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• Published: 25 April 2024

Reproductive rights in the United States: acquiescence is not a strategy

• Laura J. Esserman 1 &
• Douglas Yee   ORCID: orcid.org/0000-0002-3387-4009 2  

Nature Medicine volume  30 ,  pages 1238–1240 ( 2024 ) Cite this article

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Scientific and medical conferences should not be held in states that ban abortion, as such bans put the lives of women at risk.

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Acknowledgements

The authors thank L.M. Yee, J. Esserman, D. Grossman and N. Milliken for their input on creating Table 1 and for reviewing this manuscript.

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Department of Surgery, University of California, San Francisco, San Francisco, CA, USA

Laura J. Esserman

Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA

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L.J.E. is an unpaid board member of the not-for-profit QuantumLeap Healthcare Collaborative, is on the Medical Advisory Panel for Blue Cross Blue Shield and receives funding for a phase 1 intratumoral injection study for DCIS from Moderna.

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Esserman, L.J., Yee, D. Reproductive rights in the United States: acquiescence is not a strategy. Nat Med 30 , 1238–1240 (2024). https://doi.org/10.1038/s41591-024-02921-y

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Published : 25 April 2024

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DOI : https://doi.org/10.1038/s41591-024-02921-y

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Review of Reproductive Rights as Human Rights: Women of Color and the Fight for Reproductive Justice

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Zakiya Luna, Review of Reproductive Rights as Human Rights: Women of Color and the Fight for Reproductive Justice, Social Forces , Volume 100, Issue 1, September 2021, Page e13, https://doi.org/10.1093/sf/soab033

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Reviewer: Rocío R. García, Arizona State University, USA

In the introduction to her book, Zakiya Luna raises the question: “What happens when we center women of color’s organizing?” (p. 9). Reproductive Rights as Human Rights: Women of Color and the Fight for Reproductive Justice demonstrates the ontological and epistemological importance of this question using an array of qualitative data, including interviews, participant observations, and archival documents. In an empirically rich text with implications across sociology, feminist studies, anthropology, public policy, and ethnic studies, Reproductive Rights as Human Rights joins a powerful body of scholarship that draws on the unique standpoints of feminists of color for making sense of reproductive politics and strategies for engaging intersecting grievances, motivations, and claims-making.

Luna focuses on the intersectional movement for reproductive justice, in particular the social movement organization SisterSong that “grew to be the largest and most visible organizational coalition in the reproductive justice movement” (p. 4). Luna notes that reproductive justice—defined as equally advocating for the right to have children, the right not to have children, and the right to parent—is often understood by activists and scholars alike as intimately linked to human rights. Luna draws on this observation as a launching point to interrogate why and how reproductive justice is recognized as a human rights issue, a significant undertaking given that the United States reflects a longstanding mixture of hostility and confusion regarding the human rights approach. As Reproductive Rights as Human Rights demonstrates, the fact that few social movements in the United States draw on the human rights approach as a claims-making strategy is neither inconsequential nor a mere coincidence.

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Reproductive Rights of Women: A Way to Gender Justice

37 Pages Posted: 16 Oct 2015

Hina Iliyas

Jamia Millia Islamia

Date Written: October 15, 2015

Women have been fighting the struggle for reproductive rights for centuries. Historically, these rights are an especially controversial subject due to the moral, ethical, and religious considerations. Do reproductive rights merely mean the right to reproduce? Or is the issue inextricably linked to the numerous questions that surround women’s reproductive freedom? The ability to reproduce seems to be what sets women apart from men. But do women have control over their own reproduction? Do women have the freedom to choose whether, when, and how many children to have? Do women have access to safe birth control methods? Do women have the right to safe abortion? Can sexuality be separated from reproduction? A big ‘NO’ in answer to many such questions led to the emergence of the women’s health movement in different parts of the world in the early 1970’s. It started as small ‘consciousness raising’ groups, which began by spreading awareness among women about the functioning of their bodies and gradually evolved into multi-faceted campaigns that have significantly influenced health policies in many countries. Human Rights are those rights, which should be available to every individual without any discrimination of any kind. Recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom. The most important right of a Human is the Right to Life. It is the supreme human right from which no derogation is permitted. It is inalienable. The Article 6(1) of the International Covenant on Civil and Political Rights prohibit the arbitrary deprivation of life. But there are some controversial issues related to this supreme right. One such issue is the question of Right to abortion. Among other rights of women, it is believed that every mother has a right to abortion, it is a universal right. But the rights of the mother are to be balanced with the rights of the unborn. Earlier the right to abortion was not permitted and it was strongly opposed the society. The termination of pregnancy was termed to be a murder of the foetus. But due to the change in time and technology, nowadays this right has been legally sanctioned by most of the nations after the famous decision of Roe v. Wade by the US Supreme Court. But the oppositions are still present and people do believe that it should be legally prohibited. The question which is the reason for this discussion is -- whether a mother has a right to abortion vis-à-vis the right to life of the unborn. What are the International Instruments which sanction the right to abortion. What is the stand of India on this.

Keywords: reproduction, women, freedom, control, body, abortion

Suggested Citation: Suggested Citation

Hina Iliyas (Contact Author)

Jamia millia islamia ( email ).

Centre for Management Studies OKHLA New Delhi, ID New Delhi India

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Support for sexual and reproductive health and rights in Sub-Saharan Africa: a new index based on World Values Survey data

• Signe Svallfors 1 , 2   na1 ,
• Karin Båge 2   na1 ,
• Anna Mia Ekström 2 , 3 , 4 ,
• Yadeta Dessie 5 ,
• Yohannes Dibaba Wado 6 ,
• Mariam Fagbemi 7 , 8 ,
• Elin C. Larsson 2 , 9 ,
• Helena Litorp 2 , 10 ,
• Bi Puranen 11 ,
• Jesper Sundewall 11 , 12 , 13 ,
• Olalekan A. Uthman 2 , 14 &
• Anna E. Kågesten 2  

Reproductive Health volume  21 , Article number:  90 ( 2024 ) Cite this article

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Addressing attitudes is central to achieving sexual and reproductive health and rights (SRHR) and Agenda 2030. We aimed to develop a comprehensive index to measure attitudinal support for SRHR, expanding opportunities for global trend analyses and tailored interventions.

We designed a new module capturing attitudes towards different dimensions of SRHR, collected via the nationally representative World Values Survey in Ethiopia, Kenya, and Zimbabwe during 2020–2021 ( n  = 3,711). We used exploratory factor analysis of 58 items to identify sub-scales and an overall index. Adjusted regression models were used to evaluate the index according to sociodemographic characteristics, stratified by country and sex.

A 23-item, five-factor solution was identified and used to construct sub-indices reflecting support for: (1) sexual and reproductive rights, (2) neighborhood sexual safety, (3) gender-equitable relationships, (4) equitable masculinity norms, and (5) SRHR interventions. These five sub-indices performed well across countries and socioeconomic subgroups and were combined into a comprehensive “SRHR Support Index”, standardized on a 1–100 scale (mean = 39.19, SD = 15.27, Cronbach’s alpha = 0.80) with higher values indicating more support for SRHR. Mean values were highest in Kenya (45.48, SD = 16.78) followed by Ethiopia (40.2, SD = 13.63), and lowest in Zimbabwe (32.65, SD = 13.77), with no differences by sex. Higher education and being single were associated with more support, except in Ethiopia. Younger age and urban residence correlated with more support among males only.

The SRHR Support Index has the potential to broaden SRHR attitude research from a comprehensive perspective – addressing the need for a common measure to track progress over time.

Plain language summary

Sexual and reproductive health and rights (SRHR) are becoming increasingly polarized worldwide, but researchers have previously not been able to fully measure what people think about SRHR. More research about this topic is needed to address discriminatory norms and advance SRHR for all. In this study, we added new questions to the World Values Survey collected in Ethiopia, Kenya, and Zimbabwe during 2020–2021. We used statistical methods to develop an index capturing to what extent individuals’ attitudes were supportive of SRHR. This index, which we call the SRHR Support Index, included 23 survey questions reflecting support for five related dimensions of SRHR. Those dimensions were (1) sexual and reproductive rights, (2) neighborhood sexual safety, (3) gender-equitable relationships, (4) equitable masculinity norms, and (5) SRHR interventions. We found that individuals in Kenya were more supportive of SRHR, followed by Ethiopia and then Zimbabwe. There were no differences in support of SRHR between men and women, but individuals who were single and those with higher education were more supportive of SRHR, except in Ethiopia. Younger men living in urban areas were also more supportive. Our SRHR Support Index enables researchers, policymakers, and others to measure attitudes to SRHR in countries across the world and over time, based on new data from the World Values Survey that are readily available online. If combined with other sources of data, researchers can also investigate how people’s support of SRHR is linked to, for example, health and policy.

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Sexual and reproductive health and rights (SRHR) were put at the forefront of international population policy in the mid-1990s when the United Nations conferences in Beijing and Cairo emphasized rights to bodily autonomy and women’s empowerment [ 1 ]. The importance of SRHR for human development was reaffirmed when Agenda 2030 was adopted by the United Nations General Assembly in 2015, primarily in Sustainable Development Goal (SDG) #3 on health and well-being and #5 on gender equality [ 2 ]. Despite important progress to ensure universal access to SRHR as part of these goals – reflected in reduced rates of maternal mortality, HIV incidence, and increased access to modern contraceptives globally [ 2 ], the global progress has been far from equal within and across countries, with growing resistance and backlash towards sexual and reproductive rights – such as abortion and the rights of sexual minorities in many contexts. Recent examples include the anti-SRHR declaration “Geneva Consensus Declaration” signed by 34 countries in 2020 (15 from sub-Saharan Africa (SSA)), the US Supreme Court’s decision to overturn Roe v. Wade in 2022, and the overall shrinking space for civil society organizations promoting SRHR [ 3 , 4 , 5 , 6 , 7 , 8 ].

Resistance or support towards SRHR is intrinsically linked with social norms, which may impact an individual’s capacity to make decisions about their own body and sexuality, freely express their gender and sexual identity, and decide when, if and with whom to form relationships, have sex, marry, and have children [ 2 ]. Such norms can be difficult to measure due to their multidimensional nature, leaving a large gap in our current understanding about views and opinions related to SRHR. Existing indices and scales have mainly focused on specific SRHR aspects such as women’s empowerment or gender norms using data from, for example, the Demographic and Health Surveys (DHS) or the Global Early Adolescent Study (GEAS) [ 9 , 10 , 11 , 12 ]. A global SRHR index has also been developed to track the US government’s commitment to SRHR in global health programs [ 13 ]. These previous measures were either developed to assess limited aspects of SRHR outcomes, policies, and funding streams [ 13 ] or were based on data collected among certain populations such as married women or adolescents [ 9 , 10 , 11 , 12 ]. Consequently, there is a need for new, comprehensive measures using nationally representative data regardless of sex, age, or relationship status, to tap into the intersecting dimensions of gender, power, and decision-making that underlie support for SRHR.

We aimed to develop a comprehensive index measuring individuals’ support for SRHR based on a novel module integrated into the nationally representative World Values Survey (WVS) data collected in Ethiopia, Kenya, and Zimbabwe; and to assess the validity of the index across sociodemographic characteristics. Findings can be used to facilitate future empirical research and guide the operationalization and prioritization of survey items, thereby broadening opportunities for global comparisons and trend analyses within and across countries, and over time.

Conceptual framework

Our study is grounded in the 2018 Guttmacher-Lancet Commission integrated definition of SRHR, which builds on globally established human rights conventions and emphasizes the right for all individuals to enjoy a state of physical, emotional, psychological, and social well-being in relation to all aspects of sexuality and reproduction [ 2 ]. We used this framework both to guide the development of new items in the WVS questionnaire as well as the selection of existing WVS items in the analysis – aiming for a representation of different SRHR domains from a comprehensive perspective – and to contextualize and interpret our findings.

We also draw on social norm theory, where norms are defined as socially or culturally constructed informal rules about what is considered acceptable or appropriate when it comes to sexual and reproductive preferences, identities, choices, desires, roles, and relationships, as well as SRHR information and services in a given group, community or setting [ 2 , 14 , 15 , 16 , 17 ]. In this paper, we focus on individuals’ attitudes towards common social and cultural perceptions and practices related to SRHR, which we refer to as “support for SRHR” [ 14 ].

Study design and setting

We used cross-sectional nationally representative data on individuals’ support for SRHR collected for the first time as part of the 7th global WVS wave. While the WVS has been conducted in most countries in the world, data collection in SSA has remained limited. For the current study, we used data from a new WVS module on attitudes toward SRHR developed by our team, implemented between February 2020–June 2021 in three sub-Saharan African countries where such information has been less available: Ethiopia, Kenya, and Zimbabwe. Despite great progress to ensure SRHR for all over the past decades, these countries carry a prevailing high burden of adverse outcomes such as maternal mortality and morbidity, complications from unsafe abortion, gender-based violence, adolescent childbearing, and limited sexual rights (Supplementary Table A1) [ 18 ]. The three countries also differ in terms of their abortion legislation, prevalence of HIV, and harmful practices, as well as their population size, health, and political systems [ 19 ]. They are all signatories of key SRHR documents such as the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa [ 20 ], which provides a policy framework to ensure SRHR, including ending harmful practices and ensuring many, although not all, reproductive rights.

