The African American experience in reproductive medicine: provider, patient, and pipeline perspectives.

The goal of this Views and Reviews is to let colleagues and leaders well versed in the African American experience in reproductive medicine address the problems of racism affecting our trainees and patients and, more significantly, propose solutions. The areas in reproductive medicine that will be explored from the African American perspective include the pipeline of providers, health disparities, and access to infertility treatment.

Historical walk: the HRP Special Programme and infertility.

BACKGROUND/AIMS: The HRP Special Programme (HRP) began addressing 'reproduction' problems (infertility) at the same time as 'fertility regulation' (contraception). METHODS: This report is based upon data collected from official HRP Scientific and Technical Reports. RESULTS: In the 1970s, HRP supported research on human and nonhuman primate models to address the basic biology of reproduction. Importantly, however, it was the multicountry clinical research studies sponsored by HRP during the 1970s and 1980s which led to the identification of not only the large burden of disease but also global patterns of causation of infertility. The next decade saw the development of WHO guidelines and manuals for diagnosis, management, and treatment of infertile women and men, with HRP-sponsored operations research focused on adaptation within primary health care settings. Consensus consultations held during 2001 through 2011 resulted in recommendations to stakeholders, as well as the identification of barriers and inequities in access to infertility care services. CONCLUSION: With renewed focus on infertility through the current development of revised guidelines and manuals, and the desire to support critical clinical research protocols, including adaptation and implementation research for management and monitoring tools being developed through international partners, HRP will continue to support future success stories in family, maternal, child, and reproductive health.

Remedial agents: missionary physicians and the depopulation of Hawai'i.

This article examines the activities and perspectives of nineteenth-century American missionary physicians in the Hawaiian Islands. The physicians' attitudes toward Hawaiian morbidity and depopulation are viewed in relation to the greater missionary community's role in the political transformation of the island nation. The article argues that missionary physicians monitored and reported on Native Hawaiian depopulation (a result of introduced western diseases) while simultaneously advertising the islands' benefits to American consumptives, imperialists, and others. Mission doctors also failed to respond effectively to the greatest epidemiological crisis Hawai'i had ever faced: a venereal scourge with a resulting blight of Native Hawaiian infertility. As a result of these and other factors, American hegemony in Hawai'i by midcentury was a foregone conclusion.