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The current status of abortion laws in Latin America: prospects and strategies for change.

In order to explore ways of dealing with this phenomenon of illegal abortions and restrictive abortion laws in Latin America, several special sessions were held at last summer's international conference in Toronto, sponsored by the American Society of Law, Medicine & Ethics. The sessions brought together lawyers, health professionals, and reproductive rights advocates from a number of Latin American countries; their counterparts in the developed world; and representatives of non-governmental agencies concerned with this issue, including Catholics for a Free Choice. The goal of the sessions was to share information on the status of abortion in various countries and to try to devise strategies to make abortion law reform more palatable to Latin American governments and public opinion. One major component of the sessions was a series of papers prepared by some of the Latin American representatives describing and analyzing the situations in their countries. The papers illustrate some of the issues facing women in this part of the world.

Abortion, Illegal↗

Fetal syndromes and the charter: the Winnipeg glue-sniffing case.

The relationship between scientific knowledge and legal discourse is raised once again by a recent decision of the Supreme Court of Canada, a case involving a young Aboriginal woman who was pregnant and ordered by the court to remain in a drug treatment program at a health center until the baby was born. Her glue-sniffing habit was deemed dangerous to the normal development of the fetus. The Court held that her solvent-dependency did not justify the original court action, but both the Court and the various interveners disregarded the current state of our knowledge on the fetal syndromes. There is thus a continuing disconnect between the scientific understanding of fetal risk and the development of Constitutional law around women's reproductive rights. This paper reviews the case and follows it through the appellate process; we examine the research literature on fetal syndromes tracking the changes over time. Finally we comment on the interventions by the Winnipeg Child and Family Services, the Women's Health Rights Coalition, by The Canadian Civil Liberties Association, and both The Canadian Abortion Rights Action League and the Women's Legal Education and Action Fund.

Adult↗

[Sexuality of women living with HIV/AIDS in São Paulo].

The social and cultural setting which increases female vulnerability to HIV does not disappear when women living with HIV/AIDS discover that they are infected. Following diagnosis, new challenges arise in their emotional lives, an issue which has received little attention in the literature. This study interviewed 1068 women living with HIV/AIDS using a questionnaire consisting of both open and closed questions, aimed at describing aspects of their sexual and reproductive lives and how they perceive counseling at Reference Centers in two cities in the State of São Paulo, where they have access to free antiretroviral therapy. Of the women with stable sexual partners, 63% used condoms in all their sexual relations, or three times the national average; 43% of the partners were HIV-negative and 14% had unknown serological status; 73% of the women had children and 15% were considering becoming pregnant. Knowledge on mother-to-child transmission was less than expected, and the interviewees complained of limited space and receptiveness for discussing sexuality, especially with regard to their childbearing wishes. Counseling on sexuality should be a continuing process and requires interdisciplinary training for the professional team working in health care services, with an emphasis on sexual and reproductive rights.

Acquired Immunodeficiency Syndrome↗

The impact of health care providers on female sterilization among HIV-positive women in Brazil.

This paper explores the reproductive preferences and outcomes of HIV-positive women in two cities in Brazil. We used three types of data, all drawn from women who delivered in public sector hospitals: (1) clinical records of 427 HIV-positive women; (2) pre- and postpartum in-depth interviews with 60 HIV-positive women; and (3) a prospective survey carried out among 363 women drawn from the general population. The HIV-positive samples were collected on women who had prenatal care between July 1999 and June 2000, and the general population survey was conducted with women who started prenatal care between April 1998 and June 1999. Among the women in the clinic sample, we found dramatic differences in the proportion sterilized postpartum: 51% in Sao Paulo vs. 4% in Porto Alegre, compared to 3.4% and 1.1%, respectively, of women in the general population. Our qualitative data suggest that HIV-positive women in this study had strong preferences to have no more future children and that female sterilization was the preferred way to achieve this end. Therefore, we conclude that the large difference in rates is mainly due to HIV-positive women's differential access to sterilization in the two settings. In-depth interviews revealed that women in Sao Paulo were often encouraged by clinic staff to be sterilized postpartum. In contrast, HIV-positive women in Porto Alegre clinics were not offered sterilization as an option and those who requested it were repeatedly put off. The striking difference found in the frequency with which doctors provide postpartum sterilization to seropositive women in our study sites deserves attention and discussion in the respective medical communities. At the higher level of national policy on reproductive rights, there may be grounds for reopening discussion about the norms regarding postpartum procedures, and for devoting far more resources to expanding contraceptive options.

