Medicaid Consent to Sterilization forms: historical, practical, ethical, and advocacy considerations.

The US government developed a Medicaid Consent to Sterilization form in the mid-1970s to protect vulnerable populations from coerced sterilization. US health care practices have evolved significantly since that time. The form, however, has not changed, and may be preventing access to desired services for the same vulnerable populations it was originally created to protect. This paper discusses the relevant historical, practical use, ethical, and advocacy considerations of the Medicaid sterilization consent form and proposes changes to make the form more pertinent to today's medical environment.

A rollercoaster of policy shifts: global trends and reproductive health policy in The Gambia.

Global trends influence strategies for health-care delivery in low- and middle-income countries. A drive towards uniformity in the design and delivery of healthcare interventions, rather than solid local adaptations, has come to dominate global health policies. This study is a participatory longitudinal study of how one country in West Africa, The Gambia, has responded to global health policy trends in maternal and reproductive health, based on the authors' experience working as a public health researcher within The Gambia over two decades. The paper demonstrates that though the health system is built largely upon the principles of a decentralised and governed primary care system, as delineated in the Alma-Ata Declaration, the more recent policies of The Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria and the GAVI Alliance have had a major influence on local policies. Vertically designed health programmes have not been easily integrated with the existing system, and priorities have been shifted according to shifting donor streams. Local absorptive capacity has been undermined and inequalities exacerbated within the system. This paper problematises national actors' lack of ability to manoeuvre within this policy context. The authors' observations of the consequences in the field over time evoke many questions that warrant discussion, especially regarding the tension between local state autonomy and the donor-driven trend towards uniformity and top-down priority setting.

The special programme of research in human reproduction: forty years of activities to achieve reproductive health for all.

The Special Programme of Research in Human Reproduction (HRP), co-sponsored by the UNDP, UNFPA, WHO, and the World Bank, is celebrating 40 years of activities with an expansion of its mandate and new co-sponsors. When it began, in 1972, the main focus was on evaluating the acceptability, effectiveness, and safety of existing fertility-regulating methods, as well as developing new, improved modalities for family planning. In 1994, HRP not only made major contributions to the Plan of Action of the International Conference on Population and Development (ICPD); it also broadened its scope of work to include other aspects of health dealing with sexuality and reproduction, adding a specific perspective on gender issues and human rights. In 2002, HRP's mandate was once again broadened to include sexually transmitted infections and HIV/AIDS and in 2003 it was further expanded to research activities on preventing violence against women and its many dire health consequences. Today, the work of the Programme includes research on: the sexual and reproductive health of adolescents, women, and men; maternal and perinatal health; reproductive tract and sexually transmitted infections (including HIV/AIDS); family planning; infertility; unsafe abortion; sexual health; screening for cancer of the cervix in developing countries, and gender and reproductive rights. Additional activities by the Programme have included: fostering international cooperation in the field of human reproduction; the elaboration of WHO's first Global Reproductive Health Strategy; work leading to the inclusion of ICPD's goal 'reproductive health for all by 2015' into the Millennium Development Goal framework; the promotion of critical interagency statements on the public health, legal, and human rights implications of female genital mutilation and gender-biased sex selection. Finally, HRP has been involved in the creation of guidelines and tools, such as the 'Medical eligibility criteria for contraceptive use', the 'Global handbook for family planning providers', the 'Definition of core competencies in primary health care', and designing tools for operationalizing a human rights approach to sexual and reproductive health programmes.

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.

Approaching 4 decades of legislation in the national family planning program: an analysis of Title X's history from 1970 to 2008.

Family planning is an important public health activity. Title X (Pub L No. 91-572), enacted in 1970, remains the only national family planning program in the United States dedicated to providing voluntary and confidential services to all individuals. We conducted a thematic analysis of Title X's legislative history. Of 293 federal bills included in the legislative history, only 20 (6.8%) were enacted into law. Regardless of the proposed challenges, limited changes have been adopted. Except for technical amendments, bills involving restrictions accounted for the highest percentage of enacted bills, demonstrating efforts to undermine reproductive health rights. Title X requires political will and bipartisan support if it is to continue to protect individuals' reproductive rights.