Data source and participants

The WVS has collected data on sociocultural values and beliefs through standardized face-to-face interviews with representative population-based samples of adults since 1981, available open-access. An in-depth explanation of the WVS data collection procedures to minimize bias as well as a full methodological report for each country can be retrieved from https://www.worldvaluessurvey.org . For the present study, the full WVS sample in the three included countries comprised 3,711 males and females aged 18 years or above (Ethiopia n  = 1,230, Kenya n  = 1,266, Zimbabwe n  = 1,215). Data were collected following WVS standards including mechanisms to ensure the safety of data via direct uploading and storage of data on a highly secure password protected server. No identifying data from the participants were collected, removing the requirement for a written consent form. However, all participants were requested to provide oral informed consent, witnessed by the interviewer. The research was conducted in compliance with the principles laid out in the Declaration of Helsinki. An ethical permit was granted from the Swedish Ethical Review Authority to analyze data that were collected abroad in Sweden (Dnr 2020–05314).

Data used in the present study are based on a new SRHR module, which was first developed and piloted by our team in the Nigerian WVS wave 7 in 2018 [ 21 ]. The new module was further adapted and expanded with additional questions drawing on the Guttmacher-Lancet SRHR definition for the three countries in this study [ 19 ], which is why we did not include the Nigerian sample here.

The standard WVS questionnaire includes 14 items covering some aspects of SRHR, such as women’s role in society, subjective health status, empowerment, life satisfaction, as well as attitudes to, e.g., homosexuality, abortion, premarital sex, and divorce. In the new module, we added 44 measures of attitudes related to different domains of SRHR as per the Guttmacher-Lancet Commission definition, including child marriage, early childbearing, comprehensive sexuality education, contraceptive use, skilled birth attendance, gender-equitable relationships and gender norms, premarital sex, infertility, abortion, and sexual and gender minority rights. Supplementary Table A2 presents an overview of the complete 58-item battery and their response options. Most questions asked respondents to indicate their agreement with statements on a Likert-type response scale, such as “Please tell me if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with the following statements: A man should always have the final say about decisions in his relationship or marriage.” Some questions asked: “How frequently do the following things occur in your neighborhood – very frequently, quite frequently, not frequently, or not at all? Sexual assault/rape.” Finally, a third set of questions asked, “Please tell me for each of the following actions whether you think it can always be justified, never be justified, or something in between, using this card: Abortion.” The latter set of items was based on a 10-graded scale. Details on the development of the new SRHR module have been described elsewhere [ 19 , 21 ].

Beyond country, we also included five sociodemographic characteristics as covariates in the current analysis: age groups (18–24; 25–29; 30–39; 40–49; 50 +), sex (we use the terms male/men or female/women interchangeably), place of residence (urban; rural), highest educational level (primary or lower; secondary; tertiary), and relationship status (married or cohabiting; divorced, separated, or widowed; single).

Patient and public involvement in the study

We used deidentified secondary data publicly available on the WVS website. Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of our research.

Statistical analysis

We began with a descriptive analysis, which indicated that 25% of the full sample ( N  = 927) were missing responses for up to 46 items in the SRHR module. Non-response on these items varied by country, relationship status, and education, but not as much by age, sex, or place of residence. We excluded respondents with less than a 25% response rate on the SRHR items, i.e., those who did not respond to 14 or more of the total 58 items ( N  = 45, < 2% of the original WVS sample). Non-response rates on sociodemographic variables were low (< 3%) and deemed unproblematic for our analysis. The initial analytical sample thus included 3,666 respondents (Ethiopia n  = 1,223, Kenya n  = 1,228, Zimbabwe n  = 1,215).

While the survey items were developed using a deductive approach, to capture the comprehensive nature of the Guttmacher-Lancet definition of SRHR, we applied an inductive, data-driven approach to develop the actual index, rather than “forcing” items into specific domains. We did this by using Exploratory Factor Analysis (EFA) to identify the most parsimonious number of hypothetical dimensions that could explain covariation among the 58 included items. EFA is useful to identify the factor structure for a set of variables inductively, without constraining items to load on specific factors [ 22 ]. Bartlett’s test of sphericity and the Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy showed that EFA was feasible.

All items were coded so that higher values indicate more supportive attitudes towards SRHR. For example, responses to the statement “Sexual education helps people make informed decisions” with response options 1 = agree completely, 4 = disagree completely, were subsequently reverse coded so that higher scores represented greater agreement, and thus more support for SRHR interventions [ 2 ]. We did not reverse code negative statements where disagreement indicated more support for SRHR, such as “A man shouldn't have to do household chores”.

Drawing on previous studies [ 23 ] we did an initial assessment of how many factors to retain based on Polychoric correlations (given the Likert-type variables), principal component analysis (PCA), scree plots, and parallel analysis (PA). Then, iterated principal factors (IPF) with oblique rotation were used to determine the appropriate number of factors.

Criteria for determining factor adequacy were established a priori: parsimony was preferred over complex loadings that were salient on more than one factor. We retained factors with a minimum of three coefficients loading > 0.40, an item uniqueness of < 0.70, and that were conceptually meaningful according to the Guttmacher definition. We used Cronbach’s α to test the internal consistency between factor items, with ≥ 0.7 considered acceptable reliability [ 21 ].

We tested the resulting factor solution with retained items: for the full pooled sample, each of the three countries, and on subsamples disaggregated by the five sociodemographic characteristics.

We started the EFA with complete cases ( n  = 2,722) on 58 variables. Results from the initial PCA and scree plots (Supplementary Figure A1) suggested a 9-factor solution, but some factors did not fulfill the criteria. We thus reduced the number of factors and excluded irrelevant items iteratively, until a solution was reached that met all the criteria outlined above. By excluding some items, the number of complete cases increased ( n  = 3,135).

The factor items were combined into subindices by extracting latent scores from each factor using regression scoring. Mean scores for the subindices were combined with equal weighting into an overall index by adding the scores and then dividing it by the number of subindices. The overall index and subindex scores were standardized to a 100-graded scale for interpretability. Higher scores represented more agreement with the achievement of sexual and reproductive health and rights.

We further conducted a sensitivity analysis to assess the proposed factor solution using multiple imputations based on 10 samples with standardized scales to fill in missing data on the SRHR items [ 22 ].

Finally, we conducted multivariable linear regression models to assess the association between the index scores with sociodemographic characteristics. Both pooled and stratified models by country and sex were conducted. This final step served both to test the construct validity of the index as a potential source of bias and as an empirical evaluation of characteristics associated with support for SRHR in the study settings.

In the regression models, we included only complete cases on the retained index items and the five sociodemographic variables ( n  = 3,113 or 84% of the original WVS sample). The covariates included in the regression models are displayed in Table  1 . These sociodemographic characteristics did not differ notably from the original WVS sample (Supplementary Table A5). A sample flowchart is available in Supplementary Figure A3.

Factor analysis results

Results from the EFA suggested a 23-item, five-factor solution (Figure A2 in Supplementary Material, n  = 3,135). This solution was robust to using multiple imputation to fill missing data, using both PCA and maximum likelihood (ML) extractions, varimax and promax rotations, and excluding non-responses on SES variables. The solution performed well across the three countries, albeit with minor variations with some items having low loading (< 0.50) and high uniqueness (> 0.70) in each country. The factor solution was stable across countries, age, sex, education, residence, and relationship status (rotated factor loadings by country and sociodemographics are available upon request).

Table 2 shows the five identified factors, along with their respective rotated factor loadings, reflecting support for different aspects of SRHR. Supplementary Table A3 further displays loadings for each of the 23 variables across all five factors included in the SRHR Support Index. These factors correlated at less than 0.7, indicating low risk of multicollinearity (Supplementary Table A4).

The first factor , which we labeled “Sexual and Reproductive Rights”, included seven items measuring the justification of different rights related to one’s body, sexuality, sexual interactions, and intimate relationships (Cronbach’s α = 0.92). Three of these items are part of the previously validated “WVS Choice” subindex (abortion, divorce, and homosexuality) [ 24 ], which were now combined with an additional four items related to intimate partner violence, pre-marital sex, causal sex, and sex work. All the items in this factor share the same format; asking the extent to which the respondent believes a specific way of being or behaving can be justified on a 1–10 scale (higher values representing greater agreement), without contextualizing the behavior to a specific situation.

The second factor included four items tapping into the perceived exposure of women and girls to sexual harassment and violence by men and boys, as well as the perceived frequency of sexual assault/rape, and exchange of sex for money or goods, in the respondents’ neighborhood (Cronbach’s α = 0.86). These items all reflected women’s and girls’ freedom from, or risk of, sexual violence and exploitation within their local contexts [ 14 , 15 , 16 , 17 ]. We thus labeled this factor “Neighborhood Sexual Safety”.

The third factor was characterized by five items measuring perceptions related to male control and decision-making in relationships or marriage, gendered divisions of work in and outside the household, and power in intimate relationships (Cronbach’s α = 0.71). As these items all tap into the importance of ensuring gender equality in relationships as a domain of SRHR [ 2 ], we labeled it “Gender-Equitable Relationships”.

The fourth factor included three items drawn from the validated “Man Box scale” developed by Equimundo [ 25 ], capturing disagreement with masculinity norms promoting sexual prowess and violence, and that men should avoid talking about their feelings (Cronbach’s α = 0.65).Since all items were coded so that higher values indicated more support for SRHR, we labeled this factor “Equitable Masculinity Norms”.

Finally, the fifth factor, which we named “SRHR Interventions”, contained four items measuring perceptions related to different essential interventions for SRHR [ 2 ], including safe abortion services, contraception, infertility treatment, and sexuality education (Cronbach’s α = 0.57).

Next, we extracted each factor to scores resulting in five specific subindices, which were further combined into a full index. The resulting “SRHR Support Index” consisted of 23 items with an overall Cronbach’s α = 0.80, indicating high internal reliability. Factors 1–3 demonstrated good internal consistency, and while alpha scores were lower for Factors 4–5, they were deemed acceptable given their substantive relevance and contribution to overall reliability (which was lower without these factors) [ 22 ].

Figure  1 and Table  3 display the mean and median scores for the full SRHR Support Index and each subindex ranging from 0–100. Each item was coded in such a way that higher values reflect greater support for SRHR according to the Guttmacher-Lancet commission definition [ 2 ]). The mean value of the full Index was 39.2 (SD = 15.3) and the median was 36.2 (IQR = 28.9, 46.0), with no significant difference by sex. The lowest scores were found for respondents in Zimbabwe (mean = 32.6, SD = 13.8), followed by Ethiopia (mean = 40.4, SD = 13.6), and the highest in Kenya (mean = 45.5, SD = 13.6).

Histograms of the SRHR Support Index and its five subindices in Ethiopia, Kenya, and Zimbabwe ( n  = 3,135)

Turning to the subindices, the total mean score was highest for Equitable Masculinity Norms (subindex 4) at 66.0 (SD = 16.9) – indicating relatively high disagreement with stereotypical views on men’s dominance and power, followed by Neighborhood Sexual Safety (subindex 2), SRHR Interventions (subindex 5) at 57.3 (SD = 28.8), and Gender-Equitable Relationships (subindex 3) at 48.0 (SD = 18.2). The lowest overall support was found for Sexual and Reproductive Rights (subindex 1) with mean value 15.7 (SD = 23.6).

Like in the full Index, respondents in Ethiopia and Kenya scored higher on subindex 2, 3 and 5 than those in Zimbabwe. Kenyan respondents also scored higher on subindex 1 than those from other countries, indicating more support for sexual and reproductive rights in this context. There were no notable country differences for subindex 4, nor were there any significant differences in mean scores between men and women on any of the five subindices.

Sociodemographic characteristics associated with support for SRHR

Table 4 shows results from bivariate and adjusted linear regression models of sociodemographic characteristics and the SRHR Support Index.

In bivariate analysis (Models 1–5), the second to the youngest age group (25–29 years) was positively associated with more supportive attitudes towards SRHR (i.e., higher scores), whereas being aged 40 or above was associated with less support, compared to ages 30–39. Higher support for SRHR was also more common among respondents who were single, had higher education, residing in urban areas, compared to the reference groups. There were no significant differences by sex.

In the multivariable model (Model 6), the coefficients for urbanicity, education, and relationship status were attenuated compared to the bivariate models but remained statistically significant with SRHR Support and in the same direction. For age, only the oldest age group (50 + years) was associated with less support for SRHR compared to those aged 30–39 years.

