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PubMed2004

Abortion law, policy and services in India: a critical review.

Despite 30 years of liberal legislation, the majority of women in India still lack access to safe abortion care. This paper critically reviews the history of abortion law and policy in India since the 1960s and research on abortion service delivery. Amendments in 2002 and 2003 to the 1971 Medical Termination of Pregnancy Act, including devolution of regulation of abortion services to the district level, punitive measures to deter provision of unsafe abortions, rationalisation of physical requirements for facilities to provide early abortion, and approval of medical abortion, have all aimed to expand safe services. Proposed amendments to the MTP Act to prevent sex-selective abortions would have been unethical and violated confidentiality, and were not taken forward. Continuing problems include poor regulation of both public and private sector services, a physician-only policy that excludes mid-level providers and low registration of rural compared to urban clinics; all restrict access. Poor awareness of the law, unnecessary spousal consent requirements, contraceptive targets linked to abortion, and informal and high fees also serve as barriers. Training more providers, simplifying registration procedures, de-linking clinic and provider approval, and linking policy with up-to-date technology, research and good clinical practice are some immediate measures needed to improve women's access to safe abortion care.

Abortion, Induced↗
PubMed1991

Mating patterns in seminatural populations of mice influenced by MHC genotype.

Because of the central role of major histocompatibility complex (MHC) genes in immune recognition, it is often assumed that parasite-driven selection maintains the unprecendented genetic diversity of these genes. But associations between MHC genotype and specific infectious diseases have been difficult to identify with a few exceptions such as Marek's disease and malaria. Alternatively, MHC-related reproductive mechanisms such as selective abortion and mating preferences could be responsible for the diversity. To determine both the nature and strength of selection operating on MHC genes by we have studied components of selection in seminatural populations of mice (Mus musculus domesticus). Here we assess MHC-related patterns of reproduction and early (preweaning) mortality by analysing 1,139 progeny born in nine populations, and 662 progeny from laboratory matings. Reproductive mechanisms, primarily mating preferences, result in 27% fewer MHC-homozygous offspring than expected from random mating. MHC genotype had no detectable influence on neonatal (preweaning) mortality. These mating preferences are strong enough to account for most of the MHC genetic diversity found in natural populations of Mus.

Animals↗
PubMed1994

Ethical issues related to prenatal genetic testing. The Council on Ethical and Judicial Affairs, American Medical Association.

This report examines ethical issues related to prenatal genetic testing, including the physician's role in promoting informed reproductive decisions and physician involvement in genetic selection and manipulation. In general, it would be ethically permissible to participate in genetic selection (abortion or embryo discard) or genetic manipulation to prevent, cure, or treat genetic disease. It would not be ethical to engage in selection on the basis of benign characteristics. Genetic manipulation of benign traits, though generally unacceptable, may be permissible under exceptional circumstances. At a minimum, three criteria would have to be satisfied: there would have to be a clear and meaningful benefit to the child, there could be no trade-off with other characteristics or traits, and all citizens would have to have equal access to the genetic technology, irrespective of income or other socioeconomic characteristics.

Abortion, Therapeutic↗
PubMed2003

Potential mechanisms of avian sex manipulation.

The aim of this review is to consider the potential mechanisms birds may use to manipulate the sex of their progeny, and the possible role played by maternal hormones. Over the past few years there has been a surge of reports documenting the ability of birds to overcome the rigid process of chromosomal sex determination. However, while many of these studies leave us in little doubt that mechanisms allowing birds to achieve this feat do exist, we are only left with tantalizing suggestions as to what the precise mechanism or mechanisms may be. The quest to elucidate them is made no easier by the fact that a variety of environmental conditions have been invoked in relation to sex manipulation, and there is no reason to assume that any particular mechanism is conserved among the vast diversity of species that can achieve it. In fact, a number of intriguing proposals have been put forward. We begin by briefly reviewing some of the most recent examples of this phenomenon before highlighting some of the more plausible mechanisms, drawing on recent work from a variety of taxa. In birds, females are the heterogametic sex and so non-Mendelian segregation of the sex chromosomes could conceivably be under maternal control. Another suggestion is that follicles that ultimately give rise to males and females grow at different rates. Alternatively, the female might selectively abort embryos or 'dump lay' eggs of a particular sex, deny certain ova a chance of ovulation, fertilization or zygote formation, or selectively provision eggs so that there is sex-specific embryonic mortality. The ideas outlined in this review provide good starting points for testing the hypotheses both experimentally (behaviourally and physiologically) and theoretically.

