From ‘Mung Ming’ to ‘Baby Gammy’: a local history of assisted reproduction in Thailand

AbstractThis paper documents the rapidly changing history of IVF in Thailand since the birth of the first IVF conceived child there in 1987. The paper is based upon extensive Thai and English media material as well as interviews with leading reproductive specialists and is informed by long-term ethnographic research on IVF in Thailand. Assisted reproduction was quickly accepted in Thai society and associated with modernity and nationalist pride in Thai scientific progress. From its early beginnings in state-owned teaching hospitals, assisted reproduction rapidly expanded into the Thai private sector. Although Thai Medical Council guidelines were introduced in 1997, the loose regulatory regime saw the growth of an international trade in assisted reproductive technology services and medical facilitation companies brokering commercial surrogacies. From 2011, various controversies brought the industry into disrepute. These included: the trafficking of Vietnamese women as surrogates; non-medical sex selection and commercial ova donation and commercial surrogacy in breach of Thai Medical Council guidelines; the highly publicised case of a Japanese man commissioning 15 children with multiple surrogates; and the ‘Baby Gammy’ case involving the abandonment of a twin born with Down Syndrome. These cases exposed the exploitative downside of an assisted reproductive technology market that takes advantage of countries with little or no regulation in place and led Thai society to question the benefits of these technologies, their practitioners and the industry it has created. Since 2015, new legislation restricts clinical practices, limits eligibility for services and bans all commercial ova donation or surrogacy or its facilitation

Forming relationships in Australia: qualitative insights into a process important to human wellbeing

Drawing on in-depth interviews conducted during 2002-03 for the Australian Family Formation Decisions (AFFD) Project, this paper probes the relationship formation experiences of 115 women, men and couples of family-forming age living in eastern Australia. Contemporary relationship formation is characterized by a mixture of ambivalence and resignation to having limited control over the process on the one hand ('if it happens it happens'), and urgency on the other, especially among women seeking to fulfil maternal ambitions in their thirties after prioritizing other things earlier in their adult lives. For most the process of partnering involves trial and error, with timing - finding someone whose expectations of a relationship match one's own - posing a major challenge. It gives rise to a common phenomenon, the 'too soon syndrome', where relationships with many positive attributes are abandoned because one party perceives the other as too keen to 'settle down', and/or himself or herself as not ready to do so. The paper also examines impediments to partnering, including traditional ones like shyness; negative trial-and-error experiences; the demands of study and career establishment; pursuit of agendas emphasizing travel and enjoyment; sole parenthood; and parental marriage breakdown. A framework is provided by Beck's (1992) concept of reflexive modernization, and his associated proposition that life has become highly individualized with an emphasis on creating 'do-it-yourself' biographies

Understanding media publics and the antimicrobial resistance crisis

Antimicrobial resistance (AMR) imperils health for people across the world. This enormous challenge is being met with the rationalisation of prescription, dispensing and consumption of antimicrobials in clinical settings and in the everyday lives of members of the general population. Individuals need to be reached outside clinical settings to prepare them for the necessary changes to the pharmaceutical management of infections; efforts that depend on media and communications and, therefore, how the AMR message is mediated, received and applied. In 2016, the UK Review on Antimicrobial Resistance called on governments to support intense, worldwide media activity to promote public awareness and to further efforts to rationalise the use of antimicrobial pharmaceuticals. In this article, we consider this communications challenge in light of contemporary currents of thought on media publics, including: the tendency of health communications to cast experts and lay individuals in opposition; the blaming of individuals who appear to ‘resist’ expert advice; the challenges presented by negative stories of AMR and their circulation in public life, and; the problems of public trust tied to the construction and mediation of expert knowledge on the effective management of AMR

