Reproductive Rights without Resources or Recourse

The U.S. Supreme Court declared procreation to be a fundamental right in the early twentieth century in a case involving Oklahoma's Habitual Criminal Sterilization Act, an act that permitted unconsented sterilization of individuals convicted of certain crimes. The right that the Court articulated in that case is a negative right: it requires that the government not place unjustified roadblocks in the way of people seeking to procreate, but it does not require the government to take positive steps to help people procreate if they wish to. I argue that a positive legal right is morally necessary in the United States, given the profound significance of procreation, the current barriers to access to care, and the related issues of individual and societal justice. I assume at the outset that the right to procreate should be expansive enough to include a right to noncoital reproduction. The absence of a positive right to procreate reflects not just constitutional tradition but also a governmental and societal commitment to a longstanding set of reproductive hierarchies by which those who fall outside of the traditional framing of family too frequently find their procreative dreams hindered. Reconceiving procreative rights to include a positive right would create greater opportunities to argue and lobby for increased access to technologies that are out of reach for many.

Reproductive 'surrogacy' and parental licensing

A serious moral weakness of reproductive 'surrogacy' is that it can be harmful to the children who are created. This article presents a proposal for mitigating this weakness. Currently, the practice of commercial 'surrogacy' operates only in the interests of the adults involved (the gestator and the commissioning individuals who employ her), not in the interests of the child who is created. Whether 'surrogacy' is seen as the purchase of a baby, the purchase of parental rights, or the purchase of reproductive labor, all three views share the same significant flaws. They endorse the transfer, for a fee, of the infant from the woman who gestated it to those who commissioned it, but without justifying such a transfer; they fail to demonstrate that the commissioners have any entitlement to the infant, or, for that matter, suitability to be the infant's parents; and they fail to take any notice of the infant's needs, interests, and wellbeing. A mere genetic connection is not enough to establish that the commissioners are entitled to receive the baby or that they are competent to raise it. Their good intentions, however caring, are not enough. Therefore, just as in the practice of adoption, there should be a formal institutionalized system for screening and licensing the prospective social parents, which would make the infant's needs, interests, and wellbeing paramount. I reply to several potential objections to this proposal, including the objection that genetic parents who raise their own child are not screened and licensed.

Assisted reproduction and distributive justice

The Canadian province of Quebec recently amended its Health Insurance Act to cover the costs of In Vitro Fertilization (IVF). The province of Ontario recently de-insured IVF. Both provinces cited cost-effectiveness as their grounds, but the question as to whether a public health insurance system ought to cover IVF raises the deeper question of how we should understand reproduction at the social level, and whether its costs should be a matter of individual or collective responsibility. In this article I examine three strategies for justifying collective provisions in a liberal society and assess whether public reproductive assistance can be defended on any of these accounts. I begin by considering, and rejecting, rights-based and needs-based approaches. I go on to argue that instead we ought to address assisted reproduction from the perspective of the contractarian insurance-based model for public health coverage, according to which we select items for inclusion based on their unpredictability in nature and cost. I argue that infertility qualifies as an unpredictable incident against which rational agents would choose to insure under ideal conditions and that assisted reproduction is thereby a matter of collective responsibility, but only in cases of medical necessity or inability to pay. The policy I endorse by appeal to this approach is a means-tested system of coverage resembling neither Ontario nor Quebec's, and I conclude that it constitutes a promising alternative worthy of serious consideration by bioethicists, political philosophers, and policy-makers alike.

Sexuality education: emerging trends in evidence and practice

The International Conference on Population and Development and related resolutions have repeatedly called on governments to provide adolescents and young people with comprehensive sexuality education (CSE). Drawing from these documents, reviews and meta-analyses of program evaluations, and situation analyses, this article summarizes the elements, effectiveness, quality, and country-level coverage of CSE. Throughout, it highlights the matter of a gender and rights perspective in CSE. It presents the policy and evidence-based rationales for emphasizing gender, power, and rights within programs--including citing an analysis finding that such an approach has a greater likelihood of reducing rates of sexually transmitted infections and unintended pregnancy--and notes a recent shift toward this approach. It discusses the logic of an "empowerment approach to CSE" that seeks to empower young people--especially girls and other marginalized young people--to see themselves and others as equal members in their relationships, able to protect their own health, and as individuals capable of engaging as active participants in society.

[A comparison of reproductive rights in Europe: a right to reproduce?]

This article discusses the meaning of reproductive rights, and European attitudes to this issue, from both the ethical and legal standpoints. There is a difference in the international nomenclature between "reproductive rights "and a "right to reproduce", which translates in medical practice into a right to fertility treatment. Major national differences are outlined, particularly between France and the UK. Finally, the new phenomenon of cross-border reproductive care, a direct consequence of different national interpretations of reproductive rights, is discussed.

