Biological Children Research Articles

The gendered context of women charged with violent offences in the forensic psychiatric setting.

Women charged with violent offences may be referred by courts for forensic psychiatric assessment to determine whether mental disorder or intellectual disability impacts their fitness to stand trial and/or criminal responsibility. The profile of these women is a poorly researched area in South Africa. This study examined the socio-demographic, offence-related, and clinical profile of South African women charged with violent offences referred for forensic assessment. Fort England Hospital (FEH), a forensic psychiatric institution in the Eastern Cape. The clinical records of 173 women referred by courts for forensic psychiatric evaluation over a 24-year period (1993-2017) to FEH were systematically reviewed. Most women were single, black mothers with dependent children, who were unemployed and socio-economically impoverished. Many had backgrounds of pre-offence mental illness, alcohol use and alleged abuse. The majority were first-time offenders whose victims were known to them. Most child victims were biological children killed by their mothers. Likely primary motives for violence were related to psychopathology in half of cases, and interpersonal conflict in a third. Forensic assessment most frequently confirmed psychotic disorders and dual diagnoses. Half the cases were fit to stand trial and under half were criminally responsible. Violent female offending occurs within a gendered context, with high rates of prior trauma, alcohol use and psychosocial distress in perpetrators. An emphasis on gender-sensitive psychosocial interventions is required. This study highlights the nature and context of violent offending by women referred for forensic psychiatric assessment in South Africa.

Social Implications of In Vitro Fertilisation (IVF) on Women in India

In vitro fertilisation (IVF) is a technological innovation enabling infertile women to conceive through medical procedures. However, social inferences of IVF need to be contextualised within gender dynamics, especially in India. Though several studies have examined specific social aspects of IVF none have delineated the combination of determinants as well as implications of IVF for women. The present study assesses various social factors influencing choices for infertility treatments like IVF, and also the implications for women undergoing IVF. For a nuanced understanding of these conditions in the larger social context of India, 41 studies discussing important indices like gender dynamics, health status, power relations and social vulnerabilities of women experiencing IVF have been critically reviewed. Based on the review we contend that social pressures, gender identity, desire for a biological child, fear of marital discord and loss of self-esteem are most important factors determining such decisions.

Assessing Chemical Intolerance in Parents Predicts the Risk of Autism and ADHD in Their Children.

We sought to replicate our 2015 findings linking chemical intolerance in parents with the risk of their children developing autism and/or ADHD. Drawing upon our 2021 discovery of a strong association between chemical intolerance and mast cells, we propose an explanation for this link. In a population-based survey of U.S. adults, we used the internationally validated Quick Environmental Exposure and Sensitivity Inventory (QEESI) to assess symptom severity and chemical intolerance. Parents were asked how many of their biological children had been diagnosed with autism and/or ADHD. Parents with chemical intolerance scores in the top versus bottom tenth percentile had 5.7 times the risk of reporting a child with autism and 2.1 times for ADHD. High chemical intolerance scores among parents of children with autism, coupled with our 2021 discovery of mast cell activation as a plausible biomechanism for chemical intolerance, suggest that (1) the QEESI can identify individuals at increased risk, (2) environmental counseling may reduce personal exposures and risk, and (3) the global rise in autism and ADHD may be due to fossil-fuel-derived and biogenic toxicants epigenetically "turning on" or "turning off" critical mast cell genes that can be transmitted transgenerationally. It is important to note that this study was observational in nature; as such, further research is needed using controlled trials to confirm causality and explore the proposed mechanism.

(212) The Questionable Clinical Utility of Sperm Morphology: Rate of Isolated Teratospermia in a Population of Fertile Men