Animals↗
PubMed1999

Acceptance of screening and abortion for Down syndrome among Finnish midwives and public health nurses.

In this study we evaluated how well maternal serum screening and abortions for Down syndrome were accepted among midwives and public health nurses, and compared how those who accepted and did not accept abortions for Down syndrome differed from each other. The questionnaire was mailed in 1998 to 400 midwives and 400 public health nurses. 79 per cent responded. The majority said that all pregnant women should be offered a screening test for Down syndrome, but less than half accepted abortion for Down syndrome. Thus, the 'informative part' of the screening (serum screening itself) is supported more often than the 'operative part' (selective abortion)-or at least the 'operative part' was found to be a more difficult question. We suggest that whereas screening may be perceived as a question of more choices, information and self-determination, abortion is more clearly a moral question. The professional background characteristics and attitudes of those accepting and not accepting abortion for Down syndrome were relatively similar, but having a midwife's education, practical involvement in serum screening and having patients with Down syndrome were associated with a somewhat higher percentage of acceptance and a lower percentage of 'don't know' responses.

Abortion, Induced↗
PubMed1996

Abortions in Byzantine times (325-1453 AD).

The legislation and the texts of the most important medical writers of Byzantine times have been studied with reference to abortions, the ethical aspect of this social and medico-legal problem, the theological and the scientific approach. The theoretical basis of the permanent and absolute condemnation of all kinds of abortions except those permitted for medical reasons, is greatly influenced by the spirit of Christianity. In fact, religion supported the view that the reception of the seed in the uterus and the conception of the embryo means the beginning of life and accepted that the foetus is already a living creature. All legislation of Byzantium from the earliest times also condemned abortions. Consequently, foeticide was considered equal to murder and infanticide and the result was severe punishments for all persons who participated in an abortive technique reliant on drugs or other methods. The punishments could extend to exile, confiscation of property and death. The physicians followed the tradition of Ancient Greece, incorporated in the Hippocratic Oath, representative of the ideas of previous philosophers. According to this famous document, it is forbidden them to give a woman "an abortive suppository". The Orthodox faith reinforced this attitute, protective of every human life. On the other hand, the Church and the State accepted selective abortion based on medical data, such as prevention of dangerous conditions in pregnancy or anatomical difficulties involved. In conclusion, science, church and legislation had a common attitude to matters concerning abortion and this fact reveals an effort to apply a fair policy for the rights of the embryo and the protection of human life in Byzantine society.

Abortion, Spontaneous↗
PubMed1998

Amniocentesis before the 15th gestational week in single and twin gestations-complications and quality of genetic analysis.

BACKGROUND: Early amniocentesis has been claimed to confer a higher risk of fetal loss than standard amniocentesis after the 15th gestational week. Our experience of early amniocentesis in single and twin gestations from 1990 - 1995 is presented with 99.3% follow-up. METHODS: Amniocentesis was performed between 11 gestational weeks + 5 days and 14 gestational weeks + 6 days. RESULTS: In 1646 pregnancies 1678 amniocenteses were performed. Thirty-two reamniocenteses were done, 17 due to amniocyte culture failure and 15 due to failure to obtain sufficient amount of amniotic fluid on the first occasion. After puncture 1.49% (25/1678) suffered a spontaneous abortion. Twenty twin pregnancies were included. One spontaneous abortion was noted in this group, as well as three cases where one fetus was normal and the other had a severe defect. Selective abortions were performed without complications. CONCLUSIONS: The difference of postprocedure fetal loss in our population between early and standard amniocentesis is 0.8%. A comparison of postprocedure losses is not appropriate when amniocenteses are performed at a different gestational age, as spontaneous loss decreases with increased gestational age. Our results compare well with the only randomized study between early and standard amniocentesis where the fetal loss after early amniocentesis is similar to that in standard amniocentesis.