Table 5 further displays adjusted regression findings by country (Models 7–9) and sex (Models 10–11). When stratifying by country, there were no statistically significant differences in SRHR Support Index scores by age, sex, or place of residence. The same patterns with regards to education level and being single were found for Kenya and Zimbabwe as for the total sample across countries, but these associations did not hold in Ethiopia.

The associations with age and place of residence noted above turned out to be driven by male respondents since no significant relationship was found among females for these variables. Both males and females scored higher on the Index if they had tertiary education and if they were single; these associations were stronger among female respondents.

We aimed to develop a comprehensive index to measure support for SRHR based on nationally representative data collected by WVS in three SSA countries, for which such information has previously been missing. We identified five subindices, reflecting support for: 1) Sexual and Reproductive Rights, 2) Neighborhood Sexual Safety, 3) Gender-Equitable Relationships, 4) Equitable Masculinity Norms, and 5) SRHR Interventions. These five subindices performed well across all three countries and sociodemographic subgroups and were combined into an overall 23-item SRHR Support Index.

Our proposed SRHR Support Index touches upon several aspects of SRHR as defined by the Guttmacher-Lancet framework, such as non-discrimination related to sexuality, sexual orientation and gender identity, reproductive empowerment, consensual and non-violent relationships, satisfying sexual life, gender-equitable relationships, and SRHR information [ 2 ]. As such, this Index covers broad aspects of the human rights of all individuals to freely decide on matters related to sexuality and reproduction.

An important contribution of our measure is that it draws on nationally representative samples of both women and men, of all ages and different relationship status, allowing for a more comprehensive understanding of variations in SRHR support. The only previous measure tapping into SRHR attitudes based on WVS data is the three-item Choice subindex [ 24 ], which in our study was included in the seven-item subindex “Sexual and Reproductive Rights” capturing the justification of additional SRHR aspects which can be morally, legally, and socially stigmatized or sensitive in many contexts. Since these seven items are included in the core WVS questionnaire, this subindex is readily available for comparative and trend analyses.

In addition, the subindex “Equitable Masculinity Norms” includes three of the 15 items from the Man Box Scale, previously validated in Australia, Mexico, and the United States, indicating that these items can be used in other global settings beyond SSA [ 25 ].

While the SRHR Support Index overlaps conceptually with existing indices and scales that capture attitudes towards specific dimensions of SRHR – such as gender equality and women’s empowerment (e.g., SWPER Index [ 23 ], Women and Girls Sexual and Reproductive Empowerment Index (WGE-SRH) [ 26 ], Women’s Agency Scale [ 27 ], the Gender-Equitable Men Scale [ 28 ], the G-NORM scale [ 29 ]) or fertility (e.g., the Fertility Norms Scale [ 30 ]) – its comprehensive approach can help to further improve the understanding and tracking of countries’ progress towards realizing SRHR for all. This Index can in particular be useful to understand and advance SRHR in light of global backlashes and resistance towards sexual and reproductive rights (e.g., abortion and the rights and freedoms of sexual minorities). By focusing on supportive attitudes, the Index or its sub-components can give an indication of developments toward a more favorable landscape for advancing SRHR based on the degree to which individuals and groups support different aspects.

In terms of sociodemographic variations, being single or highly educated was associated with more support for SRHR, except in Ethiopia. Similarly, analyses of global WVS data have found supportive attitudes towards homosexuality, divorce, and abortion (as captured via the Choice index) to be closely linked with higher education, postponed marriage, delayed childbearing, and reduced number of children [ 24 ]. While there were no overall differences by sex, younger age and urban residence were associated with more supportive attitudes among males, but not females. The fact that younger male respondents had more supportive attitudes towards SRHR may indicate a generational shift or life-course differences, particularly in urban settings also seen in another study from Kenya [ 31 ].

The limitations of the current study should also be considered. First, the index development was inductively driven by data, rather than deductively by the Guttmacher-Lancet framework. Consequently, some components of SRHR were covered to a lesser extent, for example, HIV/AIDS, antenatal care, satisfying sexual life, or sexual orientations besides homosexuality [ 2 ]. In addition, the analysis was restricted to available WVS data in Ethiopia, Kenya, and Zimbabwe, limiting the generalizability of findings within and outside of SSA where further validation is needed [ 32 ]. The robust performance of the Index across the three countries in the current study is nonetheless a key strength. Its association with several sociodemographic factors (e.g., sex, age, education, and relationship status), previously shown to drive attitudes towards gender and sexuality [ 15 , 21 , 33 , 34 ], further supports the validity of the measure. Since we first developed this index, 9 items from the SRHR module have been integrated into the core questionnaire of WVS wave 8, due to be rolled out in 2024-2025, allowing for global comparisons. Four of these are found in our sub-indices 4) Gender-Equitable Relationships and 5) SRHR Interventions. Finally, our ambition is to further validate the proposed Index and subindices in additional contexts, such as India (favorably, using confirmatory instead of exploratory factor analysis) as new data becomes available.

This study addresses two important gaps in the existing literature: the need for new comprehensive measurements of support for SRHR, and the widespread data gap on such perceptions in SSA. The comprehensive SRHR Support Index proposed in this paper has the potential to broaden research on the extent to which individuals and groups support SRHR, which is highly relevant given how SRHR are becoming increasingly contested worldwide. The index performed well across countries and sociodemographic subgroups, but further validation is needed to assess its applicability in different settings and populations. This could be done by integrating all items from the Index and its subindices into the standard WVS module (covering 100 + countries) as well as other global surveys, thereby providing a baseline against which to track development over time. Doing so would also allow for broadening research on the influence of attitudes and norms on related SRHR outcomes, by linking data on the perceptions of individuals and groups (e.g., from the WVS) with health, social, and development outcomes (e.g., from the DHS). As we approach 2030, robust measurements of support and resistance towards individuals’ rights to decide over their own bodies, sexuality, and reproduction is critical to track progress towards achieving SRHR for all as part of the SDGs. The SRHR Support Index offers a tool to further advance our understanding of attitudes and norms as barriers or facilitators to SRHR globally, thereby guiding the tailoring of interventions as well as policy.

Availability of data and materials

The data used in this study are publicly available from https://www.worldvaluessurvey.org/ . STATA do-files can be requested from the corresponding author.

Abbreviations

Demographic and Health Surveys

Exploratory Factor Analysis

The Global Early Adolescent Study

Human Immunodeficiency Virus

Iterated Principal Factors

Kaiser-Meyer-Olkin

Maximum Likelihood

Parallel Analysis

Principal Component Analysis

Standard Error

Standard Deviation

Sustainable Development Goals

Sexual and Reproductive Health and Rights

• Sub-Saharan Africa
• World Values Survey

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Acknowledgements

We thank the Bill & Melinda Gates Foundation and the Expert Group for Aid Studies for funding and the World Values Survey Program for collaborating on the data collection. We are grateful to Caroline Kabiru at the African Population and Health Research Center, Amy Alexander at Gothenburg University, Kristina Gemzell Danielsson at Karolinska Institutet, and Jonas Edlund at the Department of Sociology at Umeå University, for insightful comments on a previous version of the manuscript. We thank Zangin Zeebari at Karolinska Institutet for his methodological contributions. Finally, this study would not have been possible without all the data collectors who did the interviews to collect the data with all the participants.

Open access funding provided by Karolinska Institute. This work was supported by the Bill & Melinda Gates Foundation under Grant [number OPP1186559]; and the Expert Group for Aid Studies [no grant number]. The funders had no role in the study design, analysis, interpretation of data, writing the report, or the decision to submit.

Author information

Signe Svallfors and Karin Båge are joint first authors.

Authors and Affiliations

Department of Sociology, Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305-2047, USA

Signe Svallfors

Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden

Signe Svallfors, Karin Båge, Anna Mia Ekström, Elin C. Larsson, Helena Litorp, Olalekan A. Uthman & Anna E. Kågesten

Venhälsan, Department of Infectious Diseases, Södersjukhuset, Stockholm, 118 83, Sweden

Anna Mia Ekström

Department of Clinical Science and Education, Södersjukhuset, Stockholm, 118 83, Sweden

School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, P.O. Box 235, Ethiopia

Yadeta Dessie

African Population and Health Research Center, Nairobi, Kenya

Yohannes Dibaba Wado

Kantar Public, 376 Ikorodu Road, Lagos, Nigeria

Mariam Fagbemi

Yucca Consulting Limited, 16b Ogunsona Street, Lagos, Nigeria

Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, 17177, Sweden

Elin C. Larsson

Department of Women’s and Children’s Health, Uppsala University, Akademiska sjukhuset, Uppsala, 75185, Sweden

Helena Litorp

World Values Survey Association, Institute for Future Studies, Stockholm, 10131, Sweden

Bi Puranen & Jesper Sundewall

Social Medicine and Global Health, Lund University, Malmö, 214 28, Sweden

Jesper Sundewall

HEARD, University of KwaZulu-Natal, Durban, South Africa

Warwick Medical School, Warwick Centre for Global Health, University of Warwick, Coventry, UK

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SS and KB were joint first authors of the study, led the data management and analysis, and had a leading role in writing the first draft as well as editing further drafts. AK provided senior guidance and extensive edits throughout this process. KB, AK, AME, and BP led the initial conceptualization and study design including the development of the new WVS survey module. Together with JS and OU, they were also responsible for funding acquisition. AME and BI administered the project. MF was responsible for data collection. AK, KB, OU, and HL did initial analyses of the index development that informed the current work. MF, YD, and YDW provided contextual interpretations of the results and weighed in on conclusions. JS and EL provided critical SRHR-specific expertise and contributed to the writing of the manuscript. All authors approved the final version before publication.

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Correspondence to Karin Båge .

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As per the WVS regulations, no identifying data from the participants are collected, removing the requirement for a written consent form. However, all participants were requested to provide oral informed consent, witnessed by the interviewer. The research was conducted in compliance with the principles laid out in the Declaration of Helsinki. An in-depth explanation of the WVS data collection procedures to minimize bias as well as a full methodological report for each country can be retrieved from www.worldvaluessurvey.org .

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Svallfors, S., Båge, K., Ekström, A.M. et al. Support for sexual and reproductive health and rights in Sub-Saharan Africa: a new index based on World Values Survey data. Reprod Health 21 , 90 (2024). https://doi.org/10.1186/s12978-024-01820-2

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DOI : https://doi.org/10.1186/s12978-024-01820-2

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Access to the abortion drug mifepristone could soon be limited by the Supreme Court for the whole country. Here, a nurse practitioner works at an Illinois clinic that offers telehealth abortion. Jeff Roberson/AP hide caption

Abortion pills that patients got via telehealth and the mail are safe, study finds

February 15, 2024 • The study looks at 6,000 patients who got abortion pills after an online appointment. It found that 99.7% of those abortions were not followed by any serious adverse events.

The Supreme Court will hear the case against the abortion pill mifepristone on March 26. It's part of a two-drug regimen with misoprostol for abortions in the first 10 weeks of pregnancy. Anna Moneymaker/Getty Images hide caption

Research at the heart of a federal case against the abortion pill has been retracted

February 9, 2024 • A research paper that raises questions about the safety of abortion has been retracted. The research is cited in a federal judge's ruling about the abortion pill mifepristone.

The scene at the U.S. Supreme Court on the day it overturned Roe v. Wade in June 2022. Researchers estimate that 64,565 rape-caused pregnancies have occurred in states that banned abortion since then. Jacquelyn Martin/AP hide caption

Raped, pregnant and in an abortion ban state? Researchers gauge how often it happens

January 24, 2024 • Researchers estimate nearly 65,000 rape-caused pregnancies have happened in states with abortion bans in effect since Roe v. Wade was overturned. The report is in JAMA Internal Medicine .

A patient prepares to take the first of two combination pills, mifepristone, for a medication abortion during a visit to a clinic in Kansas City, Kan., on Oct. 12, 2022. Charlie Riedel/AP hide caption

Threats to abortion access drive demand for abortion pills, analysis suggests

January 2, 2024 • Requests for abortion pills from people who were not yet pregnant spiked when patients appeared to perceive threats to abortion access, new research has found.

Elizabeth Weller speaks at a press conference in Austin, Texas on July 19. She's one of 20 women suing the state after being denied abortions despite serious pregnancy complications. Suzanne Cordeiro/AFP via Getty Images hide caption

'Jane Roe' is anonymous no more. The very public fight against abortion bans in 2023

December 26, 2023 • As the first full year since Roe v. Wade was overturned closes, the abortion landscape in the U.S. has changed legally, politically and medically.

Center for Reproductive Rights attorney Molly Duane speaks before the Texas Supreme Court in Austin on Nov. 28. The court ruled in a different abortion case on Monday. Suzanne Cordeiro/AFP via Getty Images hide caption

5 things to know about the latest abortion case in Texas

December 13, 2023 • The case involves just one abortion, but it's likely to have wider implications in the state with some of the strictest abortion laws in the country.

