Reproductive Care Research Articles

Provider views on vasectomy: cultural, gender, and political elements of Men's decisions to seek publicly funded services

IntroductionEvidence suggests a new demand for vasectomies following the Supreme Court's Dobbs v. Jackson Women's Health Organization [597 U.S. 215 (2022), (Dobbs)]. Vasectomies are safer and more cost-effective than tubal sterilization. Understanding how to support men's use of this procedure is important to improving sexual and reproductive health and wellbeing (SRHW). This study is an exploration of health care providers' perspectives on the gender, cultural and political influences on vasectomies at Title X-funded clinics across all regions of the US.MethodsProviders or health services staff (N = 21) at Title X-funded settings currently offering vasectomy services in their own clinics or via referral were recruited using list serve and email outreach. Participants took part in one-on-one or small group interviews about vasectomy procedures, patient experiences, and trends. A thematic analysis of interview transcripts through an iterative process of reviewing, note-taking, and discussing data assessed provider views on patient cultural, gender, and political vasectomy influences.ResultsQualitative interviews yielded four themes related to participant access to services, including income challenges, language barriers, medical distrust, and societal gender roles that stressed women's responsibility for contraception. Two additional themes focused on men's fear of losing reproductive health options and desire to “step up” to do their part to prevent unplanned pregnancies.DiscussionInterviewees stressed that vasectomy was for everyone but identified sub-groups of men who still faced logistical and social access challenges to the procedure. Providers also believed that men were concerned over reproductive justice in the US and wanted to do their part to help prevent unplanned pregnancies. They thought that the Dobbs decision may mark a turning point in reproductive care that could ultimately better public health initiatives and overall SRHW by including men in the conversation. Vasectomy education, marketing—along with policy changes that ease access, can support this goal.

The effectiveness of reproductive midwifery care with the flour albus approach: A Case Study of handling vaginal discharge in women of childbearing age

Introduction: Women of childbearing age have a higher risk of vaginal discharge than adolescents because of the frequent occurrence of pelvic inflammatory disease (PID). One of the symptoms of reproductive organ infections in women is vaginal discharge. Objective: This study aims to apply midwifery care to cases of vaginal discharge (flour albus). Methods: A descriptive method with a case study approach is used. Data was collected through primary data, including assessment and observation of the patient's health status, interviews to obtain subjective data, and direct examination for objective data. Secondary data was obtained through patient records, registered books in the KIA room, and literature studies. Result: The results showed that the symptoms of vaginal discharge in patients included thick white mucus, unpleasant odor, and itching in the genital area. The care provided uses red betel leaf water decoction as a treatment effort. After obstetric care was carried out from July 16 to 20, 2024, the results were obtained that the patient's vaginal discharge improved without signs of genetic infection. Conclusion: The success of this care is also marked by an increase in patients' understanding of good personal hygiene, how to properly clean the feminine area from front to back, and the effective use of red betel leaf boiled water. Thus, the management of obstetric care applied to this case of vaginal discharge is quite successful and practical, with a decoction of red betel leaves providing a positive effect in reducing the incidence of pathological vaginal discharge.