Abortion, Spontaneous↗
PubMed2004

The political economy of abortion in India: cost and expenditure patterns.

Access to abortion services is not difficult in India, even in remote areas. Providers of abortion range from traditional birth attendants to auxiliary nurse midwives and pharmacists, unqualified and qualified private doctors, to gynaecologists. Despite a well-defined law, there is a lack of regulation of abortion services or providers, and the cost to women is determined by supply side economics. The state is not a leading provider of abortions; services remain predominantly in the private sector. Abortions in the public sector are free only if the woman accepts some form of contraception; other fees may also be charged. The cost of abortion varies considerably, depending on the number of weeks of pregnancy, the woman's marital status, the method used, type of anaesthesia, whether it is a sex-selective abortion, whether diagnostic tests are carried out, whether the provider is registered and whether hospitalisation is required. A review of existing studies indicates that abortions cost a substantial amount--first trimester abortion averages Rs.500- 1000 and second trimester abortion Rs.2000-3000. Given the number of unqualified providers and with 15-20% of maternal deaths due to unsafe abortions, the costs of unsafe abortions must also be counted. It is imperative for the state to regulate the abortion economy in India, both to rationalise costs and assure safe abortions for women.

Abortion, Induced↗
PubMed1999

The burden of genetic disease and attitudes towards gene testing in Alport syndrome.

We evaluated the burden of Alport syndrome (AS) and the attitudes towards gene testing in patients with AS and their healthy family members from 37 families using a multiple-choice questionnaire. We also evaluated how the disease affected the decision to have children and the information received about the syndrome. A total of 53 individuals responded to this questionnaire. The risk of renal insufficiency and the uncertainty of the prognosis were considered the worst components of AS. Many of the respondents felt that children should be informed about AS as soon as they start asking (45%), preferably by a parent (74%). Almost all of the respondents (96%) had a positive attitude towards genetic research, which in the opinion of the majority should be aimed at better treatment and diagnosis of the disease rather than developing methods for prenatal diagnosis (89% and 75% versus 43%). AS seems to be well tolerated; 28% and 19% of the respondents found abortion acceptable in cases of an affected male and female fetus, respectively. Our study indicates a desire for prenatal tests in order to predict the health of a future child rather than for selective abortion.

Abortion, Induced↗
PubMed1992

Attitudes toward the prenatal diagnosis of cystic fibrosis: factors in decision making among affected families.

The objective of this study was to explore psychosocial factors underlying decisions about use of prenatal diagnosis for cystic fibrosis (CF), among parents of affected children. Anonymous survey questionnaires, supplemented by voluntary interviews, were used at 12 CF centers in six New England states, for a consecutive sample of families of minor children visiting CF centers during a 4-mo period. In all, 227 (71%) of 318 families responded. We hypothesized that attitudes toward utilization would be affected by (a) intentions to have children, (b) knowledge, (c) perception of risk, (d) the health of the child with CF, (e) expectations about the child's future, (f) attitudes toward abortion, (g) insurance, (h) genetic counseling, and (i) sociodemographic factors (including attendance at religious services). Of the 227 couples who responded, 69% were surgically sterile, over 45 years of age, widowed, or divorced, and 31% were at risk. Of 70 at-risk couples, 44% intended to have more children; of these, 77% had had or were considering CF prenatal diagnosis. Most families knew CF could be diagnosed prenatally; 20% would terminate for CF. Among intended prenatal diagnosis users, 44% would carry a fetus with CF to term, 28% would abort, and 28% were undecided. Stepwise logistic regression showed three variables significantly related to intentions to use prenatal diagnosis: (1) respondent's willingness to abort for CF (P less than .02, odds ratio 3.36), (2) respondent's siblings' approval of abortion for CF (P less than .03, odds ratio 2.99), and (3) respondent listed no accomplishments for the child with CF (P less than .09, odds ratio 3.01). The majority of affected families reject selective abortion for CF; many will curtail childbearing rather than use prenatal diagnosis.

