Immunization to regulate fertility: biological and cultural frameworks.

Abstract

Deliberate immunization to control fertility differs from that to control disease. Those differences can be discussed within various frameworks, e.g., intent, recipient population, biological bases, and immunological targets. Others include differing perspectives of developers, providers and users, and rights of the state to impose programs of control. Almost all of the differences are grounded in the social, economic, and gendered aspects of societies. The intent of providing a fertility-regulating vaccine is to prevent pregnancy. In theory, men as well as women could receive such vaccines; in reality, most are designed for women. Traditional vaccines are intended to prevent disease and are generally given to susceptible individuals whether male or female, child or adult. The biological bases of contraceptive vaccines are molecules specific to reproduction. The immune response generated by most anti-fertility vaccines is directed toward 'self', one's own cells and molecules. In contrast, the bases of traditional vaccines are materials derived from non-self, disease-causing microorganisms; the immunological targets are those microorganisms or their toxic products. From a developer perspective vaccines that regulate fertility differ little from those that control disease; both prevent a particular condition. Developers cite these advantages to contraceptive vaccines: non-invasive, no serious side-effects, easy to use, reduced patient failure, and long-lasting but naturally reversible. Because anti-fertility vaccines have been tested only in small-scale clinical trials, information on user reactions and experiences is limited. Not surprisingly, the perspectives of women's health advocates and of potential users (mostly women) often differ markedly from those of developers. Women cite as disadvantages the cryptic nature of immunity which leaves one without an obvious signal for the beginning of protection (against pregnancy) and its decline, and the inability to 'turn-off' an immune response. Further, long-acting contraception can complicate alleviation and side-effects, and it leaves women always vulnerable to sexual demands. Most women object to the lack of user control and are especially concerned about the enormous potential for misuse and coercion by population control programs should fertility-regulating vaccines become widely available. Many scholars and government officials subscribe to the following logic: the global environmental crisis is due to over-population which necessitates population control programs; thus pregnancy can be considered a disease subject to state control. But pregnancy is not a disease nor is over-population the single major cause of environmental degradation. However, as governments grapple with the economic, social, and ecological consequences of population growth, draconian measures to control fertility will be ever more tempting.(ABSTRACT TRUNCATED AT 400 WORDS)