"L'ENFER, C'EST LES AUTRES": Proximity as an Ethical Problem during COVID-19.

During the COVID-19 emergency, people around the world are debating concepts like physical distancing, lockdown, and sheltering in place. The ethical significance of proximity-that is, closeness or farness as ethical qualities of relations (Strathern 2020)-is thus being newly troubled across a range of habits, practices, and personal relationships. Through five case studies from Australia, Ireland, New Zealand, South Africa, and the United States, contributors to this Colloquy shed light on what the hype of the pandemic often conceals: the forms of ethical reflection, reasoning, and conduct fashioned during the pandemic.

THE PANDEMIC IMAGINERIE: Infectious Bodies and Military-Police Theater in Australia.

When pathogens and their movement between people cannot be seen, we imagine them. That imagined menagerie-imaginerie-of infection then becomes associated with marginal others whose bodies and actions become popularly conflated with disease and its transmission. This essay explores how methods of imagining and managing the COVID-19 pandemic in Australia echoed historical scripts for policing borders and containing the bodies of outsiders deemed threats to the national body.

"We have to make sure you meet certain criteria": exploring patient experiences of the criminalisation of abortion in Australia.

INTRODUCTION: Nine different sets of laws govern abortion in Australia, and the criteria for an abortion to be considered lawful varies considerably by jurisdiction. We explored how the criminal status of abortion affected patients' experiences in accessing care in a country where abortion services are widely available. METHODS: We conducted qualitative, in-depth interviews with 22 people who had an abortion in Australia since 2009 across a variety of legal contexts. We audio-recorded all interviews and transcribed them in their entirety. We carried out content and thematic analyses of the interviews using deductive and inductive techniques. RESULTS: At the time of their procedures, more than half of our participants (n = 13) obtained their abortion in a state or territory that had criminal sanctions associated with procuring an abortion and required abortion seekers to meet strict legal requirements to access care. In general, participants reported confusion about the legal status of abortion. Participants who had an abortion in criminalised settings described significant negative emotional impacts that were directly linked to the law. They were often required to fit their abortion story into a state-mandated narrative. Further, the criminalisation of abortion meant that some participants felt they could not be honest with clinicians for fear of being denied care. The participants were overwhelmingly in support of decriminalisation of abortion and increased consistency of the legal status of the procedure across Australia. CONCLUSIONS: The criminalisation of abortion in some Australian states negatively impacts patients' emotional wellbeing, undermines the patient-clinician relationship, and perpetuates abortion stigma. In the absence of legislative reform, training for clinicians - including abortion providers and general practitioners - to explain the implications of the legal status to their patients appears warranted. Patient-centred resources, such as a website with state-specific information, could fill an important knowledge gap for the public.

'Safe sex': evaluation of sex education and sexual risk by young adults in Sydney.

In this qualitative study, 28 young adults (18-29-year-olds) living in Sydney define 'safe sex', report on their experiences of sex education, and reflect on the relationship between the sex education received in school and the reality of sexual activity. Participants had a broadly neoliberal understanding of health and risk as something individuals should manage through an ideal of rational decision-making. Yet regardless of how comprehensive or limited their sex education experiences, most noted a wide gulf between safe sex as taught in the classroom and the reality of actual sexual encounters, arguing that sexual decision-making was rarely rational, and shaped by age and experience, drug use, sexual desire, and complicated interpersonal dynamics. Sex education that aims to empower by presenting individuals as sole decision-makers when it comes to prophylactic use fails to acknowledge the social contexts of sex described by participants. Significantly, young people defined 'safe sex' not only in biomedical terms such as disease transmission and pregnancy, but also in terms of the social and psychological consequences of sexual encounters, with an emphasis on consent.

"We've got rights and yet we don't have access": Exploring patient experiences accessing medication abortion in Australia.

OBJECTIVES: Across Australia, multiple strategies have emerged to decentralize abortion care and increase access to mifepristone, including incorporating medication abortion into primary care and offering the mifepristone and misoprostol regimen via telemedicine. We aimed to explore the experiences of patients accessing medication abortion care across these different health service delivery formats and different geographic areas. STUDY DESIGN: We conducted in-depth interviews with 22 people from across Australia who had used mifepristone for abortion. We audio-recorded and transcribed all interviews and managed our data with ATLAS.ti. We used deductive and inductive techniques to analyze these data for content and themes. RESULTS: Although participants were generally satisfied with the abortion care they received, many described medication abortion care in Australia as inaccessible and confusing to find. Our participants incurred variable and often significant financial costs when obtaining their abortion and many reported that their interactions with general practitioners when trying to locate an abortion provider were uninformative and stigmatizing. Participants were enthusiastic about obtaining medication abortion through a variety of service delivery modalities, including telemedicine, and believed these strategies could increase equitable and affordable access. CONCLUSIONS: Barriers to finding and accessing abortion care persist across Australia. Efforts to challenge the over-regulation of mifepristone, increase the affordability of medication abortion, and enhance training opportunities to educate a variety of clinicians about medication abortion and support provision from a range of providers appear warranted. IMPLICATIONS: The continued over regulation of mifepristone creates barriers for incorporating medication abortion into primary care settings and has significant implications for patient access and abortion stigma. Regulatory reform and provider education and training have the potential to improve abortion patients' experiences with medication abortion.