Adult↗
PubMed1985

The apparently declining prevalence of neural tube defect in two counties in South Wales over three decades illustrating the need for continuing action and vigilance.

Neural tube defects, anencephaly and spina bifida (including encephalocele) have been the major malformation problem in South Wales. Births of affected offspring of residents of Mid and South Glamorgan between 1956 and June 1985 were ascertained from various sources. To these were added terminations following prenatal diagnosis and affected spontaneous abortions of 16 weeks gestation or more since 1973. Variable fluctuation in prevalence occurred between 1956 and 1965. Since then there has been an accelerating decline in the birth prevalence of NTD but especially of anencephaly in both counties. When abortions and terminations are taken into consideration the decline until 1984, though still present, is much slower and is virtually non-existent now. The need for continuing NTD pregnancy screening and prenatal diagnosis followed by selective abortion is stressed. It is suggested that genetic counselling health education to improve maternal nutrition preconceptional counselling and population folic acid supplementation should be extended to prevent these defects.

Abortion, Therapeutic↗
PubMed1978

Regulatory policy and abortion clinics: implications for planning.

The practicalities of formulating regulatory policy associated with elective abortion often place public health officials at the center of political controversy. Resulting conflicts can inhibit a rational consideration of long-term objectives in implementing a national policy which assures legal accessibility to all who would select abortion as an alternative to term birth. Regulation which uses primarily structural criteria for monitoring and evaluating services tends to de-emphasize the importanc of contraceptive counseling as a component of abortion services. Our process/outcome evaluation of abortion clinics located in Chicago suggests that contraceptive counseling provided at the time of the abortion procedure has a potential long-term impact in terms of reducing the need for elective abortion. We suggest that regulation policy should include process and outcome criteria which support the eventual reduction in need for abortion as a long-range policy goal and suggest key issues for consideration when such a policy is formulated.

Abortion, Legal↗
PubMed1997

Female and male physicians' attitudes toward prenatal diagnosis: a Pan-Canadian survey.

Despite widespread use over the past 20 years, prenatal diagnosis (PND) remains a controversial technique because of the moral and organizational dilemmas that it raises in many countries. In order to assess attitudes to PND within the Canadian medical profession, a survey was carried out involving over 3000 physicians offering PND (general practitioners, obstetricians, pediatricians, and radiologists). Several scales were developed to measure (1) physicians' willingness to broaden access to PND, (2) acceptability of abortion when a fetal anomaly is diagnosed, and (3) physicians' directiveness in regard to abortion. This article discusses results concerning the attitudes and opinions of male and female physicians toward prenatal diagnosis, which differed on the three scales. Female physicians are more liberal than their male colleagues with regard to access to amniocentesis and selective abortion and have a less directive relationship with their patients. These tendencies are similar to those observed in prior studies. They are particularly marked for general practitioners and radiologists. Various explanatory hypotheses are examined.

Abortion, Eugenic↗
PubMed1979

Bioethical issues in family planning.

Contraception and elective abortion are two of the controversial ethical issues with which social workers must deal. Since policies regarding these issues have recently been established by the courts, the author presents a review of the relevant decisions. The policy questions stemming from a related family planning issue, namely, selective abortion because of genetic defects, are also discussed.

Abortion, Legal↗
PubMed1985

Some aspects of late abortion for congenital abnormality.

