Reply of the authors: "Response to "The illusion of reproductive choice: how restorative reproductive medicine violates reproductive autonomy and informed consent"" by Frank-Herrmann et al.

Sexual and reproductive health and rights are basic human rights: The FLASOG Panama Declaration and FIGO Cartagena Declaration.

A woman's lack of or limited reproductive autonomy could lead to adverse health effects, feeling of being inferior, and above all being unable to adequately care for her children. Little is known about the reproductive autonomy of married Ikwerre women of Rivers State, Nigeria. This study demonstrates how Ikwerre women understand the terms autonomy and reproductive rights and what affects the exercise of these rights. An exploratory research design was employed for this study. A semi-structured interview schedule was used to conduct thirty-four in-depth interviews and six focus group discussions with purposively sampled educated, semi-educated, and uneducated Ikwerre women in monogamous or polygynous marriages. The collected data was analysed qualitatively with MAXQDA 11 using open and axial coding. The interviews and focus group responses reveal a low level of awareness of autonomy and reproductive rights amongst the Ikwerre women in Nigeria. While some educated women were aware of their reproductive rights, cultural practices were reported to limit the exercise of these rights. Participants reported that Ikwerre culture is a patriarchal one where married women are expected to submit and obey their husbands in all matters; and a good married woman according to Ikwerre standard is one who complies with this culture. Women's refusal of sexual advances from their husbands is described as not being acceptable in this culture; and hence rape in marriage is not recognized in Ikwerre culture. Education and awareness creation on the importance of women's reproductive autonomy could improve their reproductive rights and autonomy in marital settings. Overcoming the patriarchal aspects of Ikwerre culture-for example, the greater value placed on male children than female children and treating women as incompetent individuals-is necessary to promote gender equality as well as help improve women's reproductive autonomy.

The issue of reproductive autonomy in developing countries has been a major global human right concern. The patriarchal system of governance and the cultural practices in most African countries and indeed Nigeria have been major hindrances to the exercise of women’s reproductive autonomy (Okemini & Adekola, 2012). According to our study, the reproductive autonomy of married Ikwerre women of Rivers State, Nigeria is perceived to be diminished. A major reason for this is the culture of absolute respect to men and the patriarchal society in which the women find themselves. In the Ikwerre culture, women are expected to have absolute respect for men. Female subordination and gender discrimination are fallout from the patriarchal society which characterizes the Ikwerre ethnic group. An Ikwerre woman who chooses to exercise her reproductive autonomy without the consent of her husband or family head is viewed as a stubborn woman. An Ikwerre wife who dares to exercise her reproductive autonomy may face dire consequences from her husband; such as been beaten, divorced or ending up in a polygynous marriage. And this brings upon the woman negative consequences such as being stigmatized by society, because unmarried, separated, or divorced women are viewed by society as witches, cursed or lacking proper home training, as well as brings dishonor to their families (Baloyi, 2013; Llika, 2005; Isiugo-Abanihe, 1995). Since a typical Ikwerre woman does not want to end up offending her husband, his family and hers, she would tolerate anything to remain married, and this includes not exercising her reproductive autonomy. Other factors that diminish married women’s reproductive autonomy are religion (the Christian religion to which the study participants belong to), poverty, which leads to over- dependence on the husband, and lack of education. A married woman who is poor will have no choice but to depend on her husband for her entire well-being. To ensure her daily livelihood and that of her children, she will have to obey her husband’s commands even to her own detriment. An uneducated married woman is blind to information, because she is unable to interact and understand what it means to have reproductive autonomy. And even if she is told, she may not know how to go about the exercise of her reproductive autonomy in a patriarchal setting like Nigeria. There is a gap in knowledge as to the real reason married Ikwerre women have diminished reproductive autonomy. The aim of this thesis therefore was to understand what women understood by autonomy and reproductive rights. To examine the reason for married Ikwerre women’s diminished reproductive autonomy and to understand how education helps in the exercise of their reproductive autonomy. This is the first time qualitative research has aimed to understand the reason for married Ikwerre women’s diminished reproductive autonomy. Given that the Ikwerres are well educated and live with educated foreigners who besiege the area due to the presence of crude oil which accounts for Nigeria’s wealth, one would expect that there would be equality amongst the genders in Ikwerres as regards autonomous decision making due to the rising development and urbanization in the region. But the Ikwerre women are perceived to have diminished reproductive autonomy. Therefore, it is imperative to understand what limits the exercise of their reproductive autonomy.