Kate Cox and her husband were expecting their third child when they got a devastating fetal diagnosis last week. She is also having problems threatening her own health. A judge said Thursday she has permission to end her pregnancy. Cox family hide caption

Texas judge grants permission for woman's abortion

December 6, 2023 • A woman who is pregnant and seeking an abortion in Texas has been granted permission to have the procedure by a state judge. The fetus has a condition that is almost always fatal.

When the Center for Reproductive Rights first announced the lawsuit against Texas in March, there were five patient plaintiffs. Now there are 20. Sarah McCammon/NPR hide caption

Texas abortion case heard before state's highest court, as more women join lawsuit

November 28, 2023 • Dr. Dani Mathisen is one of 20 patients who say abortion bans in Texas harmed them during complicated pregnancies. Attorneys in the lawsuit will argue before the Texas Supreme Court Tuesday.

A #RestoreRoe rally outside Michigan's capitol in Lansing in Sept. 2022. Voters overwhelmingly approved enshrining abortion rights in the state constitution later that year. JEFF KOWALSKY/AFP via Getty Images hide caption

In Michigan, #RestoreRoe abortion rights movement hits its limit in the legislature

Michigan public.

November 8, 2023 • Last year, Michigan voters put the right to abortion in the state constitution. This year, the state legislature kept a 24-hour waiting period and said Medicaid can't pay for the procedure.

A poll worker has an "Ohio Voted" sticker on her shirt during early in-person voting at the Hamilton County Board of Elections in Cincinnati on Oct. 11. Ohio has a constitutional amendment before voters this year that would include reproductive health protections in the state's constitution, including abortion rights. Carolyn Kaster/AP hide caption

Abortion is on the ballot in Ohio. The results could signal what's ahead for 2024

October 31, 2023 • If approved by voters on Nov. 7, 'Issue 1' would amend Ohio's state constitution to include protections for reproductive health decisions, laying the groundwork for similar measures next year.

Anti-abortion demonstrators gather outside Planned Parenthood's Water Street Health Center in Milwaukee on Monday, Sept. 2023. Planned Parenthood of Wisconsin began offering abortions at the clinic that day after not doing so for more than a year. Margaret Faust/ WPR hide caption

Abortions resume in Wisconsin after 15 months of legal uncertainty

September 21, 2023 • After Roe v. Wade was overturned, a law still on the books from 1849 left the legality of abortions in dispute in the state. This week, Planned Parenthood resumes services.

Demonstrators rally to mark the first anniversary of the US Supreme Court ruling in the Dobbs v Women's Health Organization case in Washington, DC on June 24, 2023. ANDREW CABALLERO-REYNOLDS/AFP via Getty Images hide caption

Abortion access could continue to change in year 2 after the overturn of Roe v. Wade

July 3, 2023 • It's already harder to get an abortion in many places and access is likely to be limited more with the passage of new laws.

Demonstrators protest about abortion outside the Supreme Court in Washington, June 24, 2022. In the year since, approximately 22 million women, girls and other people of reproductive age now live in states where abortion access is heavily restricted or totally inaccessible. Jacquelyn Martin/AP hide caption

A year after Dobbs and the end of Roe v. Wade, there's chaos and confusion

June 24, 2023 • With states empowered to regulate abortion, doctors say they're trapped by vague laws that criminalize care. And ongoing court battles make it hard to keep up with the procedure's legal status.

10 Essential Essays About Women’s Reproductive Rights

“Reproductive rights” let a person decide whether they want to have children, use contraception, or terminate a pregnancy. Reproductive rights also include access to sex education and reproductive health services. Throughout history, the reproductive rights of women in particular have been restricted. Girls and women today still face significant challenges. In places that have seen reproductive rights expand, protections are rolling back. Here are ten essential essays about reproductive rights:

“Our Bodies, Ourselves: Reproductive Rights”

bell hooks Published in Feminism Is For Everyone (2014)

This essay opens strong: when the modern feminism movement started, the most important issues were the ones linked to highly-educated and privileged white women. The sexual revolution led the way, with “free love” as shorthand for having as much sex as someone wanted with whoever they wanted. This naturally led to the issue of unwanted pregnancies. Birth control and abortions were needed.

Sexual freedom isn’t possible without access to safe, effective birth control and the right to safe, legal abortion. However, other reproductive rights like prenatal care and sex education were not as promoted due to class bias. Including these other rights more prominently might have, in hooks’ words, “galvanized the masses.” The right to abortion in particular drew the focus of mass media. Including other reproductive issues would mean a full reckoning about gender and women’s bodies. The media wasn’t (and arguably still isn’t) ready for that.

“Racism, Birth Control, and Reproductive Rights”

Angela Davis Published in Women, Race, & Class (1981)

Davis’ essay covers the birth control movement in detail, including its race-based history. Davis argues that birth control always included racism due to the belief that poor women (specifically poor Black and immigrant women) had a “moral obligation” to birth fewer children. Race was also part of the movement from the beginning because only wealthy white women could achieve the goals (like more economic and political freedom) driving access to birth control.

In light of this history, Davis emphasizes that the fight for reproductive freedom hasn’t led to equal victories. In fact, the movements driving the gains women achieved actively neglected racial inequality. One clear example is how reproductive rights groups ignored forced sterilization within communities of color. Davis ends her essay with a call to end sterilization abuse.

“Reproductive Justice, Not Just Rights”

Dorothy Roberts Published in Dissent Magazine (2015)

Dorothy Roberts, author of Killing the Black Body and Fatal Invention , describes attending the March for Women’s Lives. She was especially happy to be there because co-sponsor SisterSong (a collective founded by 16 organizations led by women of color) shifted the focus from “choice” to “social justice.” Why does this matter? Roberts argues that the rhetoric of “choice” favors women who have options that aren’t available to low-income women, especially women of color. Conservatives face criticism for their stance on reproductive rights, but liberals also cause harm when they frame birth control as the solution to global “overpopulation” or lean on fetal anomalies as an argument for abortion choice.

Instead of “the right to choose,” a reproductive justice framework is necessary. This requires a living wage, universal healthcare, and prison abolition. Reproductive justice goes beyond the current pro-choice/anti-choice rhetoric that still favors the privileged.

“The Color of Choice: White Supremacy and Reproductive Justice”

Loretta J. Ross, SisterSong Published in Color of Violence: The INCITE! Anthology (2016)

White supremacy in the United States has always created different outcomes for its ethnic populations. The method? Population control. Ross points out that even a glance at reproductive politics in the headlines makes it clear that some women are encouraged to have more children while others are discouraged. Ross defines “reproductive justice,” which goes beyond the concept of “rights.” Reproductive justice is when reproductive rights are “embedded in a human rights and social justice framework.”

In the essay, Ross explores topics like white supremacy and population control on both the right and left sides of politics. She acknowledges that while the right is often blunter in restricting women of color and their fertility, white supremacy is embedded in both political aisles. The essay closes with a section on mobilizing for reproductive justice, describing SisterSong (where Ross is a founding member) and the March for Women’s Lives in 2004.

“Abortion Care Is Not Just For Cis Women”

Sachiko Ragosta Published in Ms. Magazine (2021)

Cisgender women are the focus of abortion and reproductive health services even though nonbinary and trans people access these services all the time. In their essay, Ragosta describes the criticism Ibis Reproductive Health received when it used the term “pregnant people.” The term alienates women, the critics said, but acting as if only cis women need reproductive care is simply inaccurate. As Ragosta writes, no one is denying that cis women experience pregnancy. The reaction to more inclusive language around pregnancy and abortion reveals a clear bias against trans people.

Normalizing terms like “pregnant people” help spaces become more inclusive, whether it’s in research, medical offices, or in day-to-day life. Inclusiveness leads to better health outcomes, which is essential considering the barriers nonbinary and gender-expansive people face in general and sexual/reproductive care.

“We Cannot Leave Black Women, Trans People, and Gender Expansive People Behind: Why We Need Reproductive Justice”

Karla Mendez Published in Black Women Radicals

Mendez, a freelance writer and (and the time of the essay’s publication) a student studying Interdisciplinary Studies, Political Science, and Women’s and Gender Studies, responds to the Texas abortion ban. Terms like “reproductive rights” and “abortion rights” are part of the mainstream white feminist movement, but the benefits of birth control and abortions are not equal. Also, as the Texas ban shows, these benefits are not secure. In the face of this reality, it’s essential to center Black people of all genders.

In her essay, Mendez describes recent restrictive legislation and the failure of the reproductive rights movement to address anti-Blackness, transphobia, food insecurity, and more. Groups like SisterSong have led the way on reproductive justice. As reproductive rights are eroded in the United States, the reproductive rights movement needs to focus on justice.

“Gee’s Bend: A Reproductive Justice Quilt Story From the South”

Mary Lee Bendolph Published in Radical Reproductive Justice (2017)

One of Mary Lee Bendolph’s quilt designs appears as the cover of Radical Reproductive Justice. She was one of the most important strip quilters associated with Gee’s Bend, Alabama. During the Civil Rights era, the 700 residents of Gee’s Bend were isolated and found it hard to vote or gain educational and economic power outside the village. Bendolph’s work didn’t become well-known outside her town until the mid-1990s.

Through an interview by the Souls Grown Foundation, we learn that Bendolph didn’t receive any sex education as a girl. When she became pregnant in sixth grade, she had to stop attending school. “They say it was against the law for a lady to go to school and be pregnant,” she said, because it would influence the other kids. “Soon as you have a baby, you couldn’t never go to school again.”

“Underground Activists in Brazil Fight for Women’s Reproductive Rights”

Alejandra Marks Published in The North American Congress on Latin America (2021)

While short, this essay provides a good introduction to abortion activism in Brazil, where abortion is legal only in the case of rape, fetal anencephaly, or when a woman’s life is at risk. The reader meets “Taís,” a single mother faced with an unwanted pregnancy. With no legal options, she researched methods online, including teas and pills. She eventually connected with a lawyer and activist who walked her through using Cytotec, a medication she got online. The activist stayed on the phone while Taís completed her abortion at home.

For decades, Latin American activists have helped pregnant people get abortion medications while wealthy Brazilians enter private clinics or travel to other countries. Government intimidation makes activism risky, but the stakes are high. Hundreds of Brazilians die each year from dangerous abortion methods. In the past decade, religious conservatives in Congress have blocked even mild reform. Even if a new president is elected, Brazil’s abortion rights movement will fight an uphill battle.

“The Ambivalent Activist”

Lauren Groff Published in Fight of the Century: Writers Reflect on 100 years of Landmark ACLU Cases (2020)

Before Roe v. Wade, abortion regulation around the country was spotty. 37 states still had near-bans on the procedure while only four states had repealed anti-abortion laws completely. In her essay, Groff summarizes the case in accessible, engaging prose. The “Jane Roe” of the case was Norma McCorvey. When she got pregnant, she’d already had two children, one of whom she’d given up for adoption. McCorvey couldn’t access an abortion provider because the pregnancy didn’t endanger her life. She eventually connected with two attorneys: Sarah Weddington and Linda Coffee. In 1973 on January 2, the Supreme Court ruled 7-2 that abortion was a fundamental right.

Norma McCorvey was a complicated woman. She later became an anti-choice activist (in an interview released after her death, she said Evangelical anti-choice groups paid her to switch her position), but as Groff writes, McCorvey had once been proud that it was her case that gave women bodily autonomy.

“The Abortion I Didn’t Want”

Caitlin McDonnell Published in Salon (2015) and Choice Words: Writers on Abortion (2020)

While talking about abortion is less demonized than in the past, it’s still fairly unusual to hear directly from people who’ve experienced it. It’s certainly unusual to hear more complicated stories. Caitlin McDonnell, a poet and teacher from Brooklyn, shares her experience. In clear, raw prose, this piece brings home what can be an abstract “issue” for people who haven’t experienced it or been close to someone who has.

In debates about abortion rights, those who carry the physical and emotional effects are often neglected. Their complicated feelings are weaponized to serve agendas or make judgments about others. It’s important to read essays like McDonnell’s and hear stories as nuanced and multi-faceted as humans themselves.

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About the author, emmaline soken-huberty.

Emmaline Soken-Huberty is a freelance writer based in Portland, Oregon. She started to become interested in human rights while attending college, eventually getting a concentration in human rights and humanitarianism. LGBTQ+ rights, women’s rights, and climate change are of special concern to her. In her spare time, she can be found reading or enjoying Oregon’s natural beauty with her husband and dog.