Abstract Introduction Over the last several decades, sperm morphology has represented a standard component of semen analysis. However, its clinical utility is not well-defined, despite continual efforts by the WHO to address critiques of semen morphology criteria through increasingly strict guidelines. Issues with intra- and inter-laboratory technical variability, in addition to the subjective nature of the morphology assessment, have been thoroughly discussed in existing literature. Furthermore, current literature has highlighted the low predictive value of sperm morphology abnormalities in assisted fertility treatment (ART) and natural pregnancy outcomes. As of 2020, the American Society for Reproductive Medicine (ASRM) guidelines have noted that morphology alone is not highly predictive or diagnostic of infertility. However, past survey studies have demonstrated the pervasive belief among physicians of the value of sperm morphology, potentially leading to counseling patients towards more expensive ART methods. These concerns call into question the emphasis placed on sperm morphology assessment and its value in the clinical setting. Objective To better understand the impact of sperm morphology on fertility, we assessed sperm morphology in a population of known fertile men. Methods Healthy men over 18 years of age were recruited to provide one semen sample prior to vasectomy from March 2020 through November 2022. Inclusion criteria for the study was as follows: (1) patients were required to have biological children under the age of 5 years old, with no history of difficulty achieving pregnancy, and (2) had undergone no prior fertility procedures. Sperm morphology was analyzed using Papanicolaou stain with Kruger strict criteria by two technicians in an Andrology specialty laboratory per the WHO 5th edition manual. Results There were 83 men who participated in the study, 68 of whom (81.9%) had a complete sperm morphology assessment available. On average, participants were 37 years of age and had a mean BMI of 28 (22.8, 33.2). Of those with a smoking history available (n=61), 38 (62.3%) were non-smokers, 7 (11.5%) were former smokers, and 16 (26.2%) were current smokers. Patients had an average of 3 children with a mean youngest child age of 11.5 months old. There were 38 patients (55.9%) with 3% or lower normal sperm morphology, including two patients who had 0% normal morphology (Table 1). The most common morphologic abnormalities were head shape defects (n=59, 84.3%), followed by coiled tails (n=14, 20.3). Men 3% or lower normal sperm morphology were four times as likely to have both head and tail abnormalities than men with 4% or greater normal sperm morphology (n=8 vs n=2, respectively); half of these men also had lower than normal motility, whereas none of the men with 4% or greater normal sperm morphology had lower than normal motility. Conclusions More than half of fertile male patients (65.6%) had lower than normal sperm morphology in our study. The results of our study further question the clinical relevance of sperm morphology on fertility outcomes and if the current approach in assessing morphology is too strict. Disclosure No.

Norwegian Biological Parents and Stepparents' Attitudes Towards Family Obligations in Middle and Old Age.

This study investigated the associations between the current family structure and the agreement with family obligations in middle and old age. It also tested whether gender differences exist in these associations. Based on research that has observed steprelationships tend to be less close than biological relationships are, it is argued that older individuals who are stepparents have lower agreement with family obligations than their counterparts in biological families have. The analytical sample was drawn from the Norwegian Life Course Ageing and Generation survey and consisted of 5564 individuals aged 50 and older. Findings suggest that individuals who do not have biological children but who are stepparents to their partners' children agree more with filial obligations and less with parental obligations than biological parents do. The findings extend knowledge on diverse family structures in old age.

Reproductive late effects and testosterone replacement therapy in male childhood cancer survivors: A population-based study (the Fex-Can study).

Childhood cancer survivors are at risk of various endocrine late effects affecting their quality of life. The aim of this study was to assess the prevalence and predictors of endocrine and reproductive outcomes in young adult survivors. A secondary aim was to assess possible associations between testosterone replacement therapy (TRT) and other endocrine, cardiovascular and psychosocial late effects. This nationwide study comprised 1212 male childhood cancer survivors aged 19-40 years, identified through the National Quality Registry for Childhood Cancer in Sweden. Median age at diagnosis during 1981-2017 was 7 (range 0-17) and at study 29 (19-40) years. The study combined self-report survey data with cancer treatment data from the national registry. Hormone-induced puberty was self-reported by 3.8% of the survivors and ongoing TRT by 6.0%. In separate logistic regression analyses, these treatments were associated with hematopoietic stem cell transplantation and cranial radiotherapy. Hormone-induced puberty was additionally associated with younger age at diagnosis. Men with TRT had a higher prevalence of other endocrine deficiencies, cholesterol medication, depressive symptoms and fatigue as well as a lower probability of living with a partner, having a biological child or current occupation. In the total male cohort, 28.2% reported having a biological child. Reassuring reproductive outcomes after less intensive therapies and low frequency of TRT were observed in young adult male childhood cancer survivors treated in the most recent treatment era. However, men with TRT suffered from several other endocrine, cardiovascular and psychosocial late effects, indicating a need for long-term monitoring of this high-risk group.