Unintended Pregnancy After Kidney Transplantation

OBJECTIVE: To define risk factors, obstetric morbidity, and allograft outcomes associated with an unintended pregnancy after kidney transplant. METHODS: This is a retrospective cohort study of pregnancies in women after kidney transplantation enrolled in the Transplant Pregnancy Registry International with births between 1967 and 2019, with cohorts categorized as intended pregnancies and unintended pregnancies. The primary outcome was acute kidney rejection during pregnancy or by 6 weeks postpartum. Secondary outcomes included allograft loss, severe maternal morbidity, and neonatal composite morbidity. Multivariable logistic regression, Kaplan–Meier curves, and Cox proportional hazards regression models were performed, with adjustment for covariates pertinent to allograft function. RESULTS: Among 1,723 pregnancies of kidney transplant recipients, 1,081 (62.7%) were intended and 642 (37.3%) were unintended pregnancies. Risk factors for unintended pregnancy included younger age, Black race, nulliparity, chronic hypertension, and transplant from a deceased donor. Exposure to mycophenolate products (16.0% vs 5.7%) and termination (4.7% vs 0.4%) were more common in unintended pregnancies (P<.001). Unintended pregnancy was not associated with acute kidney rejection (2.3% vs 0.9%, adjusted odds ratio [AOR] 2.38, 95% CI, 0.91–6.30, P=.08). Unintended pregnancy was independently associated with allograft loss at 2 years from the end of pregnancy (8.1% vs 3.5%, AOR 2.27, 95% CI, 1.32–3.94, P=.003) but not allograft survival (adjusted hazard ratio 1.22, 95% CI, 1.00–1.49, P=.05). There were no differences in severe maternal morbidity (3.3% vs 3.6%) or neonatal composite morbidity (12.9% vs 14.3%) by pregnancy intention. CONCLUSION: Unintended pregnancy was not associated with acute kidney allograft rejection in the peripartum period, but it was associated with mycophenolate exposure and allograft loss at 2 years from pregnancy. The same social vulnerabilities that underlie difficulty in accessing reproductive care may be similarly important for transplant health. We recommend prepregnancy counseling and longitudinal follow-up of transplant recipients to reduce rates of unintended pregnancy and to optimize transplantation success over time.

Parent-Child Privilege as Resistance

In the wake of Dobbs v. Jackson Women’s Health Organization, minors face increasing restrictions in accessing reproductive care. The majority of pregnant minors consult their parents before obtaining abortions. Although the parent-child relationship is the first to exist and is often where children turn for guidance, there is no recognized parent-child privilege in the majority of states. These healthcare conversations between parent and child now may hold criminal implications. This Article provides a novel contribution in exploring parent-child communications within the health and reproductive decision-making contexts, arguing privilege is essential to protect minors in accessing care post-Dobbs. In the process, this Article provides a broader theoretical contribution—introducing a new conceptual framework of “privilege as resistance” that envisions evidentiary parent-child privilege as a tool to oppose unjust systems and laws. Privileges are generally disfavored in evidentiary law as impeding the truth; however, this Article critiques the prioritization of the carceral system’s search for truth over the relationship between the parent and child. Parent-child privilege as resistance is informed by a history filled with the separation of families and denial of intimate spaces for marginalized individuals, in particular enslaved individuals and Indigenous people. Building on this context, the Article argues that despite using parents to legitimize judicial processes, the justice system fails to recognize them and shield their communications. Privilege as resistance can enable parents to be an integral part of anti-carceral—and far more successful—approaches to juvenile justice, such as restorative justice models. With this critical lens, the Article imagines a contemporary parent-child privilege that protects a child’s privacy, bodily autonomy, and direction over their lives.

Layers of inequality: gender, medicalisation and obstetric violence in Ghana

BackgroundThis study explored how gender inequalities in health systems influence women’s experiences of obstetric violence in Ghana. Obstetric violence is recognised as a major public health concern and human rights violation. In particular, it reduces women’s trust and use of health facilities for childbirth, thereby increasing the risks of maternal and neonatal mortality. In Ghana, obstetric violence is pervasive and normalised; yet, little is known about the gendered dynamics of this phenomenon.MethodologyA qualitative study was conducted in eight public health facilities in Ghana. Specifically, semi-structured interviews were conducted with 30 midwives who work in the maternity units and 35 women who have utilised the obstetric services of the hospitals for childbirth. The midwives and women were selected using the purposive sampling technique. The transcripts of the interviews were coded using NVivo qualitative data analysis software and were thematically analysed. Secondary materials such as existing data on the medical profession in Ghana were utilised to complement the primary data.ResultsThe study revealed that there are huge structural inequalities that keep women at the lower cadres of the health system. Five major themes depicting how gender inequalities contribute to women’s experiences of obstetric violence emerged: gender inequality in the medical profession, unequally and heavily tasked, feminisation of midwifery, patriarchal pressures and ideologies, and gender insensitivity in resource provision. These inequalities impact the kind of care midwives provide, which is often characterised by mistreatment and abuse of women during childbirth. The study also discovered that patriarchal ideologies about women and their bodies lead to power and control in the delivery room and violence has become a major instrument of domination and control.ConclusionThe hierarchical structure of the healthcare profession puts the midwifery profession in a vulnerable position, with negative consequences for maternity care (obstetric violence). The study recommends that gender-responsive approaches that address structural inequalities in health systems, women’s empowerment over their bodies and male involvement in women’s reproductive care are crucial in dealing with obstetric violence in Ghana.