Abortion law reforms in Colombia and Nicaragua: issue networks and opportunity contexts

This article analyses two instances of abortion law reform in Latin America. In 2006, after a decades-long impasse, the highly controversial issue of abortion came to dominate the political agenda when Colombia liberalized its abortion law and Nicaragua adopted a total ban on abortion. The article analyses the central actors in the reform processes, their strategies and the opportunity contexts. Drawing on Htun's (2003) framework, it examines why these processes concluded with opposing legislative outcomes. The authors argue for the need to understand the state as a non-unitary site of politics and policy, and for judicial processes to be seen as a key variable in facilitating gender policy reforms in Latin America. In addition, they argue that ‘windows of opportunity’ such as the timing of elections can be critically important in legislative change processes.

South Africa's abortion values clarification workshops — an opportunity to deepen democratic communication missed

A rich literature exists on local democracy and participation in South Africa. While the importance of participation is routinely built into the rhetoric of government, debate has increasingly focused on the dysfunctionality of participatory mechanisms and institutions in post-apartheid South Africa. Processes aimed ostensibly at empowering citizens, act in practice as instruments of social control, disempowerment and cooptation. The present article contributes to these debates by way of a critique of the approach used by the South African state, in partnership with the non-governmental sector, in what are called abortion "values clarification" (VC) workshops. This article examines the workshop materials, methodology and pedagogical tools employed in South African abortion VC workshops which emanate from the organization Ipas — a global body working to enhance women's sexual and reproductive rights and to reduce abortion-related deaths and injuries. VC workshops represent an instance of a more general trend in which participation is seen as a tool for generating legitimacy and "buy-in" for central state directives rather than as a means for genuinely deepening democratic communication. The manipulation of participation by elites may serve as a means to achieve socially desirable goals in the short term but the long-term outlook for a vibrant democracy invigorated by a knowledgeable, active and engaged citizenry that is accustomed to being required to exercise careful reflection and to its views being respected, is undermined. Alternative models of democratic communication, because they are based on the important democratic principles of inclusivity and equality, have the potential both to be more legitimate and more effective in overcoming difficult social challenges in ways that promote justice.

"Abortion will deprive you of happiness!": Soviet reproductive politics in the post-Stalin era

This article examines Soviet reproductive politics after the Communist regime legalized abortion in 1955. The regime's new abortion policy did not result in an end to the condemnation of abortion in official discourse. The government instead launched an extensive campaign against abortion. Why did authorities bother legalizing the procedure if they still disapproved of it so strongly? Using archival sources, public health materials, and medical as well as popular journals to investigate the antiabortion campaign, this article argues that the Soviet government sought to regulate gender and sexuality through medical intervention and health "education" rather than prohibition and force in the post-Stalin era. It also explores how the antiabortion public health campaign produced "knowledge" not only about the procedure and its effects, but also about gender and sexuality, subjecting both women and men to new pressures and regulatory norms.

"Lonely, tragic, but legally necessary pilgrimages": transnational abortion travel in the 1970s

This article explores the work of the Calgary Birth Control Association with a particular focus on their referral service to help Albertan women obtain abortions in Seattle. The fact that Canadian women were travelling to the United States for abortions highlights the shortcomings of the Canadian health-care system and the legal changes in the 1969 omnibus bill. Cross-border travel is also compelling evidence for the argument that reproductive rights are an international issue. More particularly, this study demonstrates the tensions that reproductive-rights activists faced in addressing the needs of individual women vs the long-term objective of changing the laws and improving accessibility.

Reproductive rights in Poland: when politicians fear the wrath of the Church

The historical prestige of the Polish Catholic Church is the result of its presence as a national symbol of resistance, both under foreign occupation and during the communist regime. In the post-communist era the power of the Church within the political arena has significantly increased, through the Concordat that was signed with the state as well as through formal and informal ties with political parties. Catholicism is the de facto religion of the state, even if Poland remains a nominally secular country. This was illustrated by the adoption, in 1993, of a total abortion ban. Although the relation of Poles to the Catholic dogma on sexuality and reproductive rights tends to be weak, fearing criticism from Church authorities, most politicians avoid controversial topics and express their commitment to Catholic dogma. Thus women's groups have encountered serious difficulties in their efforts to defend women's rights to sexual and reproductive autonomy. Although accession to the European Union has put Poland in an awkward position with respect to equality of rights between women and men, it has not fundamentally altered the real situation with respect to the controversial topic of abortion.

Politics, religion and gender equality in contemporary Mexico: women's sexuality and reproductive rights in a contested secular state

This article explores the complexities of the interaction between politics, religion and gender equality in contemporary Mexico, by analysing recent developments in public debate, legal changes and implementation of government policies in two areas: 1) the inclusion of emergency contraception in public health services in 2004; and 2) the decriminalisation of abortion in Mexico City in 2008, which was followed by a massive campaign to re-criminalise abortion in the federal states. Three main findings emerge from our analysis: first, that women's sexual and reproductive autonomy has become an issue of intense public debate that is being addressed by both state-public policy and society; second, that the gradual democratisation of the Mexican political system and society is forcing the Catholic Church to play by the rules of democracy; and third, that the character and nature of the Mexican (secular) state has become an arena of intense struggle within which traditional political boundaries and ideologies are being reconfigured.