Adult↗

Women and HIV disease: an emerging social crisis.

Women are the fastest growing category of people with AIDS in the United States, yet this fact has been consistently ignored in the social work literature. Social workers' expertise is needed to curtail the escalating social crisis of women with HIV disease. This article addresses the major social issues faced by women with HIV disease and explores gender differences in HIV transmission, disease progression, and diagnosis. The author discusses the ways in which women's sexuality and reproductive rights are affected. Specific issues are examined regarding HIV-infected women who use intravenous drugs, women of color, prostitutes, and lesbian and bisexual women. The implications for the social work profession are discussed, and social workers in the AIDS arena and all concerned about HIV-infected women are urged to address this problem on an individual as well as a community level.

Female↗

Barbados tackles RTIs.

The women who gathered on an island in the Caribbean didn't go there for some R&R. They went there to discuss RTIs. The Reproductive Tract Infections (RTIs) Seminar Workshop, held in Barbados last March 16-19, 1992, convened with participants representing various women organizations and medico-legal professionals in various fields of specialization who are specially concerned with reproductive tract infections. It was sponsored by the International Women's Health Coalition and the Women and Development Unit of the University of West Indies. Institute for Social Studies and Action (ISSA) Executive Director Alexandrina Marcelo was one of the participants in the workshop. She presented a paper on the current status of RTIs and sexually transmitted diseases (STDs) affecting Filipinos, particularly women. About 30 participants attended the seminar, which concluded by voicing a growing alarm over these diseases and by emphasizing that immediate action should be part of the world leaders' plans for women's health and reproductive rights. The participants all agreed on the increasing danger of the disease and its widespread infection, and they drafted a "Call to Action" to all governments and world leaders, expressing the delegates' belief that RTIs and STDs should be given importance by not only those suffering from infection but also by governments all over the world.

Americas↗

The sexuality connection in reproductive health.

Sexuality and power relations based on gender are relevant to researchers, policymakers, and service providers in the reproductive health field, because they underlie virtually all of the behaviors and conditions that their programs address. Yet, a review of conventional treatments in the demographic and family planning literature reveals that, when they consider these topics at all, researchers typically adopt narrow definitions of sexual behavior and focus almost exclusively on risks of pregnancy and disease. This article proposes an analytic framework as a guide to researchers and family planning providers. It relates four dimensions of sexuality to reproductive health outcomes and concludes that family planning policies and programs should address a broader spectrum of sexual behaviors and meanings, consider questions of sexual enjoyment as well as risk, and confront ideologies of male entitlement that threaten women's sexual and reproductive rights and health.

Acquired Immunodeficiency Syndrome↗

The place of IVF in infertility care.

In vitro fertilization has become standard treatment for infertility without the benefit of thorough evaluation. Today, the effectiveness of IVF is the subject of ongoing debate, the medical and non-medical risks of treatment are not adequately understood, and there is great concern about the true costs of care both for individuals and society. Added to this debate are ethical dilemmas which have changed the way we think about reproductive rights, the family, parenthood, intergenerational responsibilities, and the legal status of children and embryos. In order to address these issues, the World Health Organization Regional Office for Europe held a meeting in June 1990 on the Place of In Vitro Fertilization in Infertility Care. The recommendations from the meeting are presented.

Adoption↗

Contraceptive strategies for young women in the 21st century.