The Italian Supreme Court ruling no. 18901 of May 13, 2021 has determined that doctors who are opposed to abortion can refuse to perform it on grounds of conscience, but such a refusal does not exempt them from providing assistance to the woman before and after the procedure itself. The legalization of abortion should be considered within a broader strategy to put an end to underground and unsafe abortions, to raise awareness and enhance reproductive education and accessibility to contraceptive methods. The authors have set out to briefly analyze the legal and ethical complexities inherent in the effort to reconcile women’s reproductive autonomy and freedom of choice with conscience-based refusal on the part of numerous healthcare professionals. Such an apparent conflict highlights the need for an ethically tenable solution that takes into account the dignity of unborn children, based on the conviction of many healthcare professionals primarily based on moral and religious tenets, that life begins at conception as well as the reproductive freedom and autonomy of women. (www.actabiomedica.it)

До характеристики міжнародно-правового забезпечення репродуктивних прав людини

Reproductive rights and reproductive technologies

The human rights paradigm provides an important perspective on the relationship between reproduction and health as well as an essential tool for ensuring that reproductive health is achieved and reproductive rights are protected. Indeed, this relationship can be characterized as creating a discrete human right to reproductive health. International human rights law does not carve out an explicit right to reproductive health, but different aspects of this right can be assembled from the foundation of numerous human rights principles as applied to reproductive health. This article explores the many ways that reproductive health can be perceived as a human right. The human right to reproductive health arises in part from the complex, interwoven relationship between reproductive rights and the right to health. Reproductive health can be framed as a human right based upon its centrality to human functioning, its contribution to overall human health, its interconnectedness with numerous human rights, or its relationship with social factors involving sexuality, gender, and power. The right to reproductive health should be recognized as a distinct human right and not merely as a subcomponent of the right to health or as one of several rights included within a generalized collection of reproductive rights. While reproductive health rights do indeed exist at the intersection of discourses about reproductive rights, the right to health, and other human rights, conceptualizing reproductive health as a human right acknowledges the fundamental importance of reproductive health in achieving overall health. Likewise, reproductive health rights interact with and influence the attainment of many other human rights. Framed as a distinct human right, the right to reproductive health grants individuals a specific claim to all of the aspects of this right and obligates states to respect, protect, and fulfill this right. Recognition of a broad and nuanced understanding of the right to reproductive health within human rights frameworks would significantly bolster reproductive health outcomes and the rights of women and men to make reproductive decisions. The approach adopted in this article diverges in focus to some extent from much of the existing commentary on reproductive rights, which often centers on rights protecting reproductive decisional autonomy and gives less consideration to issues of reproductive health. By presenting a contrasting model that primarily focuses on reproductive health, this article highlights the specific human rights aspects of reproductive health, assesses the effect of reproductive health on human rights as well as the effect of human rights on reproductive health, and substantiates the claim that reproductive health is a human right.

Social egg freezing is an emerging topic in China, where single women currently face restrictions in accessing this service at medical facilities. Administrative regulations prohibit single women from accessing all forms of assisted reproductive technologies. Both the first lawsuit filed by a single woman seeking to freeze her eggs and a legislative proposal aiming to protect single women's rights to access assisted reproductive technologies were denied. This has sparked controversy and discussion about the reproductive rights of single women and the legitimacy of their access to medical and technical assistance. Laws and family planning policies related to women's reproductive rights in China have undergone dramatic changes in recent years, owing to shifts in population growth trends and societal attitudes toward marriage and childbirth, subsequently leading to a notable enhancement in women's reproductive autonomy. Meanwhile, factors such as marital status and career considerations have led to a delay in childbearing, triggering a growing need and advocacy for fertility preservation among single women. In China, the pursuit of social egg freezing by single women comes into conflict with the strict regulatory restrictions on assisted reproductive technologies. This study delves into the profound impacts of demographic changes, marital trends, fertility culture, and other social factors on female fertility in China. It also discusses the legislative issues and medical-social ethical concerns associated with the application of social egg freezing for single women. Additionally, this study offers regulatory suggestions aimed at enhancing women's reproductive health and autonomy, as well as the avoidance of potential ethical risks.

