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PubMed1999

The psychological impact of reproductive difficulties on women's lives.

Little is known about the long-term impact of reproductive experiences on women's lives. This paper uses questionnaire data collected from 107 White female college graduates, when they were approximately 47 years old. More than half the sample had experienced at least one type of reproductive difficulty (abortion, miscarriage, or infertility). The stress and coping model of life difficulties (Lazarus and Folkman, 1984) was used to examine the relationship between the women's reproductive difficulties and emotional sequelae, politicization, and orientation to motherhood at midlife. As predicted, emotional responses to the reproductive difficulties varied according to the particular nature of each experience. In addition, women who had abortions and no other difficulties were more politicized at midlife than other women. Women whose reproductive experiences were especially likely to arouse feelings of not being in control of their life (those who had miscarriages or infertility) described a more agentic orientation to motherhood when compared with other women.

Americas↗

PubMed2001

Reproduction in the Noughties: will the scientists have all the fun?

The past 20-30 years have seen major advances in our understanding of human reproduction and in our ability to manipulate it, as well as major social changes in human reproductive and sexual attitudes. Many of these advances and changes developed out of the first successful in vitro fertilisation (IVF) of the human oocyte. It is also the case that 30 years ago few foresaw what was to come, and many were at best doubtful and often were very critical of the scientific work which led to human IVF and to many of the subsequent developments. This lack of foresight provides us with a lesson about the dangers that we face in looking forward and attempting to predict the future. This review will try to convey, not comprehensively but through examples, the flavour of current activities in Assisted Reproduction clinics and research laboratories around the world and what is being talked about for the future in respect of emergent patient demands and anticipated clinical needs. This clinically driven approach will form the basis for consideration of some underlying scientific aspects of reproductive research, some of the ethicolegal issues that may arise, and the implications of this anticipated future for our current approaches to medical education. The future will be considered not simply in terms of the New Reproduction itself but also in its interaction with the opportunities and challenges presented by the New Genetics. It is perhaps in the interaction between these two fields of endeavour that some of the most difficult challenges ahead lie.

Adult↗

PubMed1995

The new reproductive technologies: defying God's dominion?

Objections that the New Reproductive Technologies pose temptations to "play God" are common. This essay examines three versions of the objection: 1) these technologies "usurp God's dominion in reproduction"; 2) they permit us to "make" our offspring; and 3) they involve us in a denial of human finitude. None proves to generate a decisive case against the New Reproductive Technologies; each requires some further argument to be persuasive. Nonetheless, warning not to "play God" are shown to have an important parenetic function in the debate over medically-assisted reproduction, occasioning needed reflection on the meaning of creatureliness, finitude and responsible co-creation in the context of new forms of reproduction.

Catholicism↗

PubMed1996

Reproductive decision-making and determinants of contraceptive use in HIV-infected women.

Perinatal transmission and reproductive decisions of HIV-infected women can be categorized in statistical and epidemiological terms. These reports and figures, however, do little to fully explain the complexities of human relationships, life experiences, personal and cultural influences, and situational and environmental variables that impact on the HIV-infected woman regarding reproductive decision-making. It is only with genuine attempts to understand the woman's perspective and the dynamic and unique variables that influence reproductive decision-making, as well as maintaining a non-judgmental and culturally sensitive perspective, can we hope to assist women, and society as a whole, in coming to terms with the complexities of HIV and reproductive decision-making. Further study is needed to identify factors that influence reproductive decision-making in HIV-infected women. The determinants of contraceptive use regarding demographic factors, barriers to contraceptive use, and factors that contribute to successful contraceptive use in this population must be understood if efforts to reduce the number of unplanned pregnancies are to be successful. More conclusive data are needed on the safety and efficacy of oral contraceptives in HIV-infected women as well as data that describe the effects of longer acting hormonal contraceptives such as levonorgestrel implants (Norplant; Wyeth-Ayerst, Philadelphia, PA) and injectable medroxyprogesterone acetate (Depo Provera; Upjohn Company, Kalamazoo, MI). More research is needed to determine the effects of patient education and counseling and closer follow-up on effective long-term contraception in HIV-infected women.

Contraception↗

PubMed2004

Reproductive autonomy rights and genetic disenhancement: sidestepping the argument from backhanded benefit.

John Robertson has famously argued that the right to reproductive autonomy is exceedingly broad in scope. That is, as long as a particular reproductive preference such as having a deaf child is "determinative" of the decision to reproduce then such preferences fall under the protective rubric of reproductive autonomy rights. Importantly, the deafness in question does not constitute a harm to the child thereby wrought since unless the child could be born deaf he or she would otherwise never have existed--his or her prospective parents would simply have chosen to abort. As such, for this child, being born deaf counts as a benefit, albeit of the "backhanded" variety, since the only other practical alternative is nonexistence. In what follows, I want to investigate this argument in detail. The target of my investigation will be the possible future use of gene therapy technology to "disenhance" one's offspring. I intend to show that the apparently unlimited right to reproductive autonomy, that is, the right to choose both the quantity and qualities of future offspring, entailed by the argument from backhanded benefit can in fact be "sidestepped" through considering what sorts of reproductive practices we as a society ought to allow.