Safe, effective and affordable contraceptives have been available for a few decades, yet, in many countries, the struggle for reproductive rights continues. Children, still, are forced to give birth to children in many nations. In most industrialized countries, where contraceptive counselling and abortions have been options, fertility rates have reached all time lows. Effective contraception improves health and well-being as well and may be used for conditions other than birth control. Young girls often initially take oral contraceptives primarily to reduce menstrual pain and blood loss; they also welcome a contraceptive that eliminates menstrual bleeding. Women using oral contraceptives and Norplant experience about 50% reduction in menstrual blood; 90% reduction in blood loss is achieved with the levonorgestrel intrauterine system (Mirena). Teenagers and their parents are often misinformed about the side-effects of oral contraceptives and birth control in general, which may adversely affect compliance. Adequate, user-friendly and supportive information about contraception is necessary to ensure proper use of the pill and other birth control methods. In addition, emergency contraceptives should be easily accessible. The mortality and morbidity of young women would be dramatically reduced by the global use of medical abortion as well. Only a combined effort by policy makers, educators, parents and health-care providers can enhance the reproductive (and future!) health of both young females and males.

Adolescent↗

Management of menstrual problems and contraception in adolescents with mental retardation: a medical, legal, and ethical review with new suggested guidelines.

The controversial history of the reproductive rights of the mentally retarded has led to the formulation of laws in the past century designed to protect women from forced sterilization. Significantly, however, in their official ethical guidelines, The American College of Obstetricians and Gynecologists states that "sterilization should not be denied to individuals simply because they also may be vulnerable to coercion" (Int J Gynaecol Obstet 1999; 65:317). Recent advances in medical and surgical methods of contraception and control of menstrual abnormalities have led to a re-evaluation of the management of adolescents with special needs. Physicians, the courts, parents, and caretakers need to be aware of the latest medical and surgical options available, the current applicable laws in each state if such exist, and the ethical guidelines to determine what treatment option is in the best interests of the patient. This review examines the history of the sterilization of the mentally retarded, the latest surgical and pharmacologic treatments available, and the current legal environment and proposes an algorithm to facilitate the management of menstrual hygiene and contraception.

Contraception↗

'Reproductive autonomy' versus public good?

Hitherto sex selection could be achieved only by destroying any fetus or child of the unwanted sex. Sperm selection may change that. The technology could be used to 'balance' families. However its use in certain developing countries might 'unbalance' populations, with serious, if unintended, consequences.

Humans↗

Human reproductive cloning: an analysis of the Andrews Report.

There is nothing like an overwhelming consensus of opinion to encourage a less than rigourous approach to analyzing complex ethical issues. Unfortunately, this is nowhere more apparent than in the discussion of human reproductive cloning contained in the federal House of Representatives Standing Committee on Legal and Constitutional Affairs' report on human cloning, released last August. The report may well fulfil the first half of its project, namely the empirical task of adequately summarizing and categorizing the various submissions made to the Committee. However, it is clearly inadequate as a discussion of the ethical and legal permissibility of human reproductive cloning.

Advisory Committees↗

Human cloning and 'posthuman' society.

Since early 1997, when the creation of Dolly the sheep by somatic cell nuclear transfer was announced in Nature, numerous government reports, essays, articles and books have considered the ethical problems and policy issues surrounding human reproductive cloning. In this article, I consider what response a modern liberal society should give to the prospect of human cloning, if it became safe and practical. Some opponents of human cloning have argued that permitting it would place us on a slippery slope to a repugnant future society, comparable to that portrayed in Aldous Huxley's novel, Brave New World. I conclude that, leaving aside concerns about safety, none of the psychological or social considerations discussed in this article provides an adequate policy justification for invoking the state's coercive powers to prevent human cloning.

Cloning, Organism↗

Should older and postmenopausal women have access to assisted reproductive technology?