The impact of violence on womens personal sexual social and reproductive life reduces their autonomy and destroys their sense of personal safety and quality of life. In the context of HIV/AIDS the issue of sexual violence takes on alarming proportions since violence against women fuels the epidemic and the epidemic exacerbates the impact of violence against women. This paper considers the extent to which violence against women and reproductive autonomy have become actionable for women in Southern Africa and whether countries have adequately managed to protect women by contextualising violence against women as a reproductive rights issue and visa versa or whether they have failed to protect women by silencing and masculinising womens realities. It will be argued that all jurisdictions have made progress toward a feminisation of the law but that significant lacunae and problems still remain particularly in relation to a masculinist approach to violence against women and reproductive autonomy in the context of HIV/AIDS. State responses in the form of protective and coercive measures are examined with issues such as violence against women as a pre-disposing factor to HIV and violence upon disclosure of womens status being considered. In addition coercive practices such as the criminalisation of HIV-related behaviour and forced sterilisation are considered. (authors)

Objective to analyze the influence of the sociodemographic and reproductive characteristics on reproductive autonomy among women through the subscales of the Reproductive Autonomy Scale. Method an analytical and cross-sectional study with a stratified sample composed of 346 female rural workers registered in Chapéu de Palha Mulher Program in Pernambuco. Data collection occurred in the month of February 19th and February 23rd, 2018. The National Health Survey questionnaire and the Reproductive Autonomy Scale were used. The data were analyzed using simple and multiple linear regression analyses. Results the women presented high reproductive autonomy with the lowest autonomy being observed in relation to the “Communication” construct. Marital status, education level, skin color/race, participation in a family planning group, and having already being pregnant are significant variables for total reproductive autonomy. Conclusion the full reproductive autonomy of rural women can be influenced by sociodemographic and reproductive variables. One of the ways to increase reproductive autonomy among the women in this study would be through an intervention aimed at health education on sexual and reproductive rights and power and gender relations so that women can be guided, obtain more information on these topics, and correlate them with reproductive autonomy.

Reproductive autonomy is essential for women to achieve reproductive rights and freedom. However, the factors associated with reproductive autonomy in various contexts have not been explored. The aim of this analysis was to understand the socio-demographic, reproductive history and social context variables associated with two validated reproductive autonomy sub-scales among 516 young Ghanaian women age 15 to 24. We used multiple linear regression modelling to test associations between covariates of interest and the communication sub-scale and decision-making sub-scale. Covariates included age, educational attainment, ethnic group, employment, religion, religious attendance, relationship type, previous pregnancy, previous abortion, social support for adolescent sexual and reproductive health, and social stigma towards adolescent sexual and reproductive health. Results from final models demonstrated that factors associated with the communication scale included education (p = 0.008), ethnic group (p = 0.039), and social support for adolescent sexual and reproductive health (B = 0.12, p = 0.003). Factors associated with the decision-making scale included ethnic group (p = 0.002), religion (p = 0.003), religious attendance (p = 0.043), and previous pregnancy (p = 0.008). Communication reproductive autonomy and decision-making reproductive autonomy were associated with different factors, providing insight into potential intervention approaches and points. Social support for adolescent sexual and reproductive health was associated with increases in young women’s abilities to communicate with their partners about sexual and reproductive health issues including sex, contraceptive use and fertility.