The pernicious role of stress on intergenerational continuity of psychopathology.

Development and Psychopathology has been a premier resource for understanding stressful childhood experiences and the intergenerational continuity of psychopathology. Building on that tradition, we examined the unique and joint influences of maternal stress on children's effortful control (age 7) and externalizing behavior (age 11) as transmitted via genetics, the prenatal environment, and the postnatal environment. The sample included N = 561 adopted children and their biological and adoptive parents. Path models identified a direct effect of biological mother life stress on children's effortful control (β = -.08) and an indirect effect of her life stress on child externalizing behavior via effortful control (β = .52), but no main or indirect effects of biological parent psychopathology, prenatal stress, or adoptive mother adverse childhood experiences (ACES). Adoptive mother ACES amplified the association between biological mother life stress and child effortful control (β = -.08), externalizing behavior (β = 1.41), and the indirect effect via effortful control, strengthening associations when adoptive mothers reported average or high ACES during their own childhoods. Results suggest that novel study designs are needed to enhance the understanding of how life stress gets "under the skin" to affect psychopathology in the offspring of adults who have experienced stress.

Paternal Orphanhood, Parental Illness, and Child’s Biological Relationship to Household Head: Their Impact on Child Health in Nigeria

Abstract This research fills a hole in the literature by investigating whether, in Nigeria, differences exist in the health of paternal orphans or vulnerable children depending on whether they have a close biological relationship with the household head compared to a distant relationship when health is measured through diarrhea, fever, and cough. The research analyzes the 2013 Nigeria Demographic and Health Survey Data and employs a multi-level logistic regression as the model estimation technique. The results show that, regardless of the measure of child health, among paternal orphans or vulnerable children there is no significant difference in the health of grandchildren or children who are relatives/non-relatives of their household head in contrast to biological children of the household head. Further, results indicate that, among non-orphans or non-vulnerable children, there is a positive and statistically significant difference only in the odds of diarrhea for grandchildren compared to biological children. The devotion of foreign aid in social and health services in 2011–2013 from the United States Agency for International Development (USAID) for only orphans and vulnerable children, alongside contributions from the Nigeria government and other organizations, alleviated poor health status among said children.

Проблемы применения презумпции при установлении отцовства

Introduction. Current Russian legislation regulates the procedure for establishing a legal connection between a born child and his or her father, however, in practice, problems with applying the presumption arise when establishing paternity. The problem is caused by the fact that it is the marital relationship of the child’s parents that establishes paternity, and not any biological relationship between the child and the father. In the context of family law, perhaps the most significant legal presumption is the presumption of paternity. However, as technology advances and the institution of family develops, determining paternity becomes increasingly complex. The legal significance of the presumption of paternity lies in the fact that with its help spouses are freed from proving the origin of a child born during marriage. The presumption of paternity is based on the presumption of validity of marriage, which assumes that spouses enter into marriage voluntarily and with the intention of having children. This presumption serves to protect the rights and interests of the child, providing him or her with a stable and safe family environment. It also protects spouses from unfounded accusations of infidelity or adultery. However, the presumption of paternity is not absolute and can be rebutted in court if irrefutable evidence is presented that the child is not the biological child of the spouse. The impact of this legal instrument is felt most when it is least expected. Most often, when a married couple separates without divorcing or if the woman becomes pregnant (whether married or not), in the case of the birth of a child from a surrogate mother. In these and similar situations, there is a presumption that the husband is the father. Theoretical analysis. The main theoretical approaches to and grounds for the use of presumption in establishing paternity, both for the married and unmarried, are considered. Empirical analysis. The normative acts in the field of the application of the presumption of paternity, including foreign experience, are analyzed. Results. The author comes to the conclusion that it is necessary to apply an out-of-court procedure to overcome the presumption of paternity in cases of the birth of a child from a woman married to another man, as well as the need for state funding of genetic testing to ensure the use of DNA analysis as the only proof of kinship of the father and the child.

Current Status and Future Prospects of Stem Cell Therapy for Infertile Patients with Premature Ovarian Insufficiency.

