Prevention Corner: Health Equity and Access to Reproductive Care as Primary Prevention

Nov 29th, 2021

By Maddy LaCure

Preventing sexual violence requires a multitude of approaches and interventions to make significant social change. Due to the incredibly high rates of sexual violence nationwide, prevention efforts have historically focused on secondary and tertiary prevention. Secondary prevention is the immediate response after sexual violence and tertiary prevention is the long term response to prevent revictimization of survivors and recidivism of perpetrators (CDC, 2014).  Primary prevention challenges us to take a step back and seek out interventions that address root causes of sexual violence before victimization or perpetration has occurred. Research shows that preventionists can do this by building protective factors in individuals, relationships, communities, and society as a whole that promote a new norm that sexual violence is unacceptable (Basile, et al. 2016).  

Preventionists are exploring a wide variety of interventions that may not directly address sexual assault, but rather build opportunities for leadership development, economic empowerment, and access to resources that contribute to positive communities (Basile, et al. 2016). Health equity is one approach to increase protective factors to ensure all people have equal access and opportunity to care for their health and wellbeing. In this article, we examine the connection between current health disparities and restrictions on reproductive care that contribute to a culture that accepts sexual violence. Preventionists can advocate for health equity and access to reproductive care as primary prevention that breaks down harmful social norms about gender and power dynamics in society. 

Health disparities exist across a variety of identity groups including race, ethnicity, gender, sexual orientation, age, disability status, income, and location. Gender disparities show the connection between health outcomes and social norms in a number of ways. For example, the gender wage gap that leads to lower pay and economic inequities for women than their male counterparts has serious health implications. A 2015 NASEM study found that while men in the top 60 percent of the income distribution were making gains in life expectancy at age 50, women were experiencing losses in expected life expectancy at age 50 in the bottom two income quintiles and no progress in the third or fourth quintiles (NASEM, 2015). The devaluation of women’s contributions to the workforce leads to economic disparities and lower life expectancy.

Additionally, women experiencing violence are at an increased risk of adverse health effects such as arthritis, asthma, heart disease, gynecological problems, and risk factors for HIV or sexually transmitted diseases (STDs) than those who do not experience violence (NASEM, 2017).  In order to address these and the many other disparities, we must challenge the norms, beliefs, and behaviors that uphold the prevalence of sexual violence in our society from a health lens. Access to reproductive health care is one major focus area of health equity that faces immense challenges and restrictions nationwide. 

Texas Senate Bill 8, also known as ‘The Heartbeat Act’ went into effect on September 1, 2021 and states that ‘a physician may not knowingly perform or induce an abortion on a pregnant woman if the physician detected a fetal heartbeat for the unborn child’ typically around 6 weeks of pregnancy and allows any member of the public to file a lawsuit against the pregnant person, the doctor, and anyone else who aided or abetted to break the law (Texas S.B. No. 8, 2021).  Not only are 26 states proposing and enacting laws that restrict access to abortion and 14 states are slated to enact a complete ban if Roe v. Wade is overturned (Hubbard, K., 2021), but now Texas has set the general public out to catch people seeking an abortion and created a fine of $10,000 for those found guilty of seeking an abortion or supporting someone seeking abortion services (Texas S.B. No. 8, 2021). Although the Supreme Court has heard two challenges to S.B. 8 as of November 1st, this unprecedented law has upheld its constitutionality and remains in effect (Liptak, et al, 1 Sept. 2021 & Liptak, 1 Nov. 2021).  This bill is incredibly dangerous for women and survivors of sexual assault and sexual violence. 

In many cases, the only exception of the rule is when the mother’s life is in danger, yet there are no exceptions for survivors of rape or incest. These restrictions uphold a culture that devalues women by taking away women’s bodily autonomy and pregnant people’s right to make decisions about their healthcare and body. By taking away choice and controlling reproductive health, lawmakers are sending a message that each individual person’s autonomy and decision making over their own reproduction is not valued. This message, based in power and control, resonates very closely with sexual violence perpetration (SVP). Also based in power and control, SVP stems from societal risk factors of a culture in which individuals are not respected or valued and sex is seen as an entitlement to be taken without consent by the individual or individuals in power over the situation. Continual legal and social challenges to reproductive rights reinforce harmful gender roles, devalue women and their choices over their own reproduction, and contribute to a society that accepts and normalizes sexual violence. 

ln their 2021 report A Health Equity Approach to Sexual Violence Prevention the National Sexual Violence Resource Center and the Prevention Institute explain that ‘a health equity approach to preventing sexual violence means that we need to both understand and address the factors that contribute to violence and safety and factors that expose some communities — especially communities that have been historically oppressed — to higher rates of sexual violence’ (NSVRC, 2021, p.2). Women, communities of color, the LGBTQIA+ community, and low income communities are at some of the highest risk for sexual violence. As MCASA’s Executive Director Lisae Jordan, Esq. explained in an interview on WEAA’s Today with Dr. Kaye show, these anti-abortion laws and restrictions on reproductive care will have the greatest impact on low income women and women of color who are already faced with numerous health inequities.  

In order to address the social norms that lead to sexual violence, we must address these health inequities that restrict women’s health care and control over their own bodies. Here in Maryland, advocates and lawmakers are already looking ahead to the coming legislative session to strengthen access to affordable reproductive care and services (Kurtz, J. 3 Oct. 2021). In 1991, Maryland codified the Roe v. Wade ruling into its own laws, so even if the U.S. Supreme Court hears cases related to abortion rights, Maryland will maintain the same level of abortion access we have now. To learn more about Maryland laws and policies, visit the Maryland Abortion Access Alliance. Standing up for health equity, reproductive rights, and bodily autonomy is a crucial piece of sexual violence primary prevention. 



A Health Equity Approach to Preventing Sexual Violence (2021). National Sexual Violence Resource Center and Prevention Institute. Retrieved from: 

Basile, K.C., DeGue, S., Jones, K., Freire, K., Dills, J., Smith, S.G., Raiford, J.L. (2016). STOP SV: A Technical Package to Prevent Sexual Violence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Retrieved from:   

Hubbard, Kaia. (2021, Feb 25). 45 States Have Enacted Abortion-Related Laws in Recent Years U.S. News. Retrieved from: 

Hughes, et al. Texas S.B. No. 8 A bill to be entitled an act relating to abortion, including abortions after detection of an unborn child ’s heartbeat; authorizing a private civil right of action. Retrieved from: 

Kurtz, Josh. (2021, Oct 3). Md. Advocates, Lawmakers Look Ahead to Legislative Session to Strengthen Abortion Protections. Maryland Matters. Retrieved from: 

Liptak, Adam, et al. (2021, Sept 1). Supreme Court, Breaking Silence, Won't Block Texas Abortion Law. The New York Times, updated 2021, Oct 7. Retrieved from: 

Liptak, Adam. (2021, Nov 1). Supreme Court Appears Open to Letting Providers Challenge Texas Abortion Law. The New York Times. Retrieved from: 

Maryland Abortion Laws and Policies. Maryland Abortion Access Alliance. Retrieved from: 

Sexual Violence Prevention: Beginning the Dialogue (2004). Centers for Disease Control and Prevention.  Retrieved from:

The Growing Gap in Life Expectancy By Income: Implications for Federal Programs and Policy Responses (2015). National Academies of Sciences, Engineering, and Medicine. Retrieved from: 

The State of Health Disparities in the United States (2017). National Academies of Sciences, Engineering, and Medicine; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Retrieved from: 

Today with Dr. Kaye: Texas abortion law and women's right to choose (2021, Sept 8). WEAA Radio. Retrieved from: 

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