Study question Even when considering the right to reproduction as a negative right are there actions to be taken in order achieve a better reproductive autonomy? Summary answer Specific actions become a necessary positivisation of the right to reproduction. Ensuring socio-economic stability and promoting specific education are key parameters for promoting fertility. What is known already The reproductive autonomy of individuals consists of being able to choose the number of children desired and the appropriate timing between deliveries. However, there are many factors that prevent reproductive autonomy from being fully developed in Spain, being the country with the second lowest fertility indicator in Europe. There are texts that argue that reproductive autonomy should be approached from a Human Rights perspective and urge governments to adopt positive measures in accordance. However, the European Court of Human Rights' rulings on this issue are far from this perspective. Nevertheless, states have obligations to enhance the reproductive autonomy of individuals. Study design, size, duration In order to stablish this position, we studied the Spanish demographic and fertility indicator data and examined the existing Spanish laws regarding assisted reproductive techniques (such as Law 14/2006), the European Court of Human Rights' ruling on this matter, United Nations consensus related to this field, the Guttmacher-Lancet commission and recommendations of scientific societies such as ESHRE. Participants/materials, setting, methods Bibliography was achieved using the European Court Human Rights' ruling HUDOC database, the Spanish State Official Newsletter and United Nations Library, between others. Socio-economic and demographic indexes were obtained with Eurostat and the Spanish National Statistics Office. Selected legal aspects were included in the revision and manuscript. Main results and the role of chance The Spanish socio-economic panorama is unfavorable for the emancipation of young people and the consequent formation of families with offspring, which aggravates the existing demographic crisis and generational turnover. Importantly, people are not being fully autonomous in their reproductive decisions, mainly due to a lack of information and foresight regarding real fertility and infertility expectations. States must ensure comprehensive sexual and reproductive health promotion, which includes reproductive autonomy. The wide range of rights that constitute the so-called reproductive rights is encompassed within the framework of human rights. However, the right to reproduction is not always considered as a positive right, although the legislator must ensure that people can fully exercise their autonomy. The fact that the full positivisation of the right to reproduction is not considered does not exempt the State from obligations to ensure the reproductive autonomy of its citizens. Therefore, the positivisation of the right to reproduction must ensure socio-economic stability and reproductive health education, thus preventing future infertility problems. Public and private clinics and health centers must be provided with the necessary means to diagnose possible reproductive pathologies. Education and economic stability are solutions to most of the problems related to population growth and infertility. Limitations, reasons for caution In this study we have interpreted international Law, soft-law and reccommendations according to the actual Spanish socio-economic and demographic context, which may not be adequate to extrapolate to other countries or populations. Wider implications of the findings To consider the right to reproduction as a positive right may mean converting the State into a provider of resources for this purpose. However, positivisation of the right to reproduction materializes in education and socio-economic stability, actions worth considering, such as creating public campaigns aimed at fertility education and awareness. Trial registration number Not applicable

This paper is a comparative examination of abortion rights in the United States and France, focusing on their contrasting socio-political, legal, and cultural landscapes. The U.S system highly polarized and shaped by the 1973 Roe v. Wade decision initially guaranteeing abortion rights under the right to privacy. However, the recent 2022 Dobbs v. Jackson Women’s Health Organization ruling overturned Roe, returning abortion regulation to individual states and leading to a patchwork of restrictive and permissive laws a shift that intensified women's reproductive rights debates among religious and conservative movements. Contrastingly, France's Veil Law of 1975 legalized abortion marked a significant women’s reproductive autonomy. France has gradually expanded abortion access, with the legal limit extended to 14 weeks in 2022. The country's secularism approach as minimized the influence of religious ideologies on abortion policy, and feminist movements readily securing these rights. This comparative analysis establishes the impact of legal frameworks, political environments, and cultural contexts on women’s access to abortion services, implications for reproductive health, autonomy, and social justice.

To verify the association between reproductive autonomy and sociodemographic, sexual, and reproductive characteristics in Quilombola women (a term indicating the origin of politically organized concentrations of Afro-descendants who emancipated themselves from slavery). Cross-sectional and analytical study with 160 women from Quilombola communities in the southwest of Bahia, Brazil. Data were collected using the Reproductive Autonomy Scale and the questionnaire from the National Health Survey (adapted). Out of the 160 participating women, 91.9% declared themselves as black, one out of every three were aged ≤ 23 years, 53.8% were married or had a partner, 38.8% had studied for ≤ 4 years, over half (58.1%) were unemployed, only 32.4% had a monthly income > R$ 430 (80 US dollars), 52.5% had their first menstruation at the age of 12, 70.7% had not accessed family planning services in the last 12 months, and over half used some method to avoid pregnancy (59.0%). The women had a high level of reproductive autonomy, especially in the "Decision-making" and "Freedom from coercion" subscales with a score of 2.53 and 3.40, respectively. A significant association (p<0.05) was found between the "Total reproductive autonomy" score and marital status, indicating that single or unpartnered women had higher autonomy compared to married or partnered women. The association of social determinants of health such as marital status, education, and age impacts women's reproductive choices, implying risks for sexual and reproductive health. The intergenerational reproductive autonomy of Quilombola women is associated with sociodemographic and reproductive factors.