Premature ovarian insufficiency (POI), also known as premature menopause or premature ovarian failure, signifies the partial or complete loss of ovarian endocrine function and fertility before 40 years of age. This condition affects approximately 1% of women of childbearing age. Although 5-10% of patients may conceive naturally, conventional infertility treatments, including assisted reproductive technology, often prove ineffective for the majority. For infertile patients with POI, oocyte donation or adoption exist, although a prevalent desire persists among them to have biological children. Stem cells, which are characterized by their undifferentiated nature, self-renewal capability, and potential to differentiate into various cell types, have emerged as promising avenues for treating POI. Stem cell therapy can potentially reverse the diminished ovarian endocrine function and restore fertility. Beyond direct POI therapy, stem cells show promise in supplementary applications such as ovarian tissue cryopreservation and tissue engineering. However, technological and ethical challenges hinder the widespread clinical application of stem cells. This review examines the current landscape of stem cell therapy for POI, underscoring the importance of comprehensive assessments that acknowledge the diversity of cell types and functions. Additionally, this review scrutinizes the limitations and prospects associated with the clinical implementation of stem cell treatments for POI.

A step closer to parenthood with non-obstructive azoospermia: Unveiling the impact of microdissection testicular sperm extraction in Australia's largest single-centre study.

Non-obstructive azoospermia (NOA) diagnosis poses challenges for couples seeking parenthood. Microdissection testicular sperm extraction (MD-TESE) excels in retrieving testicular sperm cells for NOA cases. However, limited live birth data in Australian NOA patients hinders accurate counselling. This study aimed to determine the likelihood of infertile couples with a male partner diagnosed with NOA conceiving biological children using MD-TESE / intracytoplasmic sperm injection (ICSI). A retrospective cohort study included 108 NOA men treated at a public fertility unit and a private fertility centre (May 2009-May 2022). live birth rate (LBR); secondary outcomes: sperm retrieval rate, pregnancy rate, and neonatal outcomes. Among 108 patients undergoing MD-TESE, the positive sperm retrieval rate (PSRR) was 64.8% (70/108). Histology best predicted sperm retrieval success, with hypo-spermatogenesis yielding a 94.1% PSRR. Age, testicular volume, and hormonal parameters had no significant impact. Mean male age: 35.4 years; mean partner age: 32.7 years. Fertilisation rate: 50.7%. LBR per initiated cycle: 58.7% (37/63); per embryo transfer: 63.8% (37/58); per initially diagnosed NOA man: 34.3% (37/108). Cumulative LBR: 74.1% (43/58); twin rate: 10.8% (4/37). No neonatal deaths or defects were observed among 47 live offspring. This study provides valuable data for counselling NOA couples on the probability of conceiving biological offspring. MD-TESE and ICSI yielded favourable PSRR (64.8%) and LBR (63.8%). However, couples should be aware that once NOA is confirmed, the chance of taking home a baby is 34%.

Navigating Fertility Preservation and Family Planning for Transgender Men: Exploring Options and Psychological /Social Factors

Navigating fertility preservation and family planning can be a daunting task for anyone, but it can be particularly challenging for transgender men. Fertility preservation is the process of saving eggs, sperm, or embryos for future use. This is especially important for transgender men who want to have biological children in the future. Family planning is the process of choosing when and how to have children. For transgender men, it can be a complicated decision due to the psychological and social factors involved. In this post, we will explore the options available for fertility preservation and family planning for transgender men. We will also examine the psychological and social factors that may influence these decisions, including the impact of hormone therapy on fertility, societal pressures, and personal beliefs. By the end of this post, you will have a better understanding of the options available to you and the factors to consider when making these important decisions.