"All this that has happened to me shouldn't happen to nobody else": Loretta Ross and the Women of Color Reproductive Freedom Movement of the 1980s

Loretta Ross exemplifies women of color feminist participation in and transformation of the women's health movement of the 1970s and 1980s. Ross helped build a women's health movement that by the late 1980s made the demands of women of color central. This movement was attractive to many women of color who had rejected the collapse of a broader women's health movement into the abortion rights movement as too narrowly focused. Many women of color activists, including Ross, argued that the emphasis on abortion rights and choice failed to address the linked socioeconomic and community health issues confronted by many women of color and poor women. Ross's work spurred coalition building among white women and women of color that focused on expanding reproductive justice and women's health beyond legal abortion. By the 1990s these efforts had produced a vibrant and engaged feminist reproductive justice movement that promoted the socioeconomics of good health for all women.

Between the town and the mountain: abortion and the politics of life in Edith Wharton's "Summer"

In the early twentieth century, American laws focused on women's reproductive capacities and were coalescing into the ethical and moral frameworks that subtend American reproductive politics today. Edith Wharton published her 1917 novel, Summer, at a time when anti-abortion sentiment was widespread in American culture. Through a reading of Summer, the article provides a theoretical and historical framework for understanding this new American obsession with the judicial regulation of women's reproductive options. In particular, I situate the novel's presentation of abortion within the tension between the carefully defined laws of North Dormer, the town in which the majority of the story takes place, and the lawlessness of the Mountain, a place that looms throughout the story as the protagonist's birthplace and a location of utmost abjection. The novel's profound insight is that power does not function unilaterally and individually but through and on the population. Furthermore, Wharton leaps ahead by recognizing that life is not simply that which lives but that which is recognized and embraced by the law. This realization, one that Wharton must have come to terms with through her painful work with World War I refugees, shapes Charity's character and her understanding not only of how reproduction is regulated but also of how living within this regulation and control generates the norm and offers the only possibility for a liveable and legible life.

Marching toward reproductive justice: coalitional (re) framing of the March for Women's Lives

This article examines how coalition frames develop and what happens to that frame after the formal coalition ends. To that end, I analyze the frame shift around the 2004 March for Women's Lives (March). The March initially focused on established ideas of reproductive rights around which the four national mainstream co-sponsors previously organized. However, after a newer reproductive justice organization joined the coalition, material and organizing reflected a shift in framing to reproductive justice. How did this change happen? What are the impacts of this event for the women's movement? Through document analysis and interviews, I trace the negotiations that facilitated this framing shift. I argue that this new coalition frame translated into positive lasting changes in organizing for women's reproductive health even as the coalition dissolved and some of the tensions within the larger women's movement remain.

Kinderwunsch und Wunschkinder

Definition of problem:

BACKGROUND

Reproductive Biomedicine and new reproductive technologies (ART) belong to the fields of medicine that initiated most of the discussion on enhancement and desire fulfilling medicine in bioethics during the last years. One of the crucial questions to be answered is the definition of the right to procreate/right for a genetically related child. Closely connected are controversial opinions in regard to the definition of sterility as a disease/illness, or a mere fate, or malfunction, which does not have to be medically cured. Arguments: After a cursory description of the national and international debate, we introduce some results of our 'bioethical field studies', exploring and comparing the views of experts (human geneticists, ethicists, pediatricians, obstetricians and midwifes) and couples/patients (IVF couples, high genetic risk couples and couples with no known risk for an inherited disease or infertility problem) on sterility, the right to procreate, possibilities and appropriate limits of IVF in Germany.

CONCLUSION

According to the WHO, sterility has to be defined as an illness, if the respective couples have a desire for a child. IVF can be a means for a cure. Since 2004, Germany does no longer supply a thoroughly insurer financed IVF treatment. Our surveys indicate that this change, though supported by many experts, is hard to accept for couples concerned. Only obstetricians share the WHO's view that sterility should count as an illness. Many ethicists see a proclaimed human right to procreate as merely negative right, although many support free IVF treatment for poor couples. We challenge the expert majority view on the basis of the capability approach (Amartya Sen) and functional liberalism (Herlinde Pauer Studer) and with a view to the international state of the art in IVF. The desire to have children cannot be reduced to a non-authoritative preference whose fulfillment is optional, but has to be conceptualized as a normative need that ought to be met.

The environmental movement's retreat from advocating population stabilization (1970-1998): a first draft of history

The years surrounding 1970 marked the coming of age of the modern environmental movement. As that movement enters its fourth decade, perhaps the most striking change is the virtual abandonment by national environ-mental groups of U.S. population stabilization as an actively pursued goal.