Miscarriage of pregnancy is widely experienced and seldom discussed. Because of the surpassing silence on the subject, experiences of miscarriage may be misunderstood, difficult to articulate, and isolating, and attitudes toward miscarriage may be under-informed. Women are more likely to be offered cultural information on what to expect when we are expecting, than we are to be offered preparation for, or recognition of, the unexpected. Philosophers can, and should, contribute to changing that by promoting discourse on miscarriage as an experience which is meaningful, and significant to self-understanding and social awareness, and by providing a contextual realm in which related discussions of pregnancy, fertility loss, and fetal death could take place. The implications of reflections on the phenomenon of miscarriage for many lines of inquiry turn out to be multifold. To date, unfortunately, philosophers have not been central participants in theorizing about miscarriage, pregnancy loss, or fetal death outside of the confines of abortion debates.1 We ought to be concerned about the risks of furthering the social and academic silence surrounding phenomena that so many have experienced, and that raise important questions regarding grief and loss, the social construction of pregnancy, technological developments, social recognition, and, to put it grandly, the nature of human life. As our contributors observe, one reason at least for the silence on miscarriage is obvious: addressing and conceptualizing the loss that is central to some (and not all) experiences of miscarriage may risk undermining some central principles of reproductive freedom. As feminist philosophers, we are certainly sympathetic to such concerns. We suggest that the riskiness of theorizing about miscarriage, and its implications for applied philosophical arguments with respect to abortion, seem to us to be compelling reasons why this issue is especially important to offer. The practice of philosophical investigation includes the social practices of cooperatively facing our reasons for ignoring some topics while devoting attention to related issues. Existing accounts of meaning in reproductive contexts—especially those put forward in debates concerning abortion—tend to focus on the (moral) status of the fetus. This is true even of relational accounts aimed at promoting reproductive autonomy by highlighting the ways in which the fetus is inseparable from the woman who carries it. It will probably not come as a surprise that we hope this issue on miscarriage, pregnancy loss, and fetal death accomplishes a shift this conversation, in the direction of pushing past embryo-centric value judgments. In part this is because, to put it bluntly, the miscarried embryo is not the one who has to live with the experience. The essays in this special issue are a significant addition to the scarce literature on miscarriage and fetal death. Contributions are from specialists in continental and analytical philosophy, feminism, bioethics, theoretical and applied ethics, social and political philosophy, social epistemology and philosophy of language, narrative, aesthetics, popular culture, and gender studies. As guest editors, we sought to offer a variety of approaches to the topic, to further the understanding of miscarriage and fetal death as important to many areas of philosophy, especially social philosophy. We suggest that the unchosenness and invisibility of miscarriage are central to its seeming irrelevance to social identities and social norms of testimony, recognition, and ascription of significance to experiences. The first several contributions to this volume focus on the phenomenon of miscarriage and its meanings. In “‘The Event That Was Nothing’: Miscarriage as a Liminal Event,” Alison Reiheld argues that miscarriage is poorly understood and that people find it difficult to make sense of the experience of miscarriage for the reason that it is a liminal event—an event suspended in a space between socially recognized states. Reiheld identifies four distinct, but related, dimensions along which miscarriage is liminal: parenthood, procreation, death, and abortion. In relation to parenthood, miscarriage halts the transition from not being a parent to being a parent to the child that would have been born. In relation to procreation as a result of a specific pregnancy, miscarriage lies between having procreated and having not procreated. In relation to death, it is not clear whether miscarriage involves the death of someone or the loss of (potential) life given the lack of social agreement about the status of embryos and fetuses. In relation to abortion, miscarriage lies in the space between the social categories of induced abortion and pregnancy. Reiheld argues that, as a result of its liminality, miscarriage has been enrolled in social and moral debates that are not really about miscarriage at all. These include debates about the permissibility of abortion and debates about control over pregnancy. By considering particular laws bearing on miscarriage, Reiheld points to some of the dangers resulting from our failure to separate miscarriage from the states between which it is suspended. Reiheld's hope is that a better understanding of miscarriage's liminality will help us respond in better ways to women who experience miscarriage and avoid enrolling their