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REPRODUCTIVE RIGHTS OF THE INDIAN WOMEN: AN ANALYSIS

• September 2021
• In book: Women’s Rights are Human Rights: Role of Non-State Actors (pp.23-34)
• Publisher: Patna Women's College Publications

• Patna Women’s College

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• DOI: 10.1001/jama.2024.12085
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The association between reproductive rights and access to abortion services and mental health among US women

Sze yan liu.

a Department of Public Health, Montclair State University, Normal Avenue, Montclair, NJ, 07043, USA

Claire Benny

b Department of Epidemiology, University of Alberta, Edmonton, Canada

Erin Grinshteyn

c School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA

Amy Ehntholt

d NYS Office of Mental Health, New York State Psychiatric Institute, New York, NY, USA

Daniel Cook

e School of Public Health, University of Nevada Reno, Reno, NV, USA

Roman Pabayo

Associated data.

The data is publicly available. We have shared a link to the publicly available data in our paper.

This study examines whether living in US states with (1) restrictive reproductive rights and (2) restrictive abortion laws is associated with frequent mental health distress among women.

We operationalize reproductive rights using an overall state-level measure of reproductive rights as well as a state-level measure of restrictive abortion laws. We merged data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) with these state-level exposure variables and other state-level information. We used multilevel logistic regression to assess the relationship between these two measures and the likelihood of reporting 14 or more days of frequent mental health distress. We also tested whether associations differed across race, household income, education, and marital status.

In the adjusted models, a standard deviation-unit increase in the reproductive rights score was significantly associated with decreased odds of reporting frequent mental health distress (OR = 0.95, 95% CI = 0.91, 0.99). Women in states with very hostile abortion restrictions had higher odds of frequent mental health distress. Associations between state-level abortion restrictions were larger among women 25–34 years old and women with a high school degree. For example, women aged 25–34 years residing in moderate (OR = 1.54, 95% CI = 1.14, 2.04), hostile (OR = 1.59, 95% CI = 1.15, 2.18), and very hostile (OR = 1.29, 95% CI = 1.02, 1.64) states were more likely to report frequent mental health distress than women living in states with less restrictive abortion policies.

We found the association between state-level restrictions on reproductive rights and abortion access and frequent mental health distress differed by age and socioeconomic status. These results suggest abortion rights restrictions may contribute to mental health inequities among women.

• • State-lelve measures of reproductive rights and abortion access are associated with frequent mental health distress among women in the US.
• • The strongest associations were noted among women aged 25-34 and women who were HS graduates.
• • Policies restricting reproductive rights may impact the mental health of women in the general US population.

1. Introduction

The United States Supreme Court overturned the 1973 Roe v. Wade decision in July 2022, removing the constitutional right to first-trimester abortion in the US. As a result, states now have the legal authority to implement partial or outright bans on abortions, leading to large geographical variability in reproductive care accessibility. Even before Roe was overturned, states varied significantly in policies about reproductive access and women's reproductive autonomy ( Bentele et al., 2018 ).

State laws and regulations on reproduction may impede pregnant people's ability to obtain care and, in turn, affect health. An emerging body of research has found significant associations between living in restrictive reproductive states and poor maternal and infant health ( Fuentes et al., 2016 ; Gerdts et al., 2016 ; Roberts et al., 2015 ). For example, babies born in states with restrictive reproductive rights have increased odds of low birthweight, pre-term birth, and higher mortality risk ( Pabayo et al., 2020 ; Sudhinaraset et al., 2020 ; Wallace et al., 2017 ). In addition, states with restrictive reproductive rights have higher maternal mortality rates ( Addante et al., 2021 ) and higher infant mortality rates ( Krieger et al., 2015 ).

While this body of research on state-level reproductive restrictions on maternal and infant adverse outcomes is compelling, it is important to extend this research to examine the potential effects among all women. The adverse effects of living in states with restrictive reproductive rights may not be restricted to only pregnant people. The freedom to decide if, when, and how often to reproduce is necessary for women's optimal health ( Ross & Solinger, 2017 ). Barriers to accessing comprehensive reproductive healthcare created by restrictive policies will likely increase psychosocial stress and contribute to frequent mental health distress, independent of a person's pregnancy status. For example, a World Health Organization (WHO) report summarized evidence that certain contraceptive methods may be associated with higher psychological distress leading them to argue that government policies that restricts women's contraceptive options may be an upstream determinant of mental health ( WHO, 2009 ). Studies specifically focusing on abortion found that women who were denied an abortion had elevated anxiety and loss of self-esteem in the short-term ( Biggs et al., 2017 ; Foster, 2020 ).

As a social determinant of health, laws and policies can potentially have positive or negative health effects ( Mishori, 2019 ). The sexual and reproductive justice framework (SRJ) provides an overarching framework that can be applied to investigate the role of restrictive reproductive legislation in our society. SRJ emphasizes that women should have 1) the right to decide if and when to have a baby and the conditions under which to give birth, 2) the right to decide not to have a baby and the options for preventing or ending a pregnancy, and 3) the right to parent existing children with the necessary social supports in safe environments and healthy communities ( Ross & Solinger, 2017 ). The SRJ framework acknowledges that legislation directly influences larger, contextual factors, which shape our sexual health options and, by extension, our overall health.

In addition, the SRJ framework recognizes reproductive policies as a broad category that extends beyond laws that limit abortion access. Restrictive reproductive policies that may potentially impact health include restrictions on sexual education and Medicaid coverage of family planning services because they affect larger issues of bodily autonomy. In addition, SRJ acknowledges that reproductive policies are often inequitable and disproportionately affect specific groups. Previous research has supported this SRJ presumption with research finding that restrictions on reproductive rights disproportionately burden low-income women and women of color ( Goyal et al., 2020 ; Redd et al., 2021 ). In addition, women's knowledge of reproductive restrictions differed by marital status ( Lara, Holt, Peña, & Grossman, 2015 ; Gallo et al., 2021 ) which suggests the effect of reproductive restrictions on behavior and health may also differ by marital status.

Using the SRJ framework to guide our research, this study uses state-level variation in policy to examine the following two questions: 1) Do women living in states with highly restricted reproductive rights have higher odds of frequent mental health distress compared with women living in states with less restricted reproductive rights, and 2) Do women living in states with prohibitive abortion policies have higher odds of frequent mental health distress compared with those in states that are less prohibitive. We hypothesize all women living in states with highly restrictive reproductive rights will have worse mental health distress compared with those living in less restrictive states. Similarly, we theorize all women living in states with greater prohibitive abortion policies will have worse mental health distress compared with those living in less restrictive states. State-level reproductive policies are likely to have a direct effect on the mental health of reproductive age women and indirect effects on the mental health of women who are not of reproductive age. We also examine whether associations differ by marital status, race/ethnicity, income, and education, as restrictions on reproductive rights are known to disproportionately burden women of color and those from lower socioeconomic backgrounds ( Goyal et al., 2020 ; Redd et al., 2021 ).

We used data collected and made available by the Centers for Disease Control and Prevention (CDC) in the 2018 Behavioral Risk Factor Surveillance System (BRFSS) Study. BRFSS is a cross-sectional telephone survey administered annually since 1984. The study population includes non-institutionalized individuals aged 18 and older with access to a landline or cellular telephone. CDC aggregates the BRFSS surveys collected from all fifty states and the District of Columbia to produce an annual dataset. BRFSS participants answer questions about their self-reported health behaviors, health conditions, and use of preventive health services ( CDC, 2019 ). BRFSS data are commonly used by local, state, and federal governments as well as academic researchers to assess the prevalence of health conditions and health care use in the US adult population. BRFSS data is publicly available online ( CDC, 2019 ). We restricted our sample to participants whose biological sex was female from the 2018 BRFSS Study with complete information on the outcome and on individual-level potential confounders.

We merged our state-level exposure variables described below with the 2018 BRFSS survey data using the state of residence. All analyses were conducted on the newly created dataset that contains the merged survey data and the state-level exposure variables described in detail below.

2.1. Exposures

We operationalize reproductive access using an overall state-level measure of reproductive rights and a state-level measure specifically for access to abortion services. Our two state-level exposures of interest were an overall measure of reproductive rights and a more specific state-level measure of access to abortion services in 2017–2018. Both of these measures were created from data compiled by the Guttmacher Institute. Guttmacher Institute states that it, in turn, compiled these state indicators from data provided by the CDC, Guttmacher Institute, NARAL Pro-Choice America, and the National Center for Lesbian Rights. More information on these specific laws used to create our exposure measure is available on the Guttmacher Institute website ( Guttmacher Institute, 2018 ). More details about both of these exposures are included in the Appendix Table A .

The overall measure of state-level reproductive rights score is a composite index based on nine indicators and developed by the Institute for Women's Policy Research (IWPR): mandatory parental consent or notification laws for minors receiving abortions; waiting periods for abortions; restrictions on public funding for abortions; percent of women living in counties with at least one abortion provider; pro-choice governors or legislators; Medicaid expansion or state Medicaid family planning eligibility expenses; coverage of infertility treatments; same-sex marriage or second-parent adoption for individuals in a same-sex relationship; and mandatory sex education ( Hess et al., 2015 ). Each indicator reflects a specific gender-related aspect of reproduction, contributing to the face validity of the IWPR index as a reproductive rights measure. The IWPR composite index has been used in a previous study to measure the association between state-level reproductive rights and maternal and infant health outcomes ( Sudhinaraset et al., 2020 ).

Our study assigned a score of 0 or 1 to each indicator. The IWPR index score is a tally of the indicators. A higher score on this index indicates greater reproductive access. IWPR was Z-standardized to account for variations in enacted restrictive abortion policies between states and improved the interpretation of the measure. We interpret the parameter estimates as a change given one standard deviation's (SD) increase in a state's reproductive access.

For our second primary exposure, we determined access to abortion services for each US state based on the presence of restrictive state laws and policies reported by the Guttmacher Institute ( Guttmacher Institute, 2018 ). We coded policies using a binary 0/1 coding scheme to indicate if a restrictive policy was in effect in a given state. Laws included physician and hospital requirements, such as the requirement for an abortion by a licensed physician, the presence of a second physician, or whether abortion was required to be performed in a hospital. Forty-three states have gestational limits prohibiting abortions after a specified point in pregnancy. In addition, the prohibition of using state funds when federal funds are available has been enacted in 33 states and the District of Columbia. Twelve US states restrict coverage of abortion in private insurance plans. Forty-five states allow individual healthcare providers to refuse to participate in abortion services. Seventeen states have state-mandated counseling, during which pregnant individuals may be informed of a purported link between abortion and breast cancer, the ability of a fetus to feel pain, and long-term mental health consequences for the patient. Waiting period laws require a person seeking an abortion to wait a specified time period, such as 24 h, between receiving counseling and undergoing the procedure. Parental involvement laws vary across states but typically require the consent or notification of one or both parents 24–48 h in advance though some states allow grandparents or other relatives to substitute for parents. We summed the indicators to compute a total composite index for each state, reflecting the cumulative impact of multiple abortion restrictions. We categorized the composite index as supportive, moderate, hostile, or very hostile. We considered a state supportive of abortion rights if it had none or one of the above restrictions, a moderate state if it had 2–3 restrictions, a hostile state if it had 4–5, and a very hostile state if it had 6–10 restrictions.

2.2. Outcome

Our main outcome was frequent mental health distress. BRFSS asks respondents “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” This question is part of the CDC Health-Related Quality of Life (CDC HRQOL– 4). Those who reported 14+ days when mental health was not good were categorized as having frequent mental health distress and those who reported 13 or fewer days were categorized as not having frequent mental health distress. This 14-day cut-off for frequent mental distress is widely accepted as the cutoff to identify individuals who experienced frequent mental health distress in the previous month ( CDC, 1998 ; CDC, 2004 ; Dwyer-Lindgren et al., 2017 ; Quinn et al., 2023 ). Participants who said they did not know, were unsure, refused, or had a missing response were excluded from the investigation. This measure has shown acceptable test-retest relatability and strong internal validity in several populations, languages, and settings ( Moriarty et al., 2003 ).

2.3. Individual-level covariates

Individual-level potential confounders from BRFSS include age (categorical variable in ten year groups from 18 to 64 with 65 and over as the reference group), education (less than high school, high school, some college, and college graduate or more (reference group)), race and ethnicity (White non-Hispanic (reference group), Black non-Hispanic, Hispanic, Asian non-Hispanic, Native non-Hispanic, Other non-Hispanic), and marital status (single versus married/coupled (reference group)). We used tertile cut-offs to categorize total annual household income into low (less than $35,000), medium ($35,000 to $75,000), and high (greater than $75,000 (reference group)).

2.4. Area-level covariates

The number of reproductive restrictions ranged from one to four. Our fully adjusted models included the following potential state-level confounders – region, Gini coefficient, median household income, proportion Black, proportion poor, and total state population. Previous studies have used these state-level confounders to examine the association between reproductive policies and individual-level birth and maternal outcomes ( Addante et al., 2021 ; Sudhinaraset et al., 2020 ). All state-level potential confounders’ information was from the US Census. We coded the region variable using the standard Census regional categories. In our analyses, we chose New England as the reference group for the Census regional variable because the New England region was a priori generally believed to have fewer restrictive reproductive policies than other regions. The other state-level characteristics were measured as continuous variables. We applied a z-transformation to the continuously measured state-level variables to account for their skewed distributions.

