Court-ordered caesareans.

Court-ordered caesarean sections are in the news after a number of recent legal decisions authorising surgery for women who lack mental capacity to consent. The decisions have not always been based on good evidence and they raise serious concerns about the protection of the rights of mentally ill women. The authors explain the legal process and question the wisdom of recent judgements.

Abortion in Sri Lanka: the double standard.

In Sri Lanka, women do not have access to legal abortion except under life-saving circumstances. Clandestine abortion services are, however, available and quite accessible. Although safe specialist services are available to women who can afford them, others access services under unsafe and exploitative conditions. At the time of this writing, a draft bill that will legalize abortion in instances of rape, incest, and fetal abnormalities awaits approval, amid opposition. In this article, I explore the current push for legal reform as a solution to unsafe abortion. Although a welcome effort, this amendment alone will be insufficient to address the public health consequences of unsafe abortion in Sri Lanka because most women seek abortions for other reasons. Much broader legal and policy reform will be required.

Human rights approach to maternal & child health: has India fared well?

BACKGROUND & OBJECTIVES: The objectives of the study were to examine: right to access maternal health; right to access child health; and right to access improved water and sanitation in India. METHODS: We used large-scale data sets like District Level Household Survey conducted in 2007-08 and National Family Health Surveys conducted during 1992-93, 1998-99, and 2005-06 to fulfil the objectives. The selection of the indicator variables was guided by the Human Rights' Framework for Health and Convention of the Rights of the Child- Articles 7, 24 and 27. We used univariate and bivariate analysis along with ratio of access among non-poor to access among poor to fulfil the objectives. RESULTS: Evidence clearly suggested gross violation of human rights starting from the birth of an individual. Even after 60 years of independence, significant proportions of women and children do not have access to basic services like improved drinking water and sanitation. INTERPRETATION & CONCLUSIONS: There were enormous socio-economic and residence related inequalities in maternal and child health indicators included in the study. These inequalities were mostly to the disadvantage of the poor. The fulfilment of the basic human rights of women and children is likely to pay dividends in many other domains related to overall population and health in India.

Supporting breastfeeding in emergencies: protecting women's reproductive rights and maternal and infant health.

Women have the right to support that enables them to breastfeed. Supporting breastfeeding in emergencies is important because artificial feeding places mothers and children at risk. In emergencies, artificial feeding is dangerous to the infant, difficult and requires substantial resources. In contrast, breastfeeding guards infant health. It is also protective against postpartum haemorrhage, maternal depletion, maternal anaemia and closely spaced births and should therefore concern not only nutritionists, but also those involved in reproductive health. However, it is common for women's ability to breastfeed to be undermined in emergencies by the indiscriminate distribution of breast-milk substitutes and the absence of breastfeeding support. Controlling the distribution of breast-milk substitutes, providing supportive environments, and appropriate medical and practical assistance to breastfeeding women safeguards the health and well-being of mothers and babies. Greater collaboration between the nutrition and reproductive health sectors is required to promote best practice in protecting breastfeeding women and their children in emergencies.

The Patient Protection and Affordable Care Act of 2010 (PL 111-148): an analysis of maternal-child health home visitation.

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act, setting in motion a historic and, for many, a long-awaited radical change to the current American health care system. Section 2951 of the PPACA addresses provision and funding of maternal, infant, and early childhood home visiting programs. The purpose of this article is to acquaint the reader with the legislative odyssey of home visitation services to at-risk prenatal and postpartum women and children as delineated in the PPACA and to discuss the nursing practice and research implications of this landmark legislation. Few question the need for more rigorous methodology in all phases of home visitation research. Public health nursing may provide the comprehensive approach to evaluating effective home visitation programs.

Surrogate motherhood revisited: maternal identity from a Jewish perspective.

A new bill regulating ovum donation in Israel is set to pass its second and third readings in the Israel Parliament in the upcoming months. The new law will expand the number of locally donated ova available, as previously Israeli women were prohibited from donating eggs unless they were undergoing fertility treatment. Parallel to this legislative initiative, there has been a change in rabbinical thinking over who is considered the mother in a case of surrogacy. Previously, the consensus has been that the birth mother is to be considered the mother, but over the last few years there has been a change in thinking and the genetic mother is now considered the mother. The purpose of this paper is to present the ethical and legal issues from a Jewish perspective in determining maternal identity. The dilemma also demonstrates some of the difficulties in applying Talmudic law to modern problems and the various methodologies used to overcome these issues.