(375) Assessing Infertility Literacy and Knowledge Gaps Amongst Patients with Cystic Fibrosis

Abstract Introduction As patients with cystic fibrosis live longer into their reproductive years, fertility concerns are rising. We hypothesized that while patients with CF may be informed of the impact of their disease on their reproductive potential, they remain unaware of the promising role of assisted reproductive technology (ART) in helping them conceive biological children. Objective Employ a cross-sectional survey to understand experiences, preferences, and current concerns in the CF community around infertility education and infertility healthcare access. Methods This study was reviewed and approved as exempt status by the Institutional Review Board (IRB) exemption as non-human research. We distributed a voluntary and anonymous Qualtrics survey to CF patients and CF advocacy organizations to assess patient understanding of infertility within CF. The survey consisted of 21 questions and aimed to capture demographics, reproductive education specific to CF, preferences on infertility education, current conception practices, and any infertility treatment. Preference questions were assessed using the Likert Scale, and personal experiences questions were answered through free text. Results Forty-one respondents completed the survey (median age of 36 ± 14 years). The median age reported for learning about CF-associated infertility was 18 years. Respondents preferred that reproductive and infertility education be provided early; 43% reported the optimal age of education was younger than 18 years while 50% reported between 18-24 years. Of the respondents trying to conceive, 43% of patients have been trying to conceive for 1-3 years qualifying for infertility. Yet, the majority of those patients (69%) have not been offered semen analysis and 90% have not had previous fertility treatments. Conclusions Patients with CF are highly educated and empowered regarding the chronic treatment of their disease. Historically, issues regarding infertility and conception have been cast to the side, given the severity of other issues, such as lung function and survival. As CF patients live longer and healthier lives, they seek healthcare in other facets, including reproduction and infertility. The findings in our study highlight the importance of discussing reproduction and its limitation in CF at a young age to preemptively empower and prepare patients and their future partners. Furthermore, our study demonstrates a strong need to strengthen the communication between CF care teams and fertility specialists. Both men and women with CF would benefit from receiving respective guidance from embryologists and andrologists to maximize their chances of conception. Disclosure Yes, this is sponsored by industry/sponsor: Cystic Fibrosis Foundation. Clarification: No industry support in study design or execution.

Proteins in Scalp Hair of Preschool Children

Background. Early childhood experiences have long-lasting effects on subsequent mental and physical health, education, and employment. The measurement of these effects relies on insensitive behavioral signs, subjective assessments by adult observers, neuroimaging or neurophysiological studies, or retrospective epidemiologic outcomes. Despite intensive research, the underlying mechanisms of these long-term changes in development and health status remain unknown. Methods. We analyzed scalp hair from healthy children and their mothers using an unbiased proteomics platform combining tandem mass spectrometry, ultra-performance liquid chromatography, and collision-induced dissociation to reveal commonly observed hair proteins with a spectral count of 3 or higher. Results. We observed 1368 non-structural hair proteins in children and 1438 non-structural hair proteins in mothers, with 1288 proteins showing individual variability. Mothers showed higher numbers of peptide spectral matches and hair proteins compared to children, with important age-related differences between mothers and children. Age-related differences were also observed in children, with differential protein expression patterns between younger (2 years and below) and older children (3–5 years). We observed greater similarity in hair protein patterns between mothers and their biological children compared with mothers and unrelated children. The top 5% of proteins driving population variability represented biological pathways associated with brain development, immune signaling, and stress response regulation. Conclusions. Non-structural proteins observed in scalp hair include promising biomarkers to investigate the long-term developmental changes and health status associated with early childhood experiences.

Exploring women’s interpretations of survey questions on pregnancy and pregnancy outcomes: cognitive interviews in Iganga Mayuge, Uganda

BackgroundIn 2021, Uganda’s neonatal mortality rate was approximately 19 deaths per 1000 live births, with an estimated stillbirth rate of 15.1 per 1000 total births. Data are critical for indicating areas where deaths occur and why, hence driving improvements. Many countries rely on surveys like Demographic and Health Surveys (DHS), which face challenges with respondents’ misinterpretation of questions. However, little is documented about this in Uganda. Cognitive interviews aim to improve questionnaires and assess participants’ comprehension of items. Through cognitive interviews we explored women’s interpretations of questions on pregnancy and pregnancy outcomes.MethodsIn November 2021, we conducted cognitive interviews with 20 women in Iganga Mayuge health and demographic surveillance system site in eastern Uganda. We adapted the reproductive section of the DHS VIII women’s questionnaire, purposively selected questions and used concurrent verbal probing. Participants had secondary school education and were English speaking. Cognition was measured through comparing instructions in the DHS interviewers’ manual to participants’ responses and researcher’s knowledge. A qualitative descriptive approach to analysis was undertaken.ResultsWe report findings under the cognitive aspect of comprehension. Some questions were correctly understood, especially those with less technical terms or without multiple sections. Most participants struggled with questions asking whether the woman has her living biological children residing with her or not. Indeed, some thought it referred to how many living children they had. There were comprehension difficulties with long questions like 210 that asks about miscarriages, newborn deaths, and stillbirths together. Participants had varying meanings for miscarriages, while many misinterpreted stillbirth, not linking it to gestational age. Furthermore, even amongst educated women some survey questions were misunderstood.ConclusionsPopulation surveys may misclassify, over or under report events around pregnancy and pregnancy outcomes. Interviewers should begin with a standard definition of key terms and ensure respondents understand these. Questions can be simplified through breaking up long sentences, while interviewer training should be modified to ensure they thoroughly understand key terms. We recommend cognitive interviews while developing survey tools, beyond basic pre-testing. Improving respondents’ comprehension and thus response accuracy will increase reporting and data quality.