2.5. Statistical analyses

We used multilevel logistic regression to assess the relationship between reproductive rights and access to abortion services with the likelihood of reporting 14 or more days of frequent mental health distress. Multilevel models account for the clustering of BRFSS respondents within states and the District of Columbia. We adopted a series of models for this investigation. First, we estimated a state-level intercept-only model, which allowed for calculating the overall predicted probability and the plausible value range. This range is similar to the intraclass correlation coefficient (ICC), enabling us to calculate the degree of variability of the proportion of respondents reporting frequent mental health distress across states. For example, the range presents the proportions of women reporting 14 or more days of frequent mental health distress across US states in the previous 30 days. Second, we added state-level and individual-level covariates to the models ( Table 2 , Table 3 ). Third, we tested exposure and age, race, household income, education, and marital status in cross-level interaction terms to determine whether associations were heterogeneous across socio-demographic groups ( Fig. 1 ). For all models, to obtain estimates generalizable to the US general population, 2018 BRFSS sampling weights were used. Analyses were conducted using Stata v. 14.0. Ethical approval was obtained from the Institutional Review Board of the University of Alberta (Ref: Pro00123816).

The relationship between state-level reproductive rights score and odds for frequent mental health distress, 2018 BRFSS a .

The relationship between state-level abortion restriction measure and odds for frequent mental health distress, 2018 BRFSS a .

OR interaction terms and 95% CI for state-level abortion rights categorical score and sociodemographic characteristics.

The analytic dataset included 235,016 women from 50 states and the District of Columbia who responded to the 2018 BRFSS. We excluded participants with missing data on the number of days with mental distress and any covariates, resulting in a case-complete dataset of 185,825 women (79.1%). Participants who were missing data were less likely to be from households with medium household incomes ($35,000 to $75,000 (OR = 0.60, 95% = 0.49,0.74)), and high household incomes (greater than $75,000 (OR = 0.47,95% CI = 0.34,0.62)), compared with those from households with low household incomes (less than $35,000). Participants with missing data were less likely to be Non-Hispanic Black (OR = 0.72, 95% CI = 0.57,0.92) or Hispanic (OR = 0.61, 95% CI: 0.45, 0.81). Participants with missing data were likelier to have less than a high school education (OR = 2.10, 95% CI: 1.51,2.91) or a high school diploma (OR = 1.50, 95% CI:1.09, 2.08).

Table 1 summarizes sample characteristics and gives weighted percentages of the respondents with complete data. A majority of the women were White non-Hispanic (64.3%), followed by Hispanic (15.2%) and Black non-Hispanic (12.6%). Approximately 15% of females in our analytical sample reported frequent mental health distress. The number of state-level abortion restrictions ranged from one to four. The reproductive rights score ranged from 0.23 to 6.28 before it was transformed into a Z-score (Appendix Table 2 ).

Characteristics of US women participating in the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 185,825) and US states (50 states and the District of Columbia).

The intercept-only model indicated that the overall predicted probability of having frequent mental health distress in the past month was 15.3% (results not shown). Also, it confirmed the presence of significant variability in the percentage of women having frequent mental health distress in the past month. For example, the overall predictive probability of reporting frequent mental health distress in the previous month was 11.3%–20.4% across US states.

Table 2 reports the association between the state-level reproductive rights score and the likelihood of reporting frequent mental health distress. In the unadjusted model, no association was observed between the reproductive rights score and the likelihood of reporting frequent mental health distress in the previous month (OR = 0.98, 95% CI = 0.95, 1.02). After adjusting for individual-level and area-level confounders, an SD-unit increase in the reproductive rights score was significantly associated with decreased odds of reporting frequent mental health distress (OR = 0.95, 95% CI = 0.91, 0.99).

As shown in Tables 2 and in the fully adjusted model the East North Central region was associated with lower odds of reporting frequent mental health distress (OR = 0.81, 95% CI = 0.68, 0.97). Women in all age categories less than 65 had higher odds of frequent mental health distress compared to those 65 and older (e.g., 18–24 years vs. ≥65 (OR = 3.37, 95% CI = 3.01, 3.77). Women with less than a college degree had higher odds of frequent mental health distress compared with those who had a college degree (ex. Less than HS vs. College OR = 1.79, 95% CI = 1.59, 2.01). Black, Hispanic, and Asian individuals had lower odds of frequent mental health distress compared with White individuals (Black NH vs. White NH OR = 0.65, 95% CI = 0.59, 0.72; Hispanic vs. White NH OR = 0.54, 95% CI = 0.48, 0.61; Asian NH vs. White NH OR = 0.49, 95% CI = 0.37, 0.62). However, women who identified as Other race category had higher odds of frequent mental health distress compared to White NH women (OR = 1.32, 95% CI = 1.15, 1.52). Participants who reported an annual household income of less than $75,000 vs. $75,000 also had higher odds of frequent mental health distress (Less than 35K vs. greater than $75K OR = 2.54, 95% CI = 2.32, 2.77; 3k-75K vs. greater than $75K OR = 1.55, 95% CI = 1.55, 95% CI = 1.42, 1.69). Finally, being single vs. being married/coupled had higher odds of frequent mental health distress (OR = 1.40, 95% CI = 1.31, 1.49). In a series of sub-analyses, we added interaction terms between key sociodemographic characteristics that had been decided a priori to our models that adjusted for potential individual- and state-level confounders. However, none of the interaction terms in the fully adjusted models were statistically significant (results not shown), indicating that the association between the state-level reproductive rights score and odds of frequent mental health distress did not differ across race, age, marital status, household income, or educational status of the female participants.

Table 3 shows the associations between abortion restrictions at the state level and the likelihood of reporting frequent mental health distress among women. Crude analyses indicated that women who lived in states hostile (OR = 1.29, 95% CI = 1.11, 1.50) or very hostile (OR = 1.23, 95% CI = 1.12, 1.36) to abortion access were more likely to report frequent mental health distress than were women who lived in states that were supportive of abortion access. When controlling for individual-level and state-level characteristics, compared with those who lived in states that were supportive of abortion access, those residing in moderate (OR = 1.13, 95% CI = 1.03, 1.25) or very hostile (OR = 1.14, 95% CI = 1.01, 1.29) states were more likely to report frequent mental health distress.

Table 3 also indicates other sociodemographic characteristics were associated with frequent mental distress. Individual-level characteristics associated with higher odds of frequent mental health distress included younger age groups compared with those 65 and older (e.g., Ages 18 to 24 vs. ≥ 64 OR = 3.37, 95% CI = 2.98, 3.80); those with self-reported income less than $75,000 compared with $75,000 (e.g., Less than 35K vs. vs. ≥ 75K OR = 2.54, 95% CI = 2.18, 2.95); being single vs. married/couples (OR = 1.40, 95% CI = 1.31, 1.50); and having less than college degree vs. college degree (e.g., Less than high school vs. Completed College OR = 1.79, 95% CI = 1.61, 1.99). Women who identified as Other race also had increased odds of frequent mental health distress (OR = 1.32,95% CI = 1.13, 1.54). Characteristics associated with lower odds of frequent mental health distress included living in the East North Central vs. New England (OR = 0.83, 95% CI = 0.71, 0.97) and living in the Mountain region vs. New England (OR = 0.89, 95% CI = 0.79, 0.99). Black, Asian, and Hispanic women also had lower odds of frequent mental health distress status compared with their White counterparts (Black NH vs. White NH OR = 0.65, 95% CI = 0.58, 0.73; Hispanic vs. White NH OR = 0.54, 95% CI = 0.47, 0.63; Asian NH vs. White NH OR = 0.49, 95% CI = 0.43, 0.56).

Fig. 1 shows the interaction term between sociodemographic variables in the association between state-level abortion access and mental health across sociodemographic groups. Fig. 1 A summarizes the interaction terms between state-level abortion access and specific age categories. We found no statistical association between abortion restrictions and frequent mental health distress among women aged 18 to 24 or older than 55 years. However, among women aged 25–34 years, compared with those living in states supportive of access to abortion, those residing in moderate (OR = 1.54, 95% CI = 1.14, 2.04), hostile (OR = 1.59, 95% CI = 1.15, 2.18), or very hostile states (OR = 1.29, 95% CI = 1.02, 1.64) were more likely to report frequent mental health distress. Among women aged 35–44 years (OR = 1.47, 95% CI = 1.15, 2.18), only those living in states very hostile to abortion access were significantly more likely to report frequent mental health distress. Among women aged 45–54 years, those living in moderate (OR = 1.35, 95% CI = 1.00, 1.84), hostile (OR = 1.60, 95% CI = 1.16, 2.20), or very hostile states (OR = 1.50, 95% CI = 1.18, 1.90) were significantly more likely to report frequent mental health distress.

Similar heterogeneous relationships were observed across levels of education categories ( Fig. 1 B) and income categories ( Fig. 1 C). For example, among women with less than a high school education, compared with those living in states with supportive abortion access, those living in states with very hostile (OR = 1.32, 95% CI = 1.00, 1.74) policies to abortion access were more likely to report frequent mental health distress. Among women with a high school degree, those living in states with hostile (OR = 1.36, 95% CI = 1.20, 1.54) and very hostile (OR = 1.16, 95% CI = 1.02, 1.31) policies towards abortion access were more likely to report frequent mental health distress. Among women with less than $35,000 household income, compared with those who lived in states supportive of abortion access, those residing in moderate (OR = 1.34, 95% CI = 1.00, 1.82), hostile (OR = 1.30, 95% CI = 1.03, 1.65), or very hostile states (OR = 1.26, 95% CI = 0.98, 1.63) were more likely to report frequent mental health distress ( Fig. 1 C). Associations between access to abortion and mental health were not heterogeneous across racial/ethnic categories or by marital status ( Fig. 1 C–D).

4. Discussion

Our study is unique because it examines the associations between restrictive reproductive rights environments and mental health status in the general female population. Previous studies in this area have focused on pregnant people or abortion restrictions ( Biggs et al., 2017 ). Our study found that restrictive reproductive policies may be detrimentally associated with women's mental health beyond that of pregnant individuals. Our findings highlight the importance of taking a broad view of reproductive policies and not focusing solely on abortion restrictions or the effects only to pregnant people.

Results show that residing in states with greater reproductive rights was associated with decreased odds of frequent mental health distress among women. The association between the state-level reproductive rights score and odds of frequent mental health distress did not differ across female participants’ race, age, income, marital status, or educational status.

However, our results using the exposure measure of state-level abortion restrictions did indicate possibly more complex relationships. Residence in states with more abortion restrictions was associated with higher odds of frequent mental health distress among women. We found even women residing in moderate states with 2–3 abortion restrictions had higher odds of frequent mental health distress than those living in supportive states. There may be a threshold effect where the social and political climate in states with two restrictions is enough to create an environment associated with frequent mental health distress among females. Alternatively, the mix of different restrictions may explain the similar odds ratios for moderate and very hostile compared with supportive states.

Furthermore, our results suggest that state-level abortion restrictions may exacerbate socioeconomic and age disparities in mental health. Women in younger age groups and those with lower socioeconomic status (i.e., lower income or less than high school education) had higher odds of frequent mental health distress if they resided in a state that was not supportive of abortion access. By contrast, women with higher socioeconomic status (i.e., high school graduates) only experienced higher odds of frequent mental health distress if they lived in states with hostile or very hostile policies. Our results support previous reports that women with lower socioeconomic status (i.e., less income or less education) have historically encountered structural challenges in carrying out their reproductive decisions ( Ogbu-Nwobodo et al., 2022 ). State restrictions on reproductive rights and abortion restrictions may contribute to and further perpetuate age and socioeconomic status disparities in mental health. State-level restrictions add to the structural imbalance of power that women with low socioeconomic status and younger women encounter.

There may be multiple complex pathways through which living in areas with restrictive reproductive rights may adversely affect the mental health of women. One possible mechanism may be the psychological loss of control all women may experience living under restrictive reproductive laws and policies. For example, a previous cross-sectional study in Ireland reported that a sense of general control mediated the relationship between political disenfranchisement and psychological well-being ( Msetfi et al., 2018 ). Another possible mechanism may be the additional physical barriers women living in states with more restrictive reproductive policies may face as they seek high-quality, legal medical care and advice about sexual health. For example, studies have found that women living in states with restrictive reproductive policies travel farther, pay higher out-of-pocket costs, and experience greater stigma accessing legal contraceptive options ( Barr-Walker et al., 2019 ; Margo et al., 2016 ). However, further research is needed to identify how policies affect women's mental health.

