 


  • invalid-0

    There is one area of women’s reproductive health as it intersects with racism in the US that has yet to be fully redressed, and that is the phenomenon of coercive sterilization. While several states have issued apologies and instituted compensation measures for past abuses (which led to the institution in 1979 of the Department of Health, Education and Welfare’s guidelines for sterilizations performed with public money) there remain many victims who have been unable to receive justice through the courts and whose cases remain unresolved.

    From the global perspective, this is not a matter of merely redressing past wrongs, but of halting ongoing practice. Unfortunately, abuses of this nature have been reported during the last decade in countries ranging from the Czech Republic to Namibia.

  • invalid-0

    It’s interesting that you note children attending schools close by and the end of affirmative action as being called “racist,” when in fact it’s affirmative action and racially based de-segregation that could also be called racist. They’re policies based on the races of the people involved. Children shouldn’t be forced to take a bus two hours to school, schools themselves should just be made better. Affirmative action was called racist by the Urban League when it was first proposed, and JFK thought that blacks themselves would object to the policy as racist. Some have. Choosing some people over others based just on their race should be something the UN is against, not something it is for.

    I found it interesting that you write that Latinas and black women have less access to health care services than whites. In my town, it’s the opposite. There are specific health clinics held just for Hispanics and African-Americans, I kid you not, but never for Asians or Middle Easterners or whites. I always wondered what would happen if a Hispanic person went to the African-American clinic by accident or if a black person went to the Hispanic clinic. Would they be turned away? In my opinion, it’s all quite racist and reminds me of Jim Crow laws. They have nothing like this in Europe, the countries which apparently have such great health access for all races. Why would we have it here? What’s wrong with just having a clinic and saying anyone can come to it?