Penyuluhan Status Harta Waris Islam Terhadap Anak Angkat kepada Seluruh Civitas Universitas Sains Islam Malaysia

This Community Service (PKM) focuses on providing counseling about the legal status of adopted children's inheritance rights from their adoptive parents. An adopted child is a child whose rights have been transferred from the family environment and authority of the biological parents, legal guardians, or other persons responsible for caring for, educating and raising the child. The legal status of adopted children in the perspective of laws in Indonesia and Malaysia is legal, however it then becomes an issue when faced with their rights within the inheritance assets of their adoptive parents. In Islamic inheritance law, adopted children do not have legal power over inheritance rights from their adoptive parents, except through obligatory wills (wasiat wajibah). Meanwhile, in positive law, adopted children obtain equal status as biological children, so that adopted children can become heirs. This PKM program is carried out for all USIM civitas (lecturers, staff, employees, workers) in collaboration with the USIM Faroid Study Center. This PKM program aims to provide an understanding of the inheritance rights status of adopted children. This PKM program uses socialization, counseling, and mentoring methods.

Exploring workplace barriers faced by breastfeeding mothers who are PAs.

To explore physician associate/assistant (PA) mothers' breastfeeding intention, duration, as well as workplace barriers for breastfeeding among working PA mothers and to determine if specialty has an effect on breastfeeding duration. A cross-sectional online survey was administered to PA mothers who had at least one biological child while a PA student or practicing as a PA. Study participants were recruited through the American Academy of Physician Associates' special interest group, PA Moms. The 545 participants reported a breastfeeding goal of 12 months in 76.8% of births. Breastfeeding rates among participants were 96.3% at birth, 83.8% at age 3 months, 78.1% at age 6 months, and 54.8% at age 12 months. Exclusive breastfeeding rates were 77.9% at birth, 75% at age 3 months, and 42.6% at age 6 months. Workplace support from colleagues and support staff was associated with longer exclusive breastfeeding duration and any breastfeeding duration. Adequate time and place for expression of breastmilk and support from supervising or collaborating physicians were associated with longer duration of breastfeeding. Specialty had a statistically significant effect on exclusive breastfeeding duration. PA mothers failed to meet their breastfeeding goals, despite high initiation rates. Dedicated time and space to express breastmilk and workplace support may significantly improve PA mothers' breastfeeding duration.

High rate of isolated teratospermia in a population of fertile men and the questionable clinical utility of sperm morphology

ObjectiveTo better understand the impact of sperm morphology on fertility by assessing sperm morphology in a population of known fertile men. DesignProspective cohort study. SettingFertility center associated with university. Patient(s)Healthy men over 18 years of age were recruited to provide one semen sample prior to a vasectomy appointment scheduled between March 2020 through November 2022. Patients were included in the study if they had at least one biological child and no history of difficulty achieving pregnancy or fertility procedures. Intervention(s)None Main Outcome Measure(s)Sperm morphology Result(s)68 patients (mean age 36.7) were included. 38 patients (55.9%) had 3% or lower normal sperm morphology, including two patients who had 0% normal morphology. The most common morphologic abnormalities were head shape defects (n=59, 84.3%), followed by coiled tails (n=14, 20.3). Count, concentration, motility, and progressive motility were normal in more than 90% of patients. Conclusion(s)More than half of fertile male patients (55.9%) had lower than normal sperm morphology in our study. The results of our study further question the clinical relevance of sperm morphology on fertility outcomes and if the current approach in assessing morphology is too strict.