Conference preview: Interview with Detective Chief Superintendent John Carnochan.

This year's UNICEF Baby Friendly Conference in November will be as diverse as ever, with speakers touching on all aspects of infant feeding and care for new mothers and their babies. One speaker will be Detective Chief Superintendent John Carnochan, Head of the Scottish Violence Reduction Unit. Nearly four decades in the police force have taught John that early years intervention and support for vulnerable mothers, in particular, are at the heart of violence reduction, and that to reduce homicide rates we must invest resources in health professionals to support the early years.

Legal and social contexts and mental health among lesbian and heterosexual mothers.

This study examines the role of legal and social context (the level of legal and social support offered by one's country of residence) and sexual orientation in the mental health of lesbian and heterosexual mothers. Participants were sampled from the United States and Canada because the two countries have many similarities (North American location, reliance on English language, and democratic structures) but provide different legal and social rights to their lesbian citizens. The study included 52 lesbian mothers and 153 heterosexual mothers in the United States and 35 lesbian mothers and 42 heterosexual mothers in Canada. Although there were no differences between heterosexual mothers as a function of legal and social context, lesbian mothers from the United States reported more family worries about legal status and discrimination (but not more general family worries) and more depressive symptoms than did lesbian mothers in Canada. Results indicate that legal and social context moderates the role of sexual orientation in maternal mental health.

The costs of public services for teenage mothers post-welfare reform: a ten-state study.

BACKGROUND: More information is needed on the use and costs of public services by teens after the passage of major national polices in the 1990s. Both the 1996 welfare reform and later changes to the Medicaid program have affected the access of low-income adolescents to public assistance programs. In turn, these changes have affected teenaged mothers and their infants and the costs that taxpayers incur in the 50 states. STUDY QUESTION: What public services do teenage mothers use and what are their costs in the decade after the major policy changes to public assistance programs? How do patterns vary by state? METHODS: This study examines the use by teenage mothers of four public services: cash assistance, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), food stamps, and Medicaid coverage at delivery. We used 2000 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to derive rates of use for these four programs in ten states-AK, AL, FL, ME, NY [excluding New York City], NC, OK, SC, WA, and WV. We combined the rates with data on per person and family costs of these four programs to present 'birth-year' costs for a cohort of teenage mothers in the ten states. To provide a baseline from which to measure incremental public service costs to teenage mothers, we also compiled the data for mothers ages 20 to 24 years who did not report births during their teen years. RESULTS: Data from the ten states indicate that the birth-year expenses for teenage mothers for four public programs add up to more than $0.5 billion, and the costs per teenage mother exceed those for older mothers who did not have a teenage birth by almost $1,500. The largest component of these public costs is Medicaid coverage at delivery at 87 percent of the total. If all of the unintended births to teenage mothers in the ten study states were postponed, $75 million in public sector costs would be averted annually. CONCLUSIONS: The use of public programs by teenage mothers remains costly and varies markedly across the ten study states. A key reason for higher costs among teenage mothers than among mothers in their early twenties is their higher rates of enrollment in Medicaid at delivery. This rate of enrollment also varies markedly across the study states. The high level of incremental costs and rate of unintended births to teens indicate that cost-saving interventions could be developed. PUBLIC HEALTH IMPLICATIONS: Data indicate that many teenage pregnancies are unintended. Thus, a clear public health goal should be to implement and evaluate programs aimed at reducing unintended pregnancies among teenagers. Initiatives are needed to help young women make well-informed decisions about sexual activity and other risky behaviors. Insurance coverage is important to all teens and especially to those who are sexually active.

Why me? A missing girl...

Demographic imbalance created because of the declining sex ratio in India is a cause of concern to policy makers, implementers, demographers and social reformers. To take situation under control, Pre Natal Diagnostic Techniques (PNDT) Act is operational since 1996. Authors have critically reviewed the status of women and socio-cultural factors influencing their status based on data from NFHS III and census 2001 and challenges faced in the operationalisation of PNDT Act in India.