In vitro fertilisation and other assisted reproductive technologies (ART) now enable many women to have children, who would otherwise have remained childless. The most obvious application for these technologies is to help physically infertile, but otherwise healthy young women to have children. However, increasingly, other groups are seeking access to ART to conceive, raising ethical questions about who should be allowed to use these technologies to bear children. In particular, the question of access to ART by lesbian couples and single groups has roused considerable ethical, legal and public debate. This paper examines the perhaps less often considered issue of older and postmenopausal women, who are infertile due to age, using ART to conceive. A range of objections have been made to allowing these women access to ART, including concerns about their ability to care for the child, the risk of birth defects and the 'unnaturalness' of extending childbearing capacity beyond the menopause. This paper examines these objects and provides some responses.

Age Factors↗

Women in difficult circumstances: war victims and refugees.

The majority of problems that women are confronting today originate from a lack of respect for human and reproductive rights. Escalating war crises are producing an enormous number of civilian victims, of whom women and children comprise the major part. Rape used as a war tactic in Bosnia has proven to be a very powerful tool. War in Bosnia has provided a tragic incentive to work on strategies and tactics for reaching the victims in such chaotic and unpredictable circumstances.

Bosnia and Herzegovina↗

Abortion law and practice in China: an overview with comparisons to the United States.

This article utilizes legal documents, policy statements and ethnographic data to compare abortion law and practice in China and the United States. It outlines Chinese abortion law from ancient to modern times, identifies categories of reasons for aborting, and describes both folk remedies and the most common methods of modern medicine for inducing abortion. The contemporary incidence of abortion is discussed in the context of official family planning policy; evidence is presented to suggest that while modern methods are far safer than traditional remedies, the use of abortion as a major form of birth control has had an impact on women's health. The interference of the state in women's reproductive life is put in historical/cultural context and compared to U.S. views of women's reproductive rights. Differences in conception of abortion rights are attributed to contrasting historical relationships between the state and the individual and religiously and legally based theories of human rights, including fetal personhood and right to life.

Abortion, Legal↗

Illegal abortion: consequences for women's health and the health care system.

Illegal abortion is responsible for up to half of maternal deaths and consumes a large proportion of health resources in many developing countries, particularly in Africa and Latin America. The legal situation of abortion in a country does not influence the abortion rate, but illegality is associated with a much greater risk of complications and death. To make abortion legal is not enough. Access to safe abortion strongly depends on the capacity and willingness of physicians and the health system to provide safe services, which sometimes are made available in spite of restrictive laws. The abortion rate will drop and the safety of the procedure will improve, parallel to the position women occupy in a given society, and to the level of recognition of their sexual and reproductive rights. The medical profession, and FIGO in particular, has a great role to play in implementing initiatives that will reduce the consequences of illegal abortion for women and society.

Abortion, Induced↗

Women's status and the health of women and men: a view from the States.

We examined the status of women in the 50 American states in relation to women's and men's levels of health. The status of women in each state was assessed by four composite indices measuring women's political participation, economic autonomy, employment and earnings, and reproductive rights. The study design was cross-sectional and ecologic. Our main outcome measures were total female and male mortality rates, female cause-specific death rates and mean days of activity limitations reported by women during the previous month. Measures of women's status were strikingly correlated with each of these health outcomes at the state level. Higher political participation by women was correlated with lower female mortality rates (r = -0.51), as well as lower activity limitations (-0.47). A smaller wage gap between women and men was associated with lower female mortality rates (-0.30) and lower activity limitations (-0.31) (all correlations, P < 0.05). Indices of women's status were also strongly correlated with male mortality rates, suggesting that women's status may reflect more general underlying structural processes associated with material deprivation and income inequality. However, the indices of women's status persisted in predicting female mortality and morbidity rates after adjusting for income inequality, poverty rates and median household income. Associations were observed for specific causes of death, including stroke, cervical cancer and homicide. We conclude that women experience higher mortality and morbidity in states where they have lower levels of political participation and economic autonomy. Living in such states has detrimental consequences for the health of men as well. Gender inequality and truncated opportunities for women may be one of the pathways by which the maldistribution of income adversely affects the health of women.

Cause of Death↗