The Effects of Empathic Reactions to the Overturning of Roe v. Wade on Campaign Participation and Voter Turnout: Evidence from the 2022 U.S. Midterm Elections

Abstract In June 2022, the U.S. Supreme Court’s Dobbs ruling overturned Roe v. Wade, reversing the nearly 50-year-old landmark decision that affirmed a woman’s constitutional right to abortion. Several months later, voters turned out in record numbers for the 2022 midterms, though a widely predicted “Red Wave” vote did not materialize. There has since been speculation that overturning Roe v. Wade played a crucial role in the midterms, generating a “Blue Tsunami” or “Roevember” driven largely by young, pro-choice women voting out of self-interest. We posit instead that group empathy was the key motivational mechanism in the link between opposition to Dobbs and voter mobilization in that election. Analyzing data from an original national survey, we find that opposition to overturning Roe v. Wade did not directly affect one’s likelihood to vote unless one is empathic toward groups in distress. Such opposition was actually demobilizing for those low in empathy. The findings indicate group empathy serves as a catalyst for people to act on their opposition to policies that harm disadvantaged groups, in this case women as a marginalized political minority losing their constitutional right to bodily autonomy and access to reproductive care.

Navigating Funding Benchmarks: A Research Note

The Magnolia Project has served a section of “the Northwest Corridor” of Jacksonville, FL, providing reproductive and well-woman care and intensive case management to reduce infant mortality in the African American community for more than a quarter century. As a grantee of the Federal Healthy Start Program, the Magnolia Project must adhere to certain benchmarks concerning women’s health, strengthening families, and promoting system change. As with many U.S. Federal funded initiatives, these benchmarks are known to change over time. In this paper, we examine a snapshot from the 2019 to 2022 grant period to assess how the Magnolia Project fared with the federally required benchmarks.

State Actions to Ban Gender-Affirming Care for Minors and the Ways Forward

As of October 2023, twenty-one states have passed laws that ban medically necessary gender-affirming care to minors. This Note will discuss the actions of three such states—Texas, Florida, and Arkansas—in 2022.2 These state actions demonstrate three different ways in which states have restricted access to medically necessary gender-affirming care. To move forward, lawyers and advocates must continue to litigate against these bans, state legislatures should enact sanctuary statutes protecting trans youths’ access to gender-affirming care, and the U.S. Food & Drug Administration (FDA) should make medications—including puberty blockers and hormones—available on-label and across state lines through Telehealth. It is important to recognize that disapproving parents pose insurmountable barrier to minors’ self-realization, exploration of their genders, and access to care. There is abundant legal scholarship on parental consent in this context and analogous ones, such as the mature minor doctrine that concerns minors accessing abortion and reproductive care like birth control. However, this Note focuses solely on situations in which transgender youths’ parents support their children’s identities and allow them to receive gender-affirming care. When a state has a ban on gender-affirming care, parents’ consent would not matter in the face of such a ban, unless the family is financially able and willing to move to a state allowing access to such care.