The Legal Certainty Surrounding the Status of Children Born Through in-Vitro Fertilization With a Deceased Biological Father is A Subject of Discussion

The purpose of marriage includes the desire to have offspring; however, not all married couples achieve this, often due to primary health issues. Expert doctors, armed with knowledge and technology, have discovered a method in the process of reproduction known as in-vitro fertilization (IVF). This discovery serves as a solution for married couples facing health problems. IVF is a process where egg fertilization by sperm occurs outside the female body, utilizing a fertilization tube. The resulting valid fertilization is then implanted in the wife's womb, from where the egg originated. The legal regulations for IVF are based on Law Number 36 of 2009 concerning health. Assisted pregnancy efforts can only be undertaken by legally married couples, meeting specific criteria such as fertilization materials originating from the husband and wife, with the implantation performed by authorized healthcare professionals at designated facilities. If these conditions are met, the offspring resulting from IVF is considered the biological child of the married couple. However, new challenges arise when the IVF process is conducted after the husband's demise, particularly in determining the lineage and civil rights status of the child or baby born through this process. To address these new challenges, this research aims to understand the legal status of posthumous IVF implementation and the lineage and civil rights status of children born through this process. The research is conducted through a literature review, utilizing a normative approach, with data collection from primary and secondary sources. The research findings indicate that the lineage and civil rights of a child born through posthumous IVF can be established with evidence from the biological father, demonstrated through scientific and technological means or other legal evidence establishing a blood relationship, as highlighted in Constitutional Court Decision No. 46/PUU VIII/2010.Keywords: In-Vitro Fertilization (Bayi Tabung), Legal Certainty, Civil Rights.

Optimizing HIV case identification among children and understanding remaining gaps in pediatric HIV testing in Kinshasa, DRC

BackgroundIt is critical to identify children living with HIV and initiate lifesaving antiretroviral treatment (ART) early. The Pediatric Accelerated Case Finding Effort focused on contact elicitation and HIV testing of ART clients’ biological children. We describe HIV testing and seropositivity rates following the initiative and gaps along the index testing cascade to inform pediatric HIV case finding optimization.MethodsThis mixed-methods study involved collecting monthly data on index testing outcomes, including elicitation (identifying biological children < 15 years), HIV testing and linkage to treatment from March 2020 to July 2021 in 35 facilities in Kinshasa. Data were summarized and presented for the first month (as a baseline proxy) and the entire study period. Qualitative data were collected from 14 healthcare workers participating in in-depth interviews and 33 community health workers in four focus group discussions. Audio recordings were transcribed and translated from Lingala or French into English and coded using MAXQDA software. Data were thematically analyzed according pediatric case finding barriers and strategies.ResultsAt baseline (March 2020), among 3337 eligible female index clients, 1634 (49.0%) underwent elicitation to identify children with unknown HIV status. By July 2021, all eligible clients (n = 11,734) had contacts identified. Of the contacts, 9871/11,848 (83.3%) were HIV-tested. Of contacts tested, 662 (6.7%) were diagnosed as HIV-positive, with 535 (80.8%) age 5–14 years; 99.5% initiated treatment. Providers attributed gaps in HIV testing primarily to testing refusals for children due to non-disclosure among parents and logistical or financial obstacles to transportation for tracing. COVID-19 movement restrictions and exposure fears also limited provider interactions for testing. Provider-implemented strategies included transport reimbursement, extensive counseling and alternative approaches to child testing for parents in sero-discordant relationships.ConclusionsFollowing intensified efforts around pediatric case finding, we found a high HIV positivity yield of 6.7% among previously undiagnosed children, with 81% of them aged ≥5 years. While elicitation improved over time, contact tracing for HIV testing remained the largest gap, missing opportunities to reach 17% of undiagnosed children. Ensuring adequate resources for tracing and HIV testing and supporting disclosure among couples, while emphasizing elicitation of ART clients’ biological children can help to optimize pediatric case finding.