Third-party reproductive practices: legislative inertia and the need for nuanced empirical data

In their article, ‘Gamete donor anonymity and limits on numbers of offspring: the views of three stakeholders’, Margaret K. Nelson, Rosanna Hertz and Wendy Kramer draw on survey data from gamete donors, parents who used gametes to conceive, and donor-conceived offspring in order to understand the position that various stakeholders are likely to hold regarding the regulation of two issues pertaining to gamete donation: anonymity and limits on numbers of offspring.1 This commentary elaborates on the politics underlying conflicts and agreements among various stakeholders involved with third-party reproduction and details the need for data to better inform legislation regarding assisted reproductive medicine. In so doing, I draw from social science research on third-party reproductive practices as well as from my own research on surrogacy, an area of third-party reproductive practice that shares many of the particular issues involved with gamete donation. First, I discuss the dearth of laws that regulate the reproductive industry in theUnited States and the contradictions and tensions that contribute to legislative inertia regarding reproductive medicine. Next, I survey the lack of data on ethical and legal issues that arise from assisted third-party reproductive arrangements, and I show how social science research on these issues can challenge common assumptions about the practice. At the same time, I examine the difficulty in collecting good representative data in this realm. Finally, I discuss the complexities of translating the nuances of social science research into workable legislation

Primary Care Physicians’ Concerns May Affect Adolescents’ Access to Intrauterine Contraception

Purpose: Although the intrauterine device (IUD) may be safely used in adolescents, few US adolescents use IUDs. Increasing IUD use in adolescents can decrease pregnancy rates. Primary care providers’ clinical practices many be one of the many barriers to increasing adolescents access to IUDs. We explored primary care physicians’ (PCPs) approaches to contraception counseling with adolescents, focusing on their views about who would be appropriate IUD candidates. Methods: Phone interviews were conducted with 28 urban family physicians, pediatricians, and obstetrician-gynecologists. Using standard qualitative techniques, we developed coding template and applied codes. Results: Most respondents have a patient-centered general contraceptive counseling approach. However, when considering IUDs many PCPs describe more paternalistic counseling. For example, although many respondents believe adolescents’ primary concern is pregnancy prevention, many PCPs prioritize sexually transmitted infection (STI) prevention and thus would not offer an IUD. Attributes PCPs associate with an appropriate IUD candidate include responsibility, reliability, maturity, and monogamy. Conclusion: Our findings suggest that when considering IUDs for adolescents some PCPs’ subjective assessment of adolescent sexual behavior, attitudes about STI risk factors and use of overly restrictive IUD eligibility criteria impede adolescent’s IUD access. Education around best practices may be insufficient to counterbalance attitudes concerning adolescent sexuality and STI risk; there is also a need to identify and discuss PCPs potential biases or assumptions affecting contraception counseling

'Because of the risks': how US pregnant women account for refusing prenatal screening

Most research on prenatal fetal testing in general, and maternal alpha-fetoprotein (AFP) screening in particular, has focused on women who accept and even actively seek prenatal diagnosis. Much of this work suggests that agreeing to prenatal diagnosis is inextricably linked to the processes associated with the 'medicalization' of reproduction and that most women do not see refusal as an option. In contrast, little attention has been paid to women who decline fetal diagnosis. Instead, it is generally assumed that women who do so are resisting this thrust toward medicalization and/or are opposed to abortion. Our research is designed to address this imbalance. We analyze how a group of US women who refused the offer of AFP screening account for their decisions and compare their explanations with those of women who took the test. Contrary to our expectations, we found that refusal did not signify rejection of and/or resistance to the offerings of science and technology. Rather, women who refused often employed biomedical categories, particularly the concept of 'risk', to reject its very offerings. Furthermore, refusers and acceptors were more alike than different in their views on abortion, medicalization and pregnancy. We conclude that the key difference between the two groups lies in their interpretation and application of biomedical concepts and modern risk-assessment.Maternal serum alpha fetoprotein Prenatal screening Medicalization of reproduction

Role of Black Churches in Health Promotion Programs: Lessons From the Los Angeles Mammography Promotion in Churches Program

Objectives. This article assesses pastor-level factors that affect the successful recruitment and implementation of community-based health promotion programs in Black churches. Methods. Semistructured interviews with 16 pastors of Black churches were analyzed for content. Results. We found that although the involvement of Black pastors in an array of secular activities makes them open to participate in health programs, their overcommitment to other issues can negatively influence their ability to participate. Second, although Black pastors appreciate being included in and benefiting from health research, minorities' history of being underserved and exploited can lead to suspiciousness and reluctance to participate. Conclusions. Our findings suggest that those interested in developing church-based health programs in the Black community must be attuned to how the same factors can both facilitate and hinder a program's development