State Divorce Laws, Reproductive Care Policies, and Pregnancy-Associated Homicide Rates, 2018-2021

Barriers to divorce and reproductive health care can threaten the health and safety of pregnant and recently pregnant females. To examine state laws about divorce, reproductive health care (access to contraception, family planning services, and abortion), and pregnancy-associated homicide rates in US states over a 4-year period (2018-2021). In this cross-sectional study, bivariate tests and regressions were used to analyze crude rates of pregnancy-associated homicide from the National Violent Death Reporting System in 181 state-years for calendar years 2018 to 2021, with analyses conducted on September 8, 2024. Access to divorce while pregnant and reproductive health care over a 4-year period in the US. Primary outcomes (pregnancy-associated homicide by intimate partners vs non-intimate partners and rates among younger Black, Hispanic, and White females) were assessed using the National Violent Death Reporting System. Negative binomial regression was used to test 2 hypotheses: access to divorce while pregnant and reproductive health care are associated with pregnancy-associated homicide rates. Individual level data, including exact sample size, were not available in this study of state-level homicide rates. Negative binomial regression analysis showed that, where finalizing divorce during pregnancy is prohibited, intimate partner homicide rates (incidence rate ratio [IRR], 2.11; 95% CI, 1.09-4.08; P = .03) and rates among younger (age 10-24 years) White females (IRR, 2.39; 95% CI, 1.12-5.09; P = .02) were significantly higher. In state-years with greater access to reproductive health care, rates were significantly lower for non-intimate partner homicide (IRR, 0.92; 95% CI, 0.87-0.98; P = .01) and for younger Black females (IRR, 0.91; 95% CI, 0.87-0.96; P < .001) and younger Hispanic females (IRR, 0.87; 95% CI, 0.79-0.96; P = .007). In this cross-sectional study of pregnancy-associated homicide rates, barriers to divorce were associated with higher homicide rates and access to reproductive health care was associated with lower homicide rates. This study highlights the association between state legislation and pregnancy-associated homicide in the US, which is important information for policymakers.

Translating Priorities Into Practice: Midwifery Care for Uninsured Migrant Populations Across Canada.

Immigrants and newcomers are identified by many provincial midwifery associations as "priority populations." Recently, newcomer populations have shifted considerably, with more people coming to Canada with precarious immigration status who are increasingly ineligible for public healthcare insurance and facing barriers to accessing care. Our aims were to: (1) gain an understanding of the policies related to equitable access to midwifery care and how they may apply to migrant groups without public healthcare insurance and (2) identify existing policy themes, gaps, and regulatory barriers that limit access for this vulnerable population in Canada. We conducted a high-level document content analysis using a health equity framework. We aimed to identify language related to equitable access in midwifery services, with particular emphasis on uninsured populations. A total of 64 documents were analyzed, including legislation and publicly available statements from midwifery regulatory bodies and associations. Midwifery regulatory authorities and associations across Canada are consistent in establishing an expectation that midwives will provide accessible care to diverse clientele. However, how these commitments are put into practice varies considerably between jurisdictions. We compared the cases of Manitoba and Ontario to illustrate the disconnect between commitments to priority populations and implementation. While there is a clearly demonstrated intention to provide equitable access to midwifery care to all people, including "priority populations" like migrants and newcomers, in practice, these commitments have not been fully realized. Equity is encumbered by broader structural issues, such as the growth in the number of newcomers without access to public health insurance. Moves toward equity within midwifery and healthcare more broadly need to meaningfully engage with other policy sectors, such as immigration, to be able to adapt to emerging issues affecting reproductive care, such as the growing precarity of newcomer populations in Canada.

Navigating Reproductive Care in Patients With Inflammatory Bowel Disease: A Comprehensive Review.

