I've read it more than once, although much closer to its date of publication.
The more time that goes by, the more paranoid it seems to me. I know Atwood has done other scifi/apocalypse stuff since then, but I haven't read any of it. And, come on. Really? The United States falls prey to that kind of thinking but not a single other Westernized nation does? Both Canada and Japan are presented as perfectly normal cultures that do not fall prey to either wanton oppression of women or falling birthrates.
Plus, the internal logic and politics of that world don't really make any sense either. And history has shown us that falling birthrates (check!) and one very popular conservative public female with old-fashioned opinions about how men and women should relate to each other within a family (check!) can't engage that kind of draconian social machinery. Plus there was an awful lot of radioactive waste lying around without any evidence of a nuclear holocaust.
With all the draping of women in the book, it would probably be interesting to read it now with the anti-Muslim sentiments in the culture. Back when it was written, I really don't think that kind of fear was in the world. It was all Cold War This and Eastern Block Communists That.
I didn't really pay close enough attention to politics at the time (it was published in 1985) to come up with a reason why she set it in the United States and not Canada. Was Reagan so bad? Were the televangelists really so feared? Or was it Canadian politics that were looming large in some socially threatening way that required her to bump her setting one country south to better describe the terrors?