Laws and policies are a major structural determinant of population health in their ability to limit who can access health services and through what means ( Dingake, 2017 , Dingake, 2017 ). Historically, reproductive restrictions have raised overwhelming barriers for those with fewer resources. The heterogeneity of age and socioeconomic status in our sub-analyses may reflect particular groups’ inability to overcome such psychological and physical barriers created by restrictive reproductive policies. For example, women in lower socioeconomic groups may have limited resources to address obstacles to quality reproductive services, such as cost or distance. They may consequently be more affected by reproductive restrictions than women with higher socioeconomic status. By contrast, women with more abundant resources may have other options that offset the mental health burden of abortion restrictions and, perhaps, the resulting adverse mental health outcomes. In this manner, reproductive restrictions may exacerbate socioeconomic disparities in mental health.

These results should be interpreted in light of the study's limitations. First, we could not establish causality because our study uses cross-sectional data. Future longitudinal studies should examine changes in mental health measures before and after policies leading to reproductive restrictions. Researchers should take advantage of recently passed policies to conduct natural experiments to determine the potential adverse impact on health outcomes among women. Second, our outcome is based on self-reports of the number of days when the respondent's mental health was “not good”. Perceptions of health may differ by race and ethnicity because of cultural differences ( Bombak, 2013 ). Therefore, there may be misclassification errors associated with the outcome that differ by race and ethnicity. Thirdly, we did not have information that may help explain the mechanisms involved. For example, we hypothesize that perceptions of control mediate the association between state-level reproductive restrictions and mental health. However, BRFSS does not measure perceived control. Another limitation is that BRFSS measured biological sex (females and males); thus, we limited our investigation to those identified as women at birth rather than all people who could be pregnant. Although gender and sex are intrinsically and reciprocally linked, we cannot study the complexity of the non-binary nature of gender. In addition, a higher proportion of BRFSS participants excluded from this study due to missing data were racial minorities, had annual household incomes less than $35,000, and had less than high school education. This may limit the generalizability of our study results. In addition, the missingness may also lead to measurement error and potential bias toward the null, as previous studies have indicated that people of low SES are more affected by state restrictions ( Goyal et al., 2020 ; Redd et al., 2021 ). Finally, our exposure variables are composite indices based on multiple indicator policies and laws. Several of the individual indicator policies may not considerably influence our mental health outcome, which would contribute to measurement error. However, if our composite exposure variables contained such indicators, our results would be biased toward the null.

Despite these limitations, our study has several key strengths. First, our study uses a nationally representative sample and examines the associations between state-level reproductive rights and abortion access and mental health among all women. In addition, our analysis accounted for the structure of the data by using multilevel models to reflect the association between state-level restrictions and the odds of frequent mental health distress at the individual level.

State-level legislation restricted reproductive access increased dramatically in the last decade ( Nash et al., 2020 ) and the amount and intensity of these restrictions are poised to expand in the post- Roe context. The escalation of restrictive sexual health policies in the US will likely impact the health of pregnant individuals and women in general. As put forth in the SRJ framework, having the autonomy to make reproductive and sexual health decisions is a necessary condition for justice and the well-being for women ( Ross & Solinger, 2017 ). Future studies should assess the effects of specific reproductive policies. In addition, future research needs to incorporate women's lived experiences in response to such policies to fully understand how the growing intensification of reproductive policies affects all women.

Author statement

All persons who meet authorship criteria are listed as authors. All authors certify that they have participated in the components of the work including participation in the concept, design, analysis, writing, or revision of the manuscript.

Ethical statement

This study was reviewed and considered human subjects exempt by the Institutional Review Board at the University of Alberta. All authors of this study do not have any financial disclosures to report.

Financial statement

All authors report no financial funding was associated with this study.

This study did not receive any specific grant support from any funding agencies. However, RP holds a Tier II Canada Research Chair (CRC) in Social and Health Inequities and CB is a recipient of the Women and Children's Health Research Institute (WCHRI) Graduate Studentship Award. Open access fees were paid from RP’s CRC research stipend.

Declaration of competing interest

On behalf of all authors, I would like report that we have no conflict of interest.

Appendix Table A. State-level measure of reproductive rights score and access to abortion services and specific policies used to create each score

Appendix Table B. Reproductive Rights Score and Number of Abortion Restrictions for each US state

Data availability

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Content Search

Review, translation and design of nine research papers.

• Kvinna Till Kvinna

The program “Feminist Power in Action for Women’s Economic Rights” (FemPawer) aims to strengthen the capacities of young women who face multiple economic gender-based violence (E/GBV) discriminations in Jordan, Lebanon, Palestine, and Tunisia to become leaders for change. FemPawer is led by a consortium of 4 organizations and consists of a network of 39 Women's Rights Organizations (WROs), also referred to as Partner Organizations (POs), that are diverse and vary in size, experience, geographical location, and profile.

In Jordan, nine WROs conducted a research on eGBV. Kvinna till Kvinna and the Arab Women Organization (AWO) are seeking a consultancy team to review, translate, and compile these research studies into a single booklet.

About Kvinna till Kvinna and Arab Women Organization

The Kvinna till Kvinna Foundation has defended women’s rights since 1993 and is now a leading feminist organization. We work in war and conflict zones to empower women, collaborating with around 150 partner organizations in 20 countries to achieve gender equality, justice, and lasting peace. Our focus includes both conflict-affected and humanitarian contexts, supporting women's rights and peacebuilding with a long-term perspective. We aim to be a flexible and reliable partner, helping women’s rights organizations adapt to changing conflict and emergency situations.

AWO is a Jordanian local women’s rights organization dedicated to gender equality and the empowerment of women and girls. Over its 50-year history, AWO has focused on advancing women’s leadership and solutions for political, social, and economic empowerment. It brings feminist analyses to national policy dialogues, builds partnerships, coordinates women's rights meetings, and forms coalitions around gender issues.

Objectives of this consultancy

• Identify key research points and methodologies.
• Summarize findings and arguments.
• Write an introduction that provides context and outlines the key themes across all papers.
• Write conclusions that synthesize the overall findings and suggest potential areas for future research.
• Formulate observations and insights based on the reviewed papers.
• Translate all reports and summaries from Arabic to English (approximately 85,000 words)
• Design the nine research papers (both English and Arabic) into one cohesive booklet.

Intended Users

The intended users are decision makers targeted in advocacy against eGBV (government officials, private sector, international community).

To be discussed with the selected consultancy team.

Deliverables

• Nine research papers in Arabic, reviewed and consolidated, each with a summary and an introduction covering all nine papers.
• Translated document of the above from Arabic to English.
• Designed booklet, in both English and Arabic.

A detailed budget suggested by the consultant in EUR should be shared along with examples of previous work. (The monetary amount suggested by the external consultant is “All tax included”). We do not cover any tax.

Qualifications

The consultant (s) should meet the desired criteria:

• Advanced degree in Gender Studies, Social Sciences, Law, Public Policy, or a related field.
• Proven experience in conducting and reviewing research on gender-based violence, women's rights, or related fields.
• Demonstrated experience in translating academic or technical documents from Arabic to English and vice versa.
• Previous experience in designing and consolidating research documents or reports, preferably in the field of human rights or gender studies.
• Strong analytical and critical thinking skills to synthesize findings and provide insights.
• Excellent written and verbal communication skills in both Arabic and English.
• Proficiency in document design and layout software.
• In-depth understanding of economic gender-based violence and its impacts.
• Familiarity with the socio-economic and cultural context of Jordan.
• Ability to handle tight deadlines in a professional manner.
• Great communication skills.
• Organized and timely.
• Creative in overcoming barriers and ability to coordinate with multiple entities.

How to apply

The consultant(s) is invited to submit a file to [email protected] with the following title in the email subject « Review, translation and design of nine research papers».

If a consultant is not part of a team but has experience in one specific aspect of the deliverables—(1) review and analysis, (2) translation, or (3) design—you are also invited to submit your offer. Please mention which area you wish to be considered for. If we do not find a suitable team, individual consultants will be considered.

Submission deadline: July 07, 2024, at 23:55 pm GMT+3

Applicant(s) Location : Flexible/Remote

*Provision of References

• Applicants are required to provide contact information for three professional work references.
• This information should include the names of the references, their positions, their places of work, and contact details (such as email and telephone number).
• These references may be contacted to evaluate the professional competencies and past experiences of the applicant, with the aim of ensuring the selection of the most suitable candidates for the program’s requirements and goals. We will only contact the reference if you are shortlisted and we informed you that we will contact the references.

**Disclosure of previous work with consortium partners

• Applicants must clearly disclose any previous collaboration or work undertaken with any of the consortium partners involved in this program.
• Details of such collaboration should include the name of the partner, the nature of the work performed, and the period of collaboration.
• In cases where previous collaboration exists, the relevant partner may be contacted to obtain an assessment and feedback on the applicant's performance and competence.

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Spring 2025 Semester

Undergraduate courses.

Composition courses that offer many sections (ENGL 101, 201, 277 and 379) are not listed on this schedule unless they are tailored to specific thematic content or particularly appropriate for specific programs and majors.

• 100-200 level

ENGL 201.ST2 Composition II: The Mind/Body Connection

Dr. sharon smith.

In this online section of English 201, students will use research and writing to learn more about problems that are important to them and articulate ways to address those problems. The course will focus specifically on issues related to the body, the mind, and the relationship between them. The topics we will discuss during the course will include the correlation between social media and body image; the psychological effects of self-objectification; and the unique mental and physical challenges faced by college students today, including food insecurity and stress.

English 201 S06 and S11: Composition II with an emphasis in Environmental Writing

S06: MWF at 10–10:50 a.m. in Yeager Hall Addition 231

S11: MWF at 12–12:50 p.m. in Crothers Engineering Hall 217

Gwen Horsley

English 201 will help students develop skills to write effectively for other university courses, careers, and themselves. This course will provide opportunities to further develop research skills, to write vividly, and to share their own stories and ideas. Specifically, in this class, students will (1) focus on the relationships between world environments, land, animals and humankind; (2) read various essays by environmental, conservational, and regional authors; and (3) produce student writings. Students will improve their writing skills by reading essays and applying techniques they witness in others’ work and those learned in class. This class is also a course in logical and creative thought. Students will write about humankind’s place in the world and our influence on the land and animals, places that hold special meaning to them or have influenced their lives, and stories of their own families and their places and passions in the world. Students will practice writing in an informed and persuasive manner, in language that engages and enlivens readers by using vivid verbs and avoiding unnecessary passives, nominalizations, and expletive constructions.

Students will prepare writing assignments based on readings and discussions of essays included in Literature and the Environment and other sources. They will use The St. Martin’s Handbook to review grammar, punctuation, mechanics, and usage as needed.

Required Text: Literature and the Environment: A Reader On Nature and Culture. 2nd ed., edited by Lorraine Anderson, Scott Slovic, and John P. O’Grady.

LING 203.S01 English Grammar

TuTh 12:30-1:45 p.m.

Dr. Nathan Serfling

The South Dakota State University 2023-2024 Undergraduate Catalog describes LING 203 as consisting of “[i]nstruction in the theory and practice of traditional grammar including the study of parts of speech, parsing, and practical problems in usage.”

“Grammar” is a mercurial term, though. Typically, we think of it to mean “correct” sentence structure, and, indeed, that is one of its meanings. But Merriam-Webster reminds us “grammar” also refers to “the principles or rules of an art, science, or technique,” taking it beyond the confines of syntactic structures. Grammar also evolves in practice through application (and social, historical, economic changes, among others). Furthermore, grammar evolves as a concept as scholars and educators in the various fields of English studies debate the definition and nature of grammar, including how well its explicit instruction improves students’ writing. In this course, we will use the differing sensibilities, definitions, and fluctuations regarding grammar to guide our work. We will examine the parts of speech, address syntactic structures and functions, and parse and diagram sentences. We will also explore definitions of and debates about grammar. All of this will occur in units about the rules and structures of grammar; the application of grammar rhetorically and stylistically; and the debates surrounding various aspects of grammar, including, but not limited to, its instruction.

ENGL 210 Introduction to Literature

Jodi andrews.

Readings in fiction, drama and poetry to acquaint students with literature and aesthetic form. Prerequisites: ENGL 101. Notes: Course meets SGR #4 or IGR #3.

ENGL 222 British Literature II

TuTh 9:30-10:45 a.m.

This course serves as a chronological survey of the second half of British literature. Students will read a variety of texts from the Romantic period, the Victorian period, and the twentieth and twenty-first centuries, placing these texts within their historical and literary contexts and identifying the major characteristics of the literary periods and movements that produced them.

ENGL 240.ST1 Juvenile Literature

Randi l. anderson.

A survey of the history of literature written for children and adolescents, and a consideration of the various types of juvenile literature.

ENGL 240.ST1 Juvenile Literature: 5-12 Grade

In English 240 students will develop the skills to interpret and evaluate various genres of literature for juvenile readers. This particular section will focus on various works of literature at approximately the 5th-12th grade level.