experiences in debates that really have little to do with miscarriage. In “Early Pregnancy Losses: Multiple Meanings and Moral Considerations,” Amy Mullin draws on literature from a variety of disciplines to highlight some of the complex and variable features of the ethical terrain related to pregnancy loss. She then considers, specifically, the moral significance of early pregnancy loss—that is, pregnancy loss that occurs before the fetus is sentient and before the fetus is able to survive outside of the womb. Mullin points to problems with arguments that tie the moral status of the fetus to the question of whether the fetus is a person. These include the argument, defended by many feminist scholars, that the moral status of a fetus depends on the extent to which other people, and especially pregnant women, construct their fetuses as persons. Mullin proposes another way of understanding the moral significance of early pregnancy loss. Specifically, she postulates that the loss of embryos or early fetuses can be morally considerable for the reason that embryos and early fetuses have the potential to survive until infancy and to become members of the moral community (a potential resting on both the features of the fetus itself and the plans of the pregnant woman). If we accept this postulate, we are able to understand miscarriage as a loss of a being that is morally considerable without presupposing that every person will respond to pregnancy loss in the same way and without abandoning respect for reproductive autonomy. In “Miscarriage and Intercorporeality,” Ann J. Cahill develops a philosophical account of pregnancy that allows the possibility of recognizing the suffering of persons who experience miscarriage without undermining reproductive rights. Cahill resists the relational model of pregnancy defended by many feminist scholars and invoked in the accounts of miscarriage defended by Carolyn McLeod and Kate Parsons.2 On a relational model, pregnancy is conceived of as a severable relation between two distinct individuals where the pregnant woman can attach moral and emotional significance to the relationship (and indeed to the fetus) as though she were somehow outside of the relationship, whereas the fetus cannot. While Cahill acknowledges that a relational model of pregnancy has much to recommend it, she argues that this model is problematic in so far as it rests on an individualism that precludes recognition of the ways in which the lived, embodied experience of pregnancy is transformative of the pregnant woman's subjectivity. Cahill draws on Rosalyn Diprose's notion of corporeal generosity—the prereflective openness to otherness and being given to others that constitutes social relations—to account for pregnancy and miscarriage in a manner that reflects the intersubjectivity, rather than mere relationality, of these phenomena.3 Cahill holds it to be an ontological fact that identities are constructed only through interaction with other embodied beings such that the identity of any subject is tied to and implicated in the identity of other bodies and identities. She argues that the identity being constructed by the pregnant person as a pregnant person (as an expectant parent, for instance) is inescapably intertwined with the existence of the fetus. Miscarriage is, on this account, disorienting and gives rise to many, often conflicting, emotions in so far as it ends the transformative experience of pregnancy—often with painful and sometimes long-lasting physical effects—and calls into question the identity under construction. In her contribution, “Miscarriage and Person-Denying,” Lindsey Porter considers one way in which reflecting on miscarriage and people's reactions to miscarriage can inform debates about the moral status of abortion. Specifically, she argues against person-denying arguments for the moral permissibility of abortion—arguments aimed at establishing the permissibility of abortion on the grounds that the fetus is not a person and, thus, lacks moral status. Porter observes that grief is a common response to miscarriage and suggests that grief following miscarriage is evidence that some people experience miscarriage as the loss of a loved one. She draws on Martha Nussbaum's account of grief to argue that grief following miscarriage presupposes that the fetus is something that should be given moral consideration—something with moral status.4 Porter argues that, if the person-denying argument works, it works only in the “strong form” in which it is understood that the fetus is entirely outside of the sphere of moral concern. Thus, unless we dismiss people who grieve following miscarriage as being mistaken about the significance of their loss, something Porter is unwilling to do, we must reject person-denying arguments. Along with other authors contributing to this volume, Porter is very clear that her argument is not meant to undermine reproductive autonomy. Even if we reject person-denying arguments, the permissibility of abortion might be defended on other grounds. The next several contributions focus on the ways in which experiences of miscarriage are shaped by social scripts and narrative-sharing spaces (or lack of same). While several authors contributing to this volume note with dismay the social silence surrounding the phenomenon of pregnancy loss, Hilde Lindemann's “Miscarriage and the