Inflammatory bowel disease [IBD] is often diagnosed in patients during their reproductive years. It is crucial that both healthcare providers and patients are adequately informed to avoid misguided decisions regarding family planning. One of the most important aspects during conception and pregnancy is to maintain disease remission, as disease activity is associated with adverse pregnancy outcomes. Apart from methotrexate, most conventional drugs used in IBD are considered low risk during conception and pregnancy. For newer agents, evidence is still limited. If needed, surgery must not be postponed and should ideally be performed in specialized centres. In most patients, delivery should be vaginal except for patients with complex perianal disease, with an ileoanal pouch anastomosis, or if there is an obstetric contraindication. In children exposed to biological treatments during pregnancy, the risk of infections appears to be low, and psychomotor development is probably not affected. Regarding immunizations, the standard vaccination schedule for inactivated vaccines should be followed for children exposed to biologics in utero. In the case of live vaccines, such as rotavirus, decisions should be individualized and take into consideration the risk-benefit ratio, particularly in developing countries. In this review, we provide a comprehensive and updated overview of aspects related to fertility, pregnancy, breastfeeding, and the impact on the care of children born to mothers with IBD. Both the available evidence and areas of uncertainty are discussed, with the goal of assisting healthcare professionals caring for IBD patients during this important stage of their lives.

Does telemedicine hold the key for reproductive health care? A quantitative examination of women's intentions toward use and accurate information disclosure.

To investigate women's perceptions of telemedicine for reproductive health care services, focusing on how perceived benefits and privacy risks influence their intentions to adopt telemedicine and their willingness to disclose personal health information. A cross-sectional survey was conducted. The study applied the privacy calculus theory to the context of telemedicine for reproductive health, using adapted, validated variables to develop the survey. Outcome variables included intentions to adopt telemedicine and willingness to disclose accurate personal health information. Data were collected in May and June 2023 using Qualtrics online panel services, targeting women across the United States who had not used telemedicine for reproductive health. The sample comprised 847 women aged 18 and older. Structural equation modeling was employed using AMOS v28.0 to test the hypothesized relationships between perceived benefits, perceived risks, and adoption intentions. The analysis controlled for age, household income, political affiliation, religious views, and prior births. Perceived benefits were positively related to intention to adopt telemedicine for reproductive care (β: 0.600, p < 0.001), and willingness to disclose accurate personal health information (β: 0.453, p < 0.001). Unexpectedly, perceived privacy risks were positively related to adoption intentions (β: 0.128, p < 0.001), but negatively related to willingness to disclose (β: -0.282, p < 0.001). Intentions to adopt were positively associated with willingness to disclose (β: 0.089, p < 0.05). Lastly, older women and women located in states with abortion restrictions expressed lower intentions to adopt. The model explained 40.2% of variance in intention to adopt and 38.3% of variance in willingness to disclose. The study demonstrates the importance of perceived benefits and privacy risks in driving telemedicine adoption and disclosure intentions among women in the reproductive health context. These findings suggest the need for targeted strategies to address privacy concerns and support telemedicine adoption, particularly in restrictive regulatory environments.

"What can I know? Where can I go? What can I be?"