The Impact of Ethics Review on a Research-Led University Curriculum: Results of a Qualitative Study in Australia.

In the human sciences, a student research-centered pedagogy is constrained by institutional ethics review, yet there is little research on the impact of ethics review on research-led teaching. This article documents a range of ways that Australian universities are responding to ethics review of undergraduate human research. Forty teachers and administrators were interviewed at 14 universities using purposive sampling to document the range of ways teachers are avoiding ethics review or incorporating it into their curriculum. Some reported halting undergraduate research or evading ethics review, regarding it as meaningless bureaucracy divorced from actual ethical thinking. Those who incorporated ethics review into student research did so by collaborating with administrators. Institutions can facilitate research-led teaching by designing dedicated forms and decentralized review procedures for student research.

'Like a Virgin': Hymenoplasty and Secret Marriage in Egypt.

In Egypt, women seek hymenoplasty to disguise evidence of premarital sexual intercourse. Physicians hide the fact that they perform the procedure, and laypeople condemn it as against religion and morality, a way of cheating men of knowledge of their wives' sexual history. Yet high-ranking religious leaders have condoned hymenoplasty. Based on ethnographic fieldwork, archival research, and formal interviews with laypeople and physicians, in this article, I investigate this discrepancy between religious and lay opinions. Many Egyptians believe women resort to hymenoplasty after contracting secret `urfi (customary) marriages, and I examine the relationship between hymenoplasty and extramarital and paramarital sexuality. Egyptian debates around hymenoplasty and marriage are concerned with the notion that women's sexual status must be socially visible, believing that doctors and kin have the ability and obligation to read women's sexual history through physiological markers and social rituals. Hymenoplasty and secret marriage render women's sexual histories illegible to observers.

Evidence of global demand for medication abortion information: an analysis of www.medicationabortion.com.

INTRODUCTION: The worldwide expansion of the Internet offers an important modality of disseminating medically accurate information about medication abortion. We chronicle the story of www.medicationabortion.com, an English-, Spanish-, Arabic- and French-language website dedicated to three early abortion regimens. METHODS: We evaluated the website use patterns from 2005 through 2009. We also conducted a content and thematic analysis of 1910 emails submitted during this period. RESULTS: The website experienced steady growth in use. In 2009, it received 35,000 visits each month from more than 20,000 unique visitors and was accessed by users in 208 countries and territories. More than half of all users accessed the website from a country in which abortion is legally restricted. Users from more than 40 countries sent emails with individual questions. Women often wrote in extraordinary detail about the circumstances of their pregnancies and attempts to obtain an abortion. These emails also reflect considerable demand for information about the use of misoprostol for self-induction. CONCLUSION: The use patterns of www.medicationabortion.com indicate that there is significant demand for online information about abortion, and the findings suggest future priorities for research, collaboration and educational outreach.

Would you say you had unprotected sex if ...? Sexual health language in emails to a reproductive health website.

The words and metaphors that people use to describe sexuality and reproductive health reflect experiences with peers, sexual partners, health service providers and public health campaigns. In this paper we analyse 1134 emails sent to an emergency contraception website in the USA over the course of one year. Through an examination of the terminology used by authors to describe contraceptive methods, sexual intercourse and other sexual acts, we analyse what those terms signify within their textual context. We find that the kinds of risk concerns used in assessing sexual activity - whether evaluating pregnancy risk, disease transmission risk or moral risk - influence the definitions people give to terms that are multiply defined or whose definitions are culturally contested. This finding emerged clearly in the meanings given to terms for 'sex' and 'unprotected sex', which varied widely. We conclude with a discussion of the implications of this finding for research, clinical care and health education activities.

Can I get pregnant from oral sex? Sexual health misconceptions in e-mails to a reproductive health website.

BACKGROUND: This study identifies sexual and reproductive health misconceptions contained in e-mails sent to an emergency contraception website. STUDY DESIGN: From July 1, 2003, through June 30, 2004, 1134 English-language questions were e-mailed to http://ec.princeton.edu. We performed content analysis on these e-mails and grouped misconceptions into thematic categories. RESULTS: Of the questions sent during the study period, 27% (n=303, total N=1134) evinced underlying misconceptions about sexual and reproductive health issues. Content analysis revealed five major thematic categories of misconceptions: sexual acts that can lead to pregnancy; definitions of "protected" sex; timing of pregnancy and pregnancy testing; dangers that emergency contraceptives pose to women and fetuses; and confusion between emergency contraception and abortion. CONCLUSIONS: These misconceptions have several possible sources: abstinence-only sexual education programs in the US, the proliferation of medically inaccurate websites, terminology used in public health campaigns, non-evidence-based medical protocols and confusion between emergency contraception and medication abortion in the media.