Stories We Live By” reminds us of the relevance of narrative even with regard to things rarely spoken of. She considers that the stories by which people in English-speaking societies identify a woman who is pregnant as an “expectant mother” commonly look forward to, and converge on, the birth of the child. As such, it is easy to make sense of who a woman is when she is pregnant and it is easy to respond well to what the pregnant woman does to express who she is. In contrast, it is often difficult to know how to respond well to a woman who has miscarried. Lindemann argues that we do not lack stories by which to make sense of miscarriage. Rather, she contends that the difficulty lies in determining which stories help us respond well to people who experience a miscarriage. Lindemann suggests one condition: the stories we construct must reflect that miscarriage involves the loss of something valuable to the pregnant woman, to the fetus, or both. Recognizing that pregnancy is not purposeful in every respect, Lindemann argues for an account of pregnancy that emphasizes the agency of the pregnant woman—the creative activity that includes transforming biological processes in purposeful and deliberate ways by caring for, valuing, and giving meaning to (or otherwise coming to terms with) the natural processes of pregnancy in addition to the social activity of creating the stories that constitute the identity of the ‘child’ and the identity of the pregnant woman as an expectant mother. Lindemann also emphasizes the need to listen to the stories the woman is telling—her stories may or may not represent her as having suffered a loss. Whatever story we tell to make sense of miscarriage must represent the loss to the fetus. In “The Value of Pregnancy and the Meaning of Pregnancy Loss,” Byron Stoyles considers the meaning and value of pregnancy to conceptualize pregnancy loss and reactions to pregnancy loss. Stoyles begins by reflecting on the different ways in which philosophers engaged in debates about the moral and legal status of abortion conceptualize the meaning of pregnancy. He argues that most of the arguments found in the literature about abortion (including most feminist arguments) are fetal-centric in the sense that they focus on the status of the fetus to such an extent that the value and meaning of pregnancy as something involving persons other than the fetus is mostly ignored. Stoyles then builds on Hilde Lindemann's account of the value and meaning of pregnancy by considering how value in pregnancy can derive from both the activity Lindemann calls “calling the fetus into personhood” (an idea she explains in her contribution to this volume) and what he calls the activity of creating an identity as a parent. Stoyles argues that the recognition of these related activities allow us to make sense of common—albeit diverse and sometimes conflicting—reactions to pregnancy loss including confusion about the identity of the would-be parents and the fetus. In “Making Sense of Miscarriage Online,” Sarah Hardy and Rebecca Kukla explore ways in which women who have experienced miscarriage give narrative shape to their experiences online. Hardy and Kukla begin by noting ways in which it is difficult to make sense of miscarriage against the backdrop of medical institutions and practices in so far as miscarriage is treated as medically significant (as most matters related to pregnancy are), but also as something that happens mostly outside of the medical context. Using examples from Facebook, discussion boards, and blogs, Hardy and Kukla consider how women use online fora to articulate the experience of miscarriage and to shape their narrative identity outside of the medical context. They also consider ways in which online fora provide opportunities for other people to give uptake to women's responses to miscarriage by posting comments and stories affirming women's responses to miscarriage as meaningful. In their contribution, Hardy and Kukla point to a number of ways in which the functional structure of different online spaces influence the kind and quantity of content posted. Facebook, for example, allows each author extensive control over the content of her own page whereas discussion boards are inherently more conversational. Despite such differences, Hardy and Kukla contend that the internet provides important social tools for creating new kinds of collaborative interaction. Engaging online, women can maintain their anonymity, create multiple (even incompatible) narrative threads simultaneously, and otherwise make sense of the experience of miscarriage in a more or less collaborative way. The last two contributions focus more explicitly on ethical questions surrounding fetal death. In “Rethinking Abortion, Ectogenesis, and Fetal Death,” Christine Overall proposes a revised understanding of abortion and argues that pregnant women are entitled to choose abortion as this is understood to include both ending the life of the fetus in utero and the evacuation of the uterus. This view is a departure from Overall's earlier view that pregnant women are entitled to choose uterine evacuation but not to end the life of the fetus if it could survive by means of ectogenesis (gestation within an artificial uterus).5 Overall outlines how she has changed her view after considering objections to her earlier work. Specifically, the view