Child↗

PubMed1994

The global view of reproductive health.

Reproductive health is a condition in which the reproductive process is accomplished in a state of complete physical, mental and social well-being and is not merely the absence of disease or disorders of the reproductive process. The Daily Reproductive Health News in our global village does not paint a bright picture. The past few decades have witnessed a revolution in reproductive behaviour, with a major expansion in contraceptive use in developing countries. Between 1960-65 and 1985-90, the number of contraceptive users in all developing countries has increased from an estimate of 31 million to 381 million. The major expansion in contraceptive use in developing countries has consequences for the quality of life, for the present and for the future, for the society at large and for the individuals and their families. Major challenges, however, still lie ahead. There is a major unmet need for family planning. The rhetoric about population and family planning is not matched by allocation of resources.

Contraceptive Agents↗

PubMed2025

Reproductive Isolation due to Divergent Ecological Selection Is Accompanied by Vast Genomic Instability in Experimentally Evolved Yeast Populations.

Populations evolving independently in divergent environments accumulate genetic differences and potentially evolve reproductive isolation as a by-product of divergence. The speed and mechanisms underlying this process are difficult to investigate because we rarely get the opportunity to witness them in natural settings, and histories of selection and gene flow between populations are often unknown. Here, we experimentally evolved yeast for 1000 generations of evolution in both divergent and parallel environments. At regular time points during experimental evolution, we made crosses between parallel- and divergent-evolving populations to measure postzygotic reproductive isolation (gamete viability). We used whole genome population sequencing to determine the mutational load, the number and types of structural variation, and other genomic features of the parent, F1 and F2 intraspecific hybrids. We found evidence for large-scale phenotypic and genome-wide differentiation in response to divergent laboratory selection. Divergent-selected populations produced hybrids with reduced gamete viability-a classic signature of postzygotic reproductive isolation in the form of hybrid breakdown. Parallel-selected populations, on the other hand, remained more reproductively compatible (with exceptions). We found that F2 hybrid genomes contained vast genomic instability, that is, new structural variants (especially insertions, deletions and interchromosomal translocations) that were not observed in parent and F1 genomes, which is likely a result of chromosome missegregation and recombination errors in hybrid meiosis. Our results provide phenotypic and genomic evidence that partial reproductive isolation evolved due to adaptation to divergent environments, consistent with predictions of ecological speciation theory.

Reproductive Isolation↗

PubMed2026

MAdLandExpression: integrating sexual reproduction into the Physcomitrium patens expression atlas.

Physcomitrium patens is a bryophyte model system particularly valuable for evolutionary developmental and comparative genomics studies. Sexual reproduction in bryophytes offers unique insights into the evolution of land plant reproduction. Unlike seed plants, bryophytes have a dominant gametophyte phase and provide significant advantages for studying sexual reproduction, such as the possibility to maintain embryo-lethal mutants through vegetative propagation or the presence of motile male gametes. More than 25 years after the first publications of transcriptomic data for P. patens, expression data of most developmental stages of P. patens as well as its responses to various biotic and abiotic perturbations have been represented by microarrays or RNA-seq datasets. To facilitate the use of such data, we introduce the MAdLandExpression atlas as a successor of PEATmoss (Physcomitrium Expression Atlas Tool), integrating its 109 P. patens expression experiments and expanding it with 20 recently published RNA-seq samples of sexual reproduction stages, thus completing the coverage of the P. patens life cycle. The MAdLandExpression atlas also introduces new features for data visualization and analysis, such as the comparison of samples from multiple datasets and gene set normalization. Using this tool, the sexual reproduction dataset was analyzed, identifying genes potentially important for egg and sperm cell development, and confirming the behavior of known key genes in sexual development observed in previous studies.

Bryopsida↗

PubMed1993

Access to reproductive genetic services for low-income women and women of color.

This article examines access to reproductive genetics services for low-income women and women of color. It explores implications of the use of reproductive technologies; access and barriers to general prenatal care and its impact on accessing reproductive-genetic services; the implications of obtaining reproductive genetic services through public programs and funding, especially as they relate to equal provision of services. The traditional barriers to reproductive-genetics services; the decision-making process involved in genetic counseling when Caucasians dominate the process of counseling people of color; financial/insurance barriers to care for low- and moderate-income clients are also addressed. Recommendations are made to address the problems and inequities.

Abortion, Eugenic↗

PubMed1996

Current and future issues in assisted reproduction.