Shifting surrogacies: Comparative ethnographies

Gestational surrogacy is a reproductive arrangement where a woman gestates a child for others—the “intended parents”—in order to be handed over to them after birth. Since the turn of the millennium, demands for surrogacy have continuously increased due to social and demographic changes, rising rates of infertility, and the normalization of new, non-heteronormative, family forms. Many countries prohibit surrogacy, and others that previously permitted this reproductive arrangement closed down as a result of political decisions or surrogacy scandals. Moreover, surrogacy is offered at greatly varying costs, ranging from approximately US$50,000 in countries like the Republic of Georgia to US$200,000 in fertility clinics in California. Accordingly, many of these arrangements are transnational, with intended parents who cannot access surrogacy or afford surrogacy in their home country commissioning it in countries such as the United States, until recently Ukraine, and today increasingly in the Republic of Georgia. Existing research has focused on surrogacy from different angles, such as practices of kinning and de-kinning, inequality and stratification, the political economy of the fertility industry, and its gender dimensions. We engage in, but further these debates by drawing attention to settings, accounts, experiences, and new theoretical notions that diverge from “mainstream” presentations of surrogacy. Moreover, in this Special Issue, we experimented with writing joint papers with a deliberative aim to provide comparative analyses and emphasize the links between and diversity of different cases of surrogacy. Therefore, all papers have an explicit comparative character and are all based on empirical studies from more than one field site. They provide nuanced understandings of surrogacy arrangements, grounded in empirical data rather than ideological, political, or moral assessments

Unsafe abortion requiring hospital admission in the Eastern Highlands of Papua New Guinea - a descriptive study of women’s and health care workers’ experiences

Background: In Papua New Guinea induced abortion is restricted under the Criminal Code Law. Unsafe abortions are known to be widely practiced and sepsis due to unsafe abortion is a leading cause of maternal mortality.\ud \ud Methods: We undertook a six month, prospective, mixed methods study at the Eastern Highlands Provincial Hospital. Semi structured and in depth interviews were undertaken with women presenting following induced abortion. This paper describes the reasons why women resorted to unsafe abortion, the techniques used, decision to seek post abortion care and women's reflections post abortion.\ud \ud Results: 28 women were admitted to hospital following an induced abortion. Reasons for inducing an abortion included: wanting to continue with studies, relationship problems and socio-cultural factors. Misoprostol was the most frequently used method to end the pregnancy. Physical and mechanical means, traditional herbs and spiritual beliefs were also reported. Women sought care post abortion due to excessive vaginal bleeding, and severe abdominal pain with some afraid they would die if they did not seek help.\ud \ud Conclusion: In the absence of contraceptive information and services to avoid, postpone or space pregnancies, women in this setting are resorting to unsafe means to end an unwanted pregnancy, putting their lives at risk. Women need access to safe, effective means of abortion

Initial Validation and Findings From the Willing/Ready Subscale of the Church Addiction Response Scale

Addiction has been a global health crisis over recent decades and worsened substantially during COVID-19 lockdowns. We report on the development, validation, and findings from an instrument developed to assess the readiness of churches in the Appalachian Highlands to address addiction. The Church Addiction Response Scale (CARS) is a 41-item, three section measure assessing “What are your views about addiction?” (14 items), “What are your views about interacting with people who are addicted to drugs?” (11 items), and “What do you think the church’s role is in addressing addiction?” (16 items). The CARS was found to be unidimensional with strong internal consistency and initial evidence of construct validity was positive. Most respondents reported willingness to assist people living with addiction, but many reported that they felt underprepared, thus were not ready. Areas of preparation were largely those that could be addressed through training, such as understanding the physiology and psychology of addiction, available treatment options, and how to avoid doing harm. Thus, with adequate training, the likelihood of equipping a church-based workforce to provide support for people living with addiction seems attainable

The impact of targeting all elderly persons in England and Wales for yearly influenza vaccination: excess mortality due to pneumonia or influenza and time trend study.