Women seeking emergency contraceptive pills by using the internet.

OBJECTIVE: To assess barriers and attitudes related to emergency contraception access among women seeking emergency contraceptive pills by using the Internet. METHODS: We conducted quantitative surveys and qualitative interviews of 200 women seeking emergency contraceptive pills from The Emergency Contraceptive Website (http://ec.princeton.edu). Main outcome measures included barriers to and attitudes toward emergency contraception access. RESULTS: Participants were predominately white, college-educated, urban residents. Women most frequently cited structural barriers to obtaining emergency contraceptive pills, such as inconvenient office hours. Although women supported advanced prescription of emergency contraceptive pills, there was less enthusiasm for nonprescription access because of concerns that others (but not they) would engage in risky sexual behavior. Women valued the consultation with a health professional; 42% stated they would still speak with a clinician even if nonprescription access was available. CONCLUSION: The Internet as a resource for emergency contraception appears limited to women of high socioeconomic status in our sample. There is a need to address beliefs that increased access to emergency contraception promotes risky sexual behavior because current evidence refutes this concern. Clinicians should still be prepared to discuss emergency contraception with patients, despite the fact that emergency contraceptive pills are now available to most (but not all) women without a prescription.

Harm reduction or women's rights? Debating access to emergency contraceptive pills in Canada and the United States.

This article compares the ethical pivot points in debates over nonprescription access to emergency contraceptive pills in Canada and the United States. These include women's right to be informed about the contraceptive method and its mechanism of action, pharmacists' conscientious objection concerning the dispensing of emergency contraceptive pills, and rights and equality of access to the method, especially for poor women and minorities. In both countries, arguments in support of expanding access to the pills were shaped by two competing orientations toward health and sexuality. The first, "harm reduction," promotes emergency contraception as attenuating the public health risks entailed in sex. The second orientation regards access to pills as a question of women's right to engage in nonprocreative sex and to choose from among all reproductive health-care options. The authors contend that arguments for expanding access to emergency contraceptive pills that frame issues in terms of health and science are insufficient bases for drug regulation; ultimately, women's health is also a matter of women's rights.

Images of American sexuality in debates over nonprescription access to emergency contraceptive pills.

The debate over emergency contraceptive pill access in the United States revolves around speculations about Americans' sexual lives. The recently released internal U.S. Food and Drug Administration (FDA) memo that expresses fears that adolescents will form "sex-based cults" around emergency contraceptive pills echoes arguments made against the nonprescription switch at the 2003 FDA hearings. In these hearings, opponents argued that nonprescription access would lead to adolescent promiscuity and disease transmission and that adult predators would use the drug to facilitate the sexual abuse of young women. In contrast, proponents of expanded access to emergency contraceptive pills overwhelmingly portrayed their model user as a responsible adult who experiences a torn condom during consensual sex. These imaginations of American sexuality are tied to competing models of the role of medical providers in women's sexual decision making. Opponents of the nonprescription switch argued that women need a learned intermediary, not only to determine their need for emergency contraception, but also to educate them about proper sexual behavior and protect them from abuse. Proponents advocated putting more responsibility for sexual health decision making in the hands of women, not doctors, and complained about the moralizing scrutiny of medical providers. In the absence of nonprescription access to emergency contraception, advance prescription of emergency contraceptive pills can ensure that contraceptive education is not tied to a specific sexual act and therefore not perceived as a judgment about women's sexual decisions. However, advance prescription does not help women who lack access to health care or women who make sexual and contraceptive decisions without consulting physicians.

The social life of emergency contraception in the United States: disciplining pharmaceutical use, disciplining sexuality, and constructing zygotic bodies.

This article is an examination of the FDA hearing on a proposal to permit nonprescription access to the emergency contraceptive pill Plan B. Participants debated the drug's impact on female and young adult sexuality, illustrating how the rhetoric over disciplining pharmaceutical use in the American public is a displaced language for talking about disciplining women's and girls' sexuality. Debate over Plan B also focused on its mechanism of action and whether or not it was abortifacient, revealing a medical technology characterized not only by moral but also by marked scientific ambiguity. The scientific framing of the politics of emergency contraception is testament to the powerful authority of biomedicine to narrate and thus produce ideologies of bodies (individual, embryonic, social, and political), sexuality, and selves. The discourse on access to Plan B in the United States demonstrates how women's bodies are sites of control where the politics of sexuality, discourses on public health, and medical constructions of biological processes intersect.