The last quarter of the twentieth century has given rise to reproductive technologies and arrangements that in the earlier part of the century could only be dreamed of by the authors of science fiction. We stand in the middle of this reproductive revolution, trying to cope with the developments that have already occurred but with an uneasy sense that the future may be even more complicated ethically than the past and the present. In this brief essay, I will survey recent ethical and public-policy discussions of two reproductive techniques (assisted insemination and in vitro fertilization) and one reproductive arrangement (surrogate motherhood). After distinguishing three phases in the normative debate, I will briefly comment on some of the characteristics of, and continuing ambiguities in, the ethical debate of the past 25 years. At the conclusion of the essay, I will attempt to anticipate three future issues in ethics and reproduction.

Advisory Committees↗

PubMed2003

Reproductive awareness behaviour and profiles of adolescent post abortion patients in Blantyre, Malawi.

BACKGROUND: Adolescent sexuality and its sequelae are now acknowledged as major public health, social and economic problems in Malawi, for which appropriate programmes and services are being designed and implemented. OBJECTIVES: To identify the profiles of adolescent post abortion patients, their reproductive and contraceptive knowledge and factors related to the index pregnancy. SETTING: Queen Elizabeth Central Hospital, Blantyre, Malawi. DESIGN: Cross-sectional, descriptive study. METHODS: All adolescents treated for incomplete abortion, January to December 1997 were eligible. Data was collected by means of interviewer-administered questionnaire, one for each, during reproductive health education and/or post abortion contraceptive counselling and service provision. This was subsequently analysed using EPI-INFO 6.0 data analysis packages. RESULTS: Of the 465 adolescents treated during this period, 446 (95.9%) were enrolled in the study. Their mean age was 17.5 years (SD 1.3), that at menarche and sexual debut 14.3 years (SD 1.4) and 15.7 years (SD 1.75) respectively. The unmarried adolescents formed 43.9%, while students comprised 38.6% of the total. Their level and accuracy of knowledge on reproductive biology was poor. While their contraceptive knowledge was high, its use was very low, 70.9% vs 9.5% respectively. The number of sexual partners one had had ranged from 1 to 10 with a median of 1. The index pregnancy was reportedly unwanted by 45.1%. The young (< 16 years), more educated, single and students were more likely to have unwanted pregnancy. CONCLUSIONS: Sexual activity starts early in Malawi, with poor contraception, thus predisposing to unwanted pregnancy. Lack of appropriate reproductive awareness appears to be partly responsible for that. These need to be addressed through the national reproductive health programmes and services.

Abortion, Induced↗

PubMed2003

The case for regulating collaborative reproduction: a children's rights perspective.

There is little regulation of collaborative reproduction--the use of the eggs, sperm, or embryos of a third party to create a child biologically unrelated to at least one intending parent. This Article argues that the dearth of regulation should be assessed from a children's rights perspective and accordingly adjusted. After examining the effects of the experimental reproductive technologies, it concludes that traditional family law preferences and policies are undercut by the deliberate creation of collaboratively reproduced children. The lack of regulation might stem from constitutional protection afforded parents in the right of privacy and substantive due process cases. The author, however, contends that collaborative reproduction implicates the rights of children and requires a separate balancing of rights not contemplated in other cases. Collaborative reproduction also requires regulation because of its spill over effects on the acceptability of cloning. The Article concludes by offering several possible regulatory responses to the problems posed by collaborative reproduction.

Child↗

PubMed2003

Assisted reproduction--Islamic views on the science of procreation.

The field of assisted reproduction is one of the fastest growing areas in medicine. The development of new and sophisticated techniques all aim to give reproductive technologies and scientists a better understanding of reproductive biology. The development of new techniques may also be able to improve the chances of an infertile couple towards achieving a pregnancy. However the ethics and legality of assisted reproductive technology must not be brushed aside. Islamic scholars whose reference basis resides in the Holy Quran and the Hadith have addressed different issues relating to assisted reproductive technology. Some of the issues remain controversial and need detailed discussion before it can be deemed as appropriate and legible for use as guidelines in the development of the processes involved.

Beginning of Human Life↗

PubMedDate not supplied

Reproductive choice in Islam: gender and state in Iran and Tunisia.

This report examines the extent to which reproductive choice is compatible with Islamic principles. It presents the argument that the impact of Islam on reproductive choice is largely a function of the political context in which gender issues are defined. Indicators of reproductive health in countries of the Middle East are reviewed and the way these relate to constraints on reproductive choice is assessed. The examples of Tunisia and Iran are used to illustrate the way in which Islam is invoked to legitimate conflicting positions concerning women and their reproductive options.

Choice Behavior↗

PubMed1995

Reproductive biology knowledge, and behaviour of teenagers in East, Central and Southern Africa: the Zimbabwe case study.