Co-sponsored by the Information Policy and Information Ethics special interest groups (SIGs), this proposal is for a pair of 90-minute speaker panels, facilitated by the respective SIG convenors and supporting interlocutors, which will draw on concepts of Habermas's ideal speech and public discourse. We begin with the premise that there are multiple theoretical lenses through which to critique increasingly hostile proposals of law and/or policies that limit bodily sovereignty and speech/intellectual freedom. Such polices can be understood as attempts to organize historically marginalized bodies in both physical and digital realms (e.g., through restrictions on access to knowledge, or production of dis/mal information, etc.). Thus, challenges that limit access to spaces and knowledge (focusing libraries and education) demonstrate a need to counter the breakdown of "ideal speech" within a pluralistic society that is free of coercion (Habermas, 1985) while acknowledging the role of identity, positionality, and embodiment with a post-critical lens. This back-to-back SIG session will be comprised of two panels: first, a panel focusing on Information Ethics, which will explore the notion of what is allowed and is not allowed in public and quasi-public physical and virtual spaces; and second, a panel focusing on Information Policy, which examines how conflicts in ethics are manifest in policies that determine or exert limitations on discourse in public spaces, focusing on libraries and educational spaces. Together, the panels will demonstrate theoretical and practical departure points that can be applied in a wide range of LIS/IS educational contexts. The first co-sponsored panel explores how identity and embodiment are linked, as embodied knowledge can be understood as identity expressions, whether enacted through affordances or limitations to exercise autonomy and that which a society and community construct for it, e.g., gender affirming and reproductive care, expressions of sexuality, and the racialized body. Professional identity, which is the identity transposed into and developed within a profession, can impact understanding of affiliation with a profession and behaviour within it (e.g., Pierson, 2023). This first co-sponsored panel will focus on the guiding question: How do we prepare students to navigate the complex realities of identity, embodiment, and professional ethical imperatives to maintain the library as a commons for ideal speech and public discourse? The second co-sponsored panel pivots attention to laws and policies that limit public speech and discourse. Limitations on expression can be considered an act of symbolic violence (Bourdieu and Passeron, 1990), designed to subordinate certain bodies, ideas, identities, etc. However, policy-makers are tasked with governing public spaces to balance the rights of individuals with the collective. When (if ever) is it acceptable to create policies that limit speech or peoples’ right to express themselves in public spaces? How might policies be developed, and what do policies look like, that take into account and respect individuals’ rights and create a collective space where all bodies are able to flourish? Both discussions will be supported by co-convenor and interlocutors representing both North American and international voices, prompting organic discussion in the tradition of the commons and public discourse.

Telemedicine in Obstetrics and Gynecology in the Kyrgyz Republic (Literature Review)

The purpose of this article is to conduct a systematic review of the literature on telemedicine in obstetrics and gynecology, assessing its advantages and potential application in the Kyrgyz Republic. Telemedicine expands access to healthcare, especially for women in remote areas. The article highlights key areas, such as remote pregnancy monitoring, chronic disease management, and reproductive care. The possibilities of integrating telemedicine technologies into the healthcare system of the Kyrgyz Republic and ways to overcome infrastructural and cultural barriers are discussed.

The landscape of assisted reproductive technology access in India.

Historically, infertility has been stigmatized in the Indian society, primarily due to societal norms that equate marriage with procreation. In twentieth century, India focused primarily on over-fertility in its family planning programs, with little attention given to the complexities of infertility. The introduction of Assisted Reproductive Technology (ART) in the late 1970s made a global revolution, including in India, offering hope to infertile couples. Despite a significant rise in ART clinics offering a wide range of treatment options in the recent years, challenges remain, particularly regarding the affordability. In India, ART is typically dominated by the private sector as government support remains limited. Efforts to standardize ART practices, including the establishment of the National ART & Surrogacy Registry and ART act aim to regulate, improve outcomes and curb unethical practice. Despite these advancements, the high cost of treatment cycles and lack of insurance coverage limit many couples' ability to undergo fertility treatment. Addressing these issues requires a multifaceted approach, including policy reform, increased public awareness, and the development of affordable treatment options to ensure broader access to reproductive care across India.

REPRODUCTIVE HEALTH IN TRANS AND GENDER-DIVERSE PATIENTS: Trauma-informed reproductive care for transgender and nonbinary people.