OBJECTIVE: To investigate the impact on mortality due to pneumonia or influenza of the change from risk-based to age group-based targeting of the elderly for yearly influenza vaccination in England and Wales. DESIGN: Excess mortality estimated using time series of deaths registered to pneumonia or influenza, accounting for seasonality, trend and artefacts. Non-excess mortality plotted as proxy for long-term trend in mortality. SETTING: England and Wales. PARTICIPANTS: Persons aged 65-74 and 75+ years whose deaths were registered to underlying pneumonia or influenza between 1975/1976 and 2004/2005. OUTCOME MEASURES: Multiplicative effect on average excess pneumonia and influenza deaths each winter in the 4-6 winters since age group-based targeting of vaccination was introduced (in persons aged 75+ years from 1998/1999; in persons aged 65+ years from 2000/2001), estimated using multivariable regression adjusted for temperature, antigenic drift and vaccine mismatch, and stratified by dominant circulating influenza subtype. Trend in baseline weekly pneumonia and influenza death rates. RESULTS: There is a suggestion of lower average excess mortality in the six winters after age group-based targeting began compared to before, but the CI for the 65-74 years age group includes no difference. Trend in baseline pneumonia and influenza mortality shows an apparent downward turning point around 2000 for the 65-74 years age group and from the mid-1990s in the 75+ years age group. CONCLUSIONS: There is weakly supportive evidence that the marked increases in vaccine coverage accompanying the switch from risk-based to age group-based targeting of the elderly for yearly influenza vaccination in England and Wales were associated with lower levels of pneumonia and influenza mortality in older people in the first 6 years after age group-based targeting began. The possible impact of these policy changes is observed as weak evidence for lower average excess mortality as well as a turning point in baseline mortality coincident with the changes

Delivery of alcohol advice to dental patients

• Alcohol harms have significant health, social and economic costs in Scotland• Alcohol is a major risk factor for oral and throat cancers• Dental Professionals (DPs) are ideally placed to screen their patients’ alcohol consumption and provide brief advice to those who may have an increased risk of cancer• Many DPs in the UK are reluctant to deliver alcohol advice to patient

The immune self, hygiene and performative virtue in general public narratives on antibiotics and antimicrobial resistance

This paper employs an assemblage lens to generate analyses of general public narratives on antimicrobial resistance (AMR). Global efforts to reduce AMR include communications aiming to promote general public awareness, provide knowledge, encourage careful antibiotics use, and discourage demands for them. These efforts are somewhat compromised by the assumptions they make of individual lack of knowledge and motivation and the manner in which the AMR problem is framed in isolation from the biological, social and economic structures that produce it. Conceptualising AMR as an effect of antimicrobial assemblages of which publics are but one part, we analysed interviews with the general public on the lived experience of infections, antibiotic treatments and AMR. Far from science and policy discourse on AMR, these narratives showed antibiotics to be partly solutions to the social and biomedical challenges of infection, framed by self-defensive immunity and hygiene, the affective benefits of 'immune boosting', and the imperative to sustain the moral standing of the healthy citizen. Failing public awareness and action on AMR can be attributed to public health messages that overlook the social, affective and moral dimensions of infection care and separate AMR from its socio-economic drivers

Malnutrition is associated with dynamic physical performance

Background Malnutrition and poor physical performance are both conditions that increase in prevalence with age; however, their interrelation in a clinically relevant population has not been thoroughly studied. Aims This study aimed to determine the strength of the association between malnutrition and measures of both static and dynamic physical performance in a cohort of geriatric outpatients. Methods This cross-sectional study included 286 older adults (mean age 81.8, SD 7.2 years, and 40.6% male) who were referred to geriatric outpatient mobility clinics. The presence of malnutrition was determined using the Short Nutritional Assessment Questionnaire (SNAQ, cut-off ≥ 2 points). Measures of dynamic physical performance included timed up and go (TUG), 4-m walk test, and chair stand test (CST). Static performance encompassed balance tests and hand grip strength (HGS). Physical performance was standardized into sex-specific Z-scores. The association between malnutrition and each individual measure of physical performance was assessed using linear regression analysis. Results 19.9% of the cohort was identified as malnourished. Malnutrition was most strongly associated with CST and gait speed; less strong but significant associations were found between malnutrition and TUG. There was no significant association between malnutrition and HGS or balance. Discussion Physical performance was associated with malnutrition, specifically, dynamic rather than static measures. This may reflect muscle power being more impacted by nutritional status than muscle strength; however, this needs to be further addressed. Conclusions Malnutrition is associated with dynamic physical performance in geriatric outpatients, which should inform diagnosis and treatment/prevention strategies