Readings for this course include works such as Night, Brown Girl Dreaming, All American Boys, Esperanza Rising, Anne Frank’s Diary: A Graphic Adaptation, Animal Farm, Fahrenheit 451, The Giver, The Hobbit, Little Women, and Lord of the Flies . These readings will be paired with chapters from Reading Children’s Literature: A Critical Introduction to help develop understanding of various genres, themes, and concepts that are both related to juvenile literature, and also present in our readings.

In addition to exploring various genres of writing (poetry, non-fiction, fantasy, historical, non-fiction, graphic novels, etc.) this course will also allow students to engage in a discussion of larger themes present in these works such as censorship, race, rebellion and dissent, power and oppression, gender, knowledge, and the power of language and the written word. Students’ understanding of these works and concepts will be developed through readings, discussion posts, quizzes and exams.

ENGL 240.ST2 Juvenile Literature Elementary-5th Grade

April myrick.

A survey of the history of literature written for children and adolescents, and a consideration of the various genres of juvenile literature. Text selection will focus on the themes of imagination and breaking boundaries.

ENGL 242.S01 American Literature II

TuTh 11 a.m.-12:15 p.m.

Dr. Paul Baggett

This course surveys a range of U.S. literatures from about 1865 to the present, writings that treat the end of slavery and the development of a segregated America, increasingly urbanized and industrialized U.S. landscapes, waves of immigration, and the fulfilled promise of “America” as imperial nation. The class will explore the diversity of identities represented during that time, and the problems/potentials writers imagined in response to the century’s changes—especially literature’s critical power in a time of nation-building. Required texts for the course are The Norton Anthology of American Literature: 1865 to the Present and Toni Morrison’s A Mercy.

WMST 247.S01: Introduction to Women, Gender and Sexuality Studies

As an introduction to Women, Gender and Sexuality studies, this course considers the experiences of women and provides an overview of the history of feminist thought and activism, particularly within the United States. Students will also consider the concepts of gender and sexuality more broadly to encompass a diversity of gender identifications and sexualities and will explore the degree to which mainstream feminism has—and has not—accommodated this diversity. The course will focus in particular on the ways in which gender and sexuality intersect with race, class, ethnicity, and disability. Topics and concepts covered will include: movements for women’s and LGBTQ+ rights; gender, sexuality and the body; intersectionality; rape culture; domestic and gender violence; reproductive rights; Missing and Murdered Indigenous Women (MMIW); and more.

ENGL 283.S01 Introduction to Creative Writing

MWF 1-1:50 p.m.

Prof. Steven Wingate

Students will explore the various forms of creative writing (fiction, nonfiction and poetry) not one at a time in a survey format—as if there were decisive walls of separation between then—but as intensely related genres that share much of their creative DNA. Through close reading and work on personal texts, students will address the decisions that writers in any genre must face on voice, rhetorical position, relationship to audience, etc. Students will produce and revise portfolios of original creative work developed from prompts and research. This course fulfills the same SGR #2 requirements ENGL 201; note that the course will involve creative research projects. Successful completion of ENGL 101 (including by test or dual credit) is a prerequisite.

English 284: Introduction to Criticism

This course introduces students to selected traditions of literary and cultural theory and to some of the key issues that animate discussion among literary scholars today. These include questions about the production of cultural value, about ideology and hegemony, about the patriarchal and colonial bases of Western culture, and about the status of the cultural object, of the cultural critic, and of cultural theory itself.

To address these and other questions, we will survey the history of literary theory and criticism (a history spanning 2500 years) by focusing upon a number of key periods and -isms: Greek and Roman Classicism, The Middle Ages and Renaissance, The Enlightenment, Romanticism, Realism, Formalism, Historicism, Political Criticism (Marxism, Post-Colonialism, Feminism, et al.), and Psychological Criticism. We also will “test” various theories we discuss by examining how well they account for and help us to understand various works of poetry and fiction.

• 300-400 level

ENGL 330.S01 Shakespeare

TuTh 8-9:15 a.m.

Dr. Michael S. Nagy

This course will focus on William Shakespeare’s poetic and dramatic works and on the cultural and social contexts in which he wrote them. In this way, we will gain a greater appreciation of the fact that literature does not exist in a vacuum, for it both reflects and influences contemporary and subsequent cultures. Text: The Riverside Shakespeare: Complete Works. Ed. Evans, G. Blakemore and J. J. M. Tobin. Boston: Houghton Mifflin, 1997.

ENGL 363 Science Fiction

MWF 11-11:50 a.m.

This course explores one of the most significant literary genres of the past century in fiction and in film. We will focus in particular on the relationship between science fiction works and technological and social developments, with considerable attention paid to the role of artificial intelligence in the human imagination. Why does science fiction seem to predict the future? What do readers and writers of the genre hope to find in it? Through readings and viewings of original work, as well as selected criticism in the field, we will address these and other questions. Our reading and viewing selections will include such artists as Ursula K. LeGuin, Octavia Butler, Stanley Kubrick and Phillip K. Dick. Students will also have ample opportunity to introduce the rest of the class to their own favorite science fiction works.

ENGL 383.S01 Creative Writing I

MWF 2-2:50 p.m.

Amber Jensen

Creative Writing I encourages students to strengthen poetry, creative nonfiction, and/or fiction writing skills through sustained focus on creative projects throughout the course (for example, collections of shorter works focused on a particular form/style/theme, longer prose pieces, hybrid works, etc.). Students will engage in small- and large-group writing workshops as well as individual conferences with the instructor throughout the course to develop a portfolio of creative work. The class allows students to explore multiple genres through the processes of writing and revising their own creative texts and through writing workshop, emphasizing the application of craft concepts across genre, but also allows students to choose one genre of emphasis, which they will explore through analysis of self-select texts, which they will use to deepen their understanding of the genre and to contextualize their own creative work.

ENGL 475.S01 Creative Nonfiction

Mondays 3-5:50 p.m.

In this course, students will explore the expansive and exciting genre of creative nonfiction, including a variety of forms such as personal essay, braided essay, flash nonfiction, hermit crab essays, profiles and more. Through rhetorical reading, discussion, and workshop, students will engage published works, their own writing process, and peer work as they expand their understanding of the possibilities presented in this genre and the craft elements that can be used to shape readers’ experience of a text. Students will compile a portfolio of polished work that demonstrates their engagement with course concepts and the writing process.

ENGL 485.S01 Writing Center Tutoring

MW 8:30-9:45 a.m.

Since their beginnings in the 1920s and 30s, writing centers have come to serve numerous functions: as hubs for writing across the curriculum initiatives, sites to develop and deliver workshops, and resource centers for faculty as well as students, among other functions. But the primary function of writing centers has necessarily and rightfully remained the tutoring of student writers. This course will immerse you in that function in two parts. During the first four weeks, you will explore writing center praxis—that is, the dialogic interplay of theory and practice related to writing center work. This part of the course will orient you to writing center history, key theoretical tenets and practical aspects of writing center tutoring. Once we have developed and practiced this foundation, you will begin work in the writing center as a tutor, responsible for assisting a wide variety of student clients with numerous writing tasks. Through this work, you will learn to actively engage with student clients in the revision of a text, respond to different student needs and abilities, work with a variety of writing tasks and rhetorical situations and develop a richer sense of writing as a complex and negotiated social process.

ENGL 492.S01 The Vietnam War in Literature and Film

Tuesdays 3-5:50 p.m.

Dr. Jason McEntee

In 1975, the United States officially included its involvement in the Vietnam War, thus marking 2025 as the 50th anniversary of the conclusion (in name only) of one of the most chaotic, confusing, and complex periods in American history. In this course, we will consider how literature and film attempt to chronicle the Vietnam War and, perhaps more important, its aftermath. I have designed this course for those looking to extend their understanding of literature and film to include the ideas of art, experience, commercial products, and cultural documents. Learning how to interpret literature and movies remains the highest priority of the course, including, for movies, the study of such things as genre, mise-en-scene (camera movement, lighting, etc.), editing, sound and so forth.

We will read Dispatches , A Rumor of War , The Things They Carried , A Piece of My Heart , and Bloods , among others. Some of the movies that we will screen are: Apocalypse Now (the original version), Full Metal Jacket , Platoon , Coming Home , Born on the Fourth of July , Dead Presidents , and Hearts and Minds . Because we must do so, we will also look at some of the more fascinatingly outrageous yet culturally significant fantasies about the war, such as The Green Berets and Rambo: First Blood, Part II .

ENGL 492.S02 Classical Mythology

TuTh 3:30-4:45 p.m.

Drs. Michael S. Nagy and Graham Wrightson

Modern society’s fascination with mythology manifests itself in the continued success of novels, films and television programs about mythological or quasi-mythological characters such as Hercules, the Fisher King, and Gandalf the Grey, all of whom are celebrated for their perseverance or their daring deeds in the face of adversity. This preoccupation with mythological figures necessarily extends back to the cultures which first propagated these myths in early folk tales and poems about such figures as Oðin, King Arthur, Rhiannon, Gilgamesh, and Odysseus, to name just a few. English 492, a reading-intensive course cross-listed with History 492, primarily aims to expose students to the rich tradition of mythological literature written in languages as varied as French, Gaelic, Welsh, Old Icelandic, Greek, and Sumerian; to explore the historical, social, political, religious, and literary contexts in which these works flourished (if indeed they did); and to grapple with the deceptively simple question of what makes these myths continue to resonate with modern audiences. Likely topics and themes of this course will include: Theories of myth; Mythological Beginnings: Creation myths and the fall of man; Male and Female Gods in Myth; Foundation myths; Nature Myths; The Heroic Personality; the mythological portrayal of (evil/disruptive) women in myth; and Monsters in myth.

Likely Texts:

• Dalley, Stephanie, trans. Myths from Mesopotamia: Creation, the Flood, Gilgamesh, and Others. Oxford World’s Classics, 2009
• Faulkes, Anthony, trans. Edda. Everyman, 1995
• Gregory, Lady Augusta. Cuchulain of Muirthemne: The Story of the Men of the Red Branch of Ulster. Forgotten Books, 2007
• Jones, Gwyn, Thomas Jones, and Mair Jones. The Mabinogion. Everyman Paperback Classics, 1993
• Larrington, Carolyne, trans. The Poetic Edda . Oxford World’s Classics, 2009
• Matarasso, Pauline M., trans. The Quest of the Holy Grail. Penguin Classics, 1969
• Apollodorus, Hesiod’s Theogony
• Hesiod’s Works and Days
• Ovid’s Metamorphoses, Homeric Hymns
• Virgil’s Aeneid
• Iliad, Odyssey
• Apollonius of Rhodes Argonautica
• Ovid’s Heroides
• Greek tragedies: Orestaia, Oedipus trilogy, Trojan Women, Medea, Hippoolytus, Frogs, Seneca's Thyestes, Dyskolos, Amphitryon
• Clash of the Titans, Hercules, Jason and the Argonauts, Troy (and recent miniseries), Oh Brother, Where Art Thou?

ENGL 492.ST1 Science Writing

Erica summerfield.

This course aims to teach the fundamentals of effective scientific writing and presentation. The course examines opportunities for covering science, the skills required to produce clear and understandable text about technical subjects, and important ethical and practical constraints that govern the reporting of scientific information. Students will learn to present technical and scientific issues to various audiences. Particular emphasis will be placed on conveying the significance of research, outlining the aims, and discussing the results for scientific papers and grant proposals. Students will learn to write effectively, concisely, and clearly while preparing a media post, fact sheet, and scientific manuscript or grant.

Graduate Courses

Engl 575.s01 creative nonfiction.

In this course, students will explore the expansive and exciting genre of creative nonfiction, including a variety of forms such as personal essay, braided essay, flash nonfiction, hermit crab essays, profiles, and more. Through rhetorical reading, discussion, and workshop, students will engage published works, their own writing process, and peer work as they expand their understanding of the possibilities presented in this genre and the craft elements that can be used to shape readers’ experience of a text. Students will compile a portfolio of polished work that demonstrates their engagement with course concepts and the writing process.

ENGL 592.S01: The Vietnam War in Literature and Film

Engl 704.s01 introduction to graduate studies.

Thursdays 3-5:50 p.m.

Introduction to Graduate Studies is required of all first-year graduate students. The primary purpose of this course is to introduce students to modern and contemporary literary theory and its applications. Students will write short response papers and will engage at least one theoretical approach in their own fifteen- to twenty-page scholarly research project. In addition, this course will further introduce students to the M.A. program in English at South Dakota State University and provide insight into issues related to the profession of English studies.

ENGL 792.ST1 Grant Writing

This online course will familiarize students with the language, rhetorical situation, and components of writing grant proposals. Students will explore various funding sources, learn to read an RFP, and develop an understanding of different professional contexts and the rhetorical and structural elements that suit those distinct contexts. Students will write a sample proposal throughout the course and offer feedback to their peers, who may be writing in different contexts, which will enhance their understanding of the varied applications of course content. Through their work in the course, students will gain confidence in their ability to find, apply for, and receive grant funding to support their communities and organizations.