Present methods of prenatal diagnosis are not applicable until at least 16 weeks of gestation. Most abortions for suspected congenital abnormality are therefore usually done in the second trimester of pregnancy. Abortions at over 20 weeks of gestation account for about 0.8% of all abortions for residents of England and Wales, but the operations are unpleasant and carry a significant morbidity. Screening the population for neural tube defects has led to a marked reduction in the recorded incidence of infants born with the condition. A survey in the Northern Region of England, with official statistics from Scotland, shows that in spite of the contribution made by selective abortion, there appears to be a genuine reduction in the population incidence of neural tube defect in Scotland. The diagnosis of chromosomal abnormalities, and to a lesser extent of neural tube defects, depends on amniocentesis and there is evidence of more delay in initiating amniocentesis for neural tube defect than for chromosomal tests, probably because of administrative delay associated with the use of serum alphafetoprotein screening. The possible impact of proposals to change the law concerning the limit of viability of the fetus on the practice of late abortion for congenital abnormality is examined. Abortion for congenital abnormality should be permitted after 22 weeks' gestation.

Abortion, Induced↗
PubMed1994

International study of sex ratio and twinning of neural tube defects.

The goal of this study, based on information collected from eight congenital malformation registry programs around the world, was to analyze sex and twinning of affected infants and fetuses, according to type of neural tube defect (NTD) and other variables. The type of defect and its location, whether it occurred in isolated form or was associated with other malformations, population from which data were retrieved, vital status of the infant, and gestational age of the fetus/infant were considered. The material included 3,416 infants and 168 selectively aborted fetuses with anencephaly, 4,830 infants and 76 fetuses with spina bifida, and 1,022 infants and 19 fetuses with encephalocele. Less than 20% of infants with anencephaly or spina bifida and more than one-third of infants with encephalocele had associated malformations. A female excess was found among all infants with NTD but a male excess in fetuses delivered spontaneously before week 20, indicating selective male late fetal deaths. Sex ratio varied by type of NTD, vital status at birth, presence of associated malformations, and year of birth, with an increasing sex ratio for anencephaly during the 1960s and 1970s. Twinning was positively associated with NTD but the extent of this association varied with NTD type and program, while the distribution by sex type of pair of twin appeared to be similar to that of all births. Twins concordant for anencephaly or encephalocele were mainly found when the defect occurred as part of a syndrome, and only in like-sexed pairs. Twins concordant for spina bifida had the isolated form of the defect and 5 of 6 pairs were like-sexed.(ABSTRACT TRUNCATED AT 250 WORDS)

Diseases in Twins↗
PubMed1998

Preimplantation diagnosis of thalassemias.

PURPOSE: Preimplantation genetic diagnosis (PGD) is an important option for couples at risk of having children with beta-globin mutations to avoid selective abortions of affected fetuses following prenatal diagnosis. METHODS: We performed PGD for thalassemia in 12 clinical cycles (IVS1-110, and IVS-745 mutations) using biopsy of the first and second polar bodies (PBs) extruded from oocytes during maturation and fertilization, coupled with nested polymerase chain reaction analysis and restriction digestion. RESULTS: A total of 118 oocytes was obtained, of which 78 had results for both the first and the second PBs. This resulted in the selection and transfer of 30 unaffected embryos (2.5 embryos per cycle). To avoid a possible misdiagnosis due to allele dropout (ADO), we have also introduced simultaneous detection of two highly polymorphic linked markers, a short tandem repeat immediately at the 5' end of the globin gene and HUMTH01 which is a syntenic short tandem repeat. The application of multiplex polymerase chain reaction of the beta-globin gene and linked polymorphic markers enabled detection of ADO in five first PBs, thus avoiding the transfer of potentially affected embryos resulting from their corresponding oocytes. CONCLUSIONS: Confirmation studies of the embryos resulting from the oocytes predicted to contain an affected gene confirmed the diagnosis in 98% of the cases, thus demonstrating the accuracy and reliability of PB PGD of thalassemia mutations. The application of PB analysis in six patients resulted in two ongoing pregnancies with a thalassemia-free fetus already confirmed in both of them by prenatal diagnosis.

Alleles↗