Overall defends in her contribution to this volume is aimed at rethinking abortion in a way that is consistent with pregnant women's bodily autonomy and women's right to not reproduce. The former reflects Overall's view that the pregnant woman's relationship to the fetus determines what can be done for or to it (on Overall's account, the fetus has no independent moral status until it emerges from the woman's body) and respects that women's bodily autonomy should include being entitled to determine what happens not only to one's body but also to one's body parts and the products of one's body (including the fetus). The latter respects that reproductive autonomy should reflect a right not to reproduce and the reality that a woman might want there to be no genetic offspring resulting from the pregnancy that is ended. Though Overall argues for the right for the pregnant woman to kill the fetus in utero, she opposes “after-birth abortion” for the reason that, on her view, an infant does not have the same moral status as a fetus. Since an infant is no longer in the same relationship to the pregnant woman as a fetus, a woman's entitlement to end the life of the fetus ends once it is removed from her body. Overall goes on to consider moral questions and potential problems related to the possibility of ectogenesis which she no longer regards as part of the solution to debates related to abortion. The collection closes with Sarah Clark Miller's “The Moral Meanings of Miscarriage,” in which she attends to the range of ethical challenges presented by complex and varied responses to miscarriage. Miller articulates the urgency of the need for a “perinatal ethics,” that is, not just a prenatal bioethics which tends to be the focus of clinical obstetrics literature, but a more robust ethical approach that addresses the moral issues that arise before, during, and after pregnancy, appreciative of the changes in a woman's identity over the course of the arc of miscarriage experience. Miller contends that miscarriage exceeds the standard categories of ethical analysis, involving the blending of moral agent and moral patient in the same individual, the presence of distinctive reactive attitudes along with social and political denial of recognition that an event occurred at all, the moral standing of fetal life, and the moral self-understanding of women who suffer pregnancy loss. Miller concludes that, absent a better formulation of ethics regarding miscarriage, we are in danger of neglecting the moral considerability of women when we fail to attend to their moral emotions regarding their pregnancy losses. Even these brief synopses indicate some fruitful and productive overlaps among the diverse articles that comprise this volume. There is controversy, for example, over the centrality of loss with regard to miscarriage; Cahill rejects the narrative of loss, while Lindemann argues that loss accrues to the fetus as well. The collected articles draw important connections between miscarriage and elective abortion, two phenomena that in common discourse are viewed as entirely distinct. To the contrary, our authors (especially Overall, Stoyles, and Porter) articulate important ways in which ways of thinking about abortion can affect our understanding of miscarriage, and vice versa. Mullin and Miller argue that paying philosophical attention to miscarriage should and must transform our understanding of the ethics of pregnancy and reproductive autonomy, and while Reiheld provides the most detailed account of the liminality of miscarriage, several other articles address its uncanny nature, the slippery in-betweenness that may contribute to the social and intellectual silence that surrounds the topic. Finally, almost every article in the collection mentions that silence, but Kukla and Hardy describe the way that cyberspace not only provides an opportunity for the sharing of narratives, but in fact shapes those narratives in significant ways. Yet unexplored questions remain. Reiheld's contribution articulates some of the ways that the liminality of miscarriage intersects with laws regarding pregnancy to increase the vulnerability of pregnant bodies; yet even more attention is needed to the various ways in which miscarriage has been criminalized, leading to the incarceration of women who have experienced pregnancy loss.6 There is more to be said too about the experience of the partners (of all sexes) of pregnant persons who have experienced miscarriage. What philosophical meanings can be found in an embodied experience that happens to another that has potentially transformative effects on the partner's own (perhaps embodied) subjectivity? Finally, the intriguing parallels between miscarriage and elective abortion need further exploration. How might recognizing the similarities between these phenomena (without ignoring their important differences) assist in reframing the political discourse on reproductive autonomy? These questions and, we are sure, many others, would benefit from further attention. Thus it is our hope that this volume is merely the beginning of a long-standing, vigorous philosophical exploration of these common, yet all too frequently ignored, experiences. The editors would like to express their gratitude to the Kenneth Mark Drain Chair in Ethics at Trent University Trust for funds to make this issue open access in entirety.