Sexuality in the teenager is often complicated by unplanned/unwanted pregnancy, abortion and the risks of STDs including AIDS. There is therefore a need for improved understanding of factors affecting adolescent sexuality and the implementation of programmes designed to improve their knowledge, risk awareness and subsequent behavioural outcomes. A multicentre study of reproductive health knowledge and behaviour followed by a health education intervention was undertaken amongst teenagers in selected countries of East, Central and Southern Africa. Reported here are findings at baseline derived from the Zimbabwe component on reproductive biology knowledge and behavior. A self-administered questionnaire was used among 1 689 adolescent pupils drawn from rural, urban, co-education, single sex, boarding and day secondary schools in Zimbabwe. Correct knowledge on reproductive biology as measured by the meaning and interpretation of menstruation and wet dreams varied by school from 68 pc to 86 pc, with a significant trend (p < 0,01) based on level of education at baseline. The reported mean age at which menarche took place was 13,5 years +/- 1,3 (mean +/- SD). First coitus was reported to have taken place at the mean age of 12 years for boys and 13,6 years for girls. Seventeen pc of the adolescent pupils reported that they were sexually experienced and 33,2 had relationships. There were misconceptions reported on menstruation with 23 pc reporting that it was an illness. Peers, followed by magazines were the first sources of information on various aspects of reproductive biology, both of which might not provide the correct first information. Among pupils reporting that they were sexually experienced, the largest proportion (56 pc) had unprotected sex. The findings point to the need for targeting the adolescent pupils for information on reproductive biology and increased awareness on the risks of pregnancy, STDs and HIV.

Adolescent↗

PubMedDate not supplied

Human rights and reproductive choice.

A central challenge in developing reproductive health strategies is giving real meaning to the right of couples and individuals to determine, freely and responsibly, the number and spacing of their children. This article places the right of reproductive choice in legal and historical contexts, highlights salient issues that arise in trying to formulate international standards for its enforcement, and examines two particularly thorny issues: the tension between demographic priorities and reproductive choice and the tension between international standards and local custom/religion. The article calls on health professionals to participate actively in the elaboration of reproductive rights, both through their immediate work in the health-care field and through involvement in the international policymaking process that will take place in three upcoming international conferences.

Birth Intervals↗

PubMed2006

Integration of sexual and reproductive health in the medical curriculum in Pakistan.

OBJECTIVE: To assess the knowledge of medical practitioners regarding management of selected reproductive tract infections, diagnosis of sexual dysfunction and identification of sexual abuse and to assess the attitudes and practices of health care providers regarding sexual and reproductive rights in order to recommend areas that need to be incorporated in a sexual and reproductive health curriculum. DESIGN: A cross-sectional survey. PLACE AND DURATION OF STUDY: From March to August 2003 in the District Turbat of Balochistan, Pakistan. SUBJECT AND METHODS: Selected indicators of knowledge, attitudes and practices regarding sexual and reproductive health of primary care physicians were assessed using a pre-tested questionnaire and formal/informal interviews. Variables were identified from the literature and previous in-depth interviews, and then formulated into respective questions. A Lichert scale marked from 1 to 5 was used for categorizing responses into agreed, neutral and disagreed. Descriptive statistics were computed using SPSS version 10 for windows. Qualitative interviews were translated and transcribed and analyzed according to pre-judged and emerging themes. RESULTS: Out of 45 physicians interviewed, nearly half scored less than 50% in the knowledge section. Attitudes and practices assessed suggested a tendency to be judgmental, gender/rights discriminatory and with little provision for enabling clients to make their own decisions, so essential for quality sexual health service provision. CONCLUSION: Keeping in view the importance of the sexual health issues and a lack of ability of health care providers to handle it effectively, deficient areas of sexual health must be integrated into the medical curriculum. Medical educators have the responsibility to train physicians and other health professionals in the core competencies to improve the sexual and reproductive health of their communities.

Adult↗

PubMed1996

Behavioral and environmental determinants of reproductive success in traditional Moroccan Berber groups.

The reproductive histories of women aged 45-70 years from a homogeneous Berber population of South Morocco were sampled from three contrasting environments: a small town (n = 75), villages in the lowlands (n = 217), and villages in the highlands (n = 128). The main reproductive variables oppose the relatively better conditions of fertile life in the lowlands to the more hostile ones in the highlands. Path analysis confirms this difference through reproductive behaviors and suggests the existence of mechanisms for controlling family size in town and in the rural lowlands, but not in the highlands. The estimates of survival function show significant differences among the three groups, the conditions for survival in the highlands being clearly less favorable. Rank tests of the association of survival data with several covariates indicate the association of survival data with vaccinations and with conditions of delivery. In spite of the lower rate of offspring survival, the highlander group would demonstrate a higher overall number of children reaching reproductive maturity, thanks to an extended reproductive span.

Aged↗