There are some unique aspects to providing trauma-informed reproductive care to transgender and nonbinary people, who are affected by minority stress, stigma, and particular forms of trauma; we review the evidence and suggest strategies for the provision of trauma-informed reproductive care to gender minorities. Stigma and minority stress affect the health of transgender and nonbinary (TGNB) people, leading to disparities across a range of outcomes. Barriers to accessing care, including reproductive care, further complicate these health disparities. Interpersonal stigma within the healthcare system, and high rates of physical and sexual violence survivorship, make TGNB people particularly vulnerable to healthcare trauma and poor care. This is particularly true among TGNB people with multiple intersecting marginalized identities. Trauma-informed care provides a framework for medical practitioners to provide safe, holistic, and sensitive care. Scant academic literature discusses trauma-informed reproductive care for TGNB individuals. We present a narrative review of the evidence for trauma-informed reproductive care for TGNB people and suggest potential application and implementation.

Impact of coronavirus disease 2019 on global access to assisted reproductive technologies services and related effects (2020–2021)

Coronavirus disease 2019 had a major effect on access to reproductive health care services globally, which was most profound between April 2020 and May 2020. During that time, 82% of countries reported cessation or significant curtailment of reproductive clinical services pertaining to infertility care. Most countries had essentially returned to prepandemic levels of activity by January 2021. However, the magnitude of the longer-term sequelae including changes in family planning preferences and access to ongoing reproductive care, including contraception, is only now undergoing assessment.

Web-based health education utilizing “Sahabat Sehat Serviks” to prevent cervical cancer among adolescent girls

Cervical cancer is the second leading cause of death among women in Indonesia, caused by the Human Papillomavirus (HPV). The progression of this disease takes a long time, and one of the at-risk groups is adolescent girls who engage in deviant sexual behavior, improper reproductive organ care, and unhealthy lifestyles. Adolescents need to have good knowledge, attitudes, and skills from an early age because these can influence their future behavior, especially in early cervical cancer prevention. Therefore, it is necessary to provide contemporary cervical cancer education through the website "Sahabat Sehat Serviks" to improve adolescents' knowledge, followed by changes in attitudes and skills. This study aims to determine the effect of health education through the website on increasing the knowledge, attitudes, and skills of adolescent girls in the early prevention of cervical cancer. The research design is a quasi-experiment with a quantitative approach, using a pre-post with a control group design. The study population consisted of 179 adolescent girls aged 11–13 years. The sample included 36 respondents selected by proportional stratified random sampling. The results showed significant differences in knowledge, attitudes, and skills among respondents who received cervical cancer health education through the "Sahabat Sehat Serviks" e-health website, with p-values of 0.000 for knowledge, 0.014 for attitudes, and 0.001 for skills. The "Sahabat Sehat Serviks" website is effective as a medium for cervical cancer health education for adolescent girls in improving knowledge, attitudes, and skills for early cervical cancer prevention.

Introduction

Introduction to Special Issue: Reproductive Care and Justice Guest editors: Rebecca Fraser and Emma Long (UEA)

Re/Thinking Bioethics: Reproduction and Non-Reproduction in an Intersectional Bioethics’ Perspective

The article begins by reconstructing the main feminist bioethics perspective as a “new discourse” within the official bioethical discussion. It illustrates how the moral discussion and juridification have contributed to remove reproduction and non-reproduction from the personal and intimate context, reinventing them as a “states business”. This process framed these issues in terms of “duties”, “rights”, “family planning”, “demography”, and “population policy”. In this manner, law and morality have helped to reinforce a specific construct of fertility, motherhood, and family. By comparing two interrelated forms of Cross Border Reproductive Care (CBRC), concerning abortion and surrogacy, the article analyses how bioethical and legal frameworks – through their polarized and dichotomic discussion between law and morality – confirm and strengthen gender injustice in reproductive life. That comparison of cross-border travels highlights that surrogacy and abortion restrictions stem from a shared social and legal paradigm that relies on traditional gender roles and reveals how the stratification of reproduction is based on multiple discrimination along the lines of gender, race, and class. Finally, the article introduces an intersectional bioethics point of view on reproductive health to re-read the phenomena of non-reproductive and reproductive tourism and to propose a critique of the main global Northern feminist bioethical discourses and ethical-philosophical paradigms.