The advantages and disadvantages of altruistic and commercial surrogacy in India.

BACKGROUND: Comprehensive commercial surrogacy became legal in India in 2002, and many foreigners, including individuals and same-sex couples, sought Indian surrogacy services due to their affordability. Numerous scandals resulted, with increasing calls for the government to eliminate the exploitation of women in lower social strata. In 2015, the Indian government decided to exclude foreign clients and commercial surrogacy remained legal for local Indian couples only. Furthermore, to eliminate exploitation, the concept of altruistic surrogacy was introduced in 2016. In 2020, some restrictions within altruistic surrogacy practice were removed. Controversy remains, however, in various sectors, not least because surrogacy is a relatively new concept in India. In this paper, the advantages and disadvantages of both altruistic and commercial surrogacy in the Indian context are considered, and more appropriate policy concerning surrogacy practices is suggested. METHODS: This paper is based on fieldwork conducted in India from 2010 to 2018. Interview surveys were conducted among doctors, policy makers, activists, former surrogates, and brokers. Government documents and media reports were also important sources. RESULTS: Surrogacy for commercial purposes began in India in 2002, and stakeholders within the commercial surrogacy industry became well established. It was found that such stakeholders were strongly opposed to altruistic surrogacy as introduced in 2016. It was also found that women in lower social strata still sought some form of financial compensation from their reproductive labor. Controversies surrounding altruistic surrogacy continue within Indian society. CONCLUSION: Policies and practices aimed at eliminating exploitive need to consider the Indian context carefully. Any surrogacy practice might potentially be exploitive, and the distinction between commercial and altruistic surrogacy is too simplistic to be useful, with more nuanced understanding required. It is of critical importance that investigation continues on how to eliminate the exploitation of Indian surrogate mothers throughout the process, regardless of monetary compensation. The entire surrogacy process should be managed with sensitivity, particularly in relation to the well-being of the mother and child.

Ongoing Commercialization of Gestational Surrogacy due to Globalization of the Reproductive Market before and after the Pandemic.

Surrogacy tourism in Asian countries has surged in recent decades due to affordable prices and favourable regulations. Although it has recently been banned in many countries, it is still carried out illegally across borders. With demand for surrogacy in developed countries increasing and economically vulnerable Asian women lured by lucrative compensation, there are efforts by guest countries to ease the strict surrogacy regulations in host countries. Despite a shift toward "altruistic surrogacy", commercial surrogacy persists. Recent research carried out by international organizations that seek to establish a legal relationship between the commissioning parents and children in cross-border surrogacy arrangements, under the guise of the "best interests of the child," appears to promote a resurgence of overseas commercial surrogacy rather than restrict it. Further commercialization of surrogacy should be prevented by carefully investigating the reality of the surrogacy process.

The association between overweight and prevalence of food allergy in Japanese children: a cross-sectional study.

BACKGROUND: Food allergy (FA) is a common disease in children, and its prevalence has increased in developed countries. The impact of overweight on children health also becomes an important social problem. However, the relationship between overweight and FA is still unclear. We examined the association between overweight and the prevalence of FA among Japanese children. METHODS: We analyzed data obtained using a self-administered questionnaire from 1772 Japanese children. Weight groups according to body mass index cutoff points proposed by the International Obesity Task Force were used to create two groups: overweight and non-overweight. Children were separated into four age groups (3-6 years, 6-9 years, 9-12 years, and 12-15 years) to examine age differences. We performed univariate and multivariate logistic models to examine the association between overweight and FA. RESULTS: The prevalence of FA was significantly higher in boys (10.6%, p = 0.014) than girls (4.5%) and girls (7.9%, p = 0.012) than boys (2.5%) for 6-9 and 12-15 age groups, respectively. While the prevalence of FA was significantly higher in overweight than non-overweight girls (26.1%, p = 0.005) in the 12-15 age group, no significant difference was found in boys. In girls, overweight was significantly associated with FA after adjustment for age and asthma (odds ratio 1.99, 95% confidence interval 1.01-3.89, p = 0.046). CONCLUSIONS: Our results showed that being overweight was significantly associated with a higher prevalence of FA in girls, but not in boys. Further prospective studies are necessary to find the causal relationship between overweight and FA.

Absence of laws regarding sperm and oocyte donation in Japan and the impacts on donors, parents, and the people born as a result.

An absence of any statutory law in Japan regarding donor conception creates uncertainty about the status of donors in relation to the child(ren) born as a result. Laws that provide for certainty regarding the status of the donor are called for, as are laws that address donor anonymity. It would be pragmatic to introduce a prospective system that requires open donation, allowing information to be recorded and released to donor-conceived people upon request. For past donations, a voluntary register should be established, which would allow those people who are seeking information to register this.

Non-commercial Surrogacy in Thailand: Ethical, Legal, and Social Implications in Local and Global Contexts.

In this paper, the ethical, legal, and social implications of Thailand's surrogacy regulations from both domestic and global perspectives are explored. Surrogacy tourism in Thailand has expanded since India strengthened its visa regulations in 2012. In 2015, in the wake of a major scandal surrounding the abandonment of a surrogate child by its foreign intended parents, a law prohibiting the practice of surrogacy for commercial purposes was enacted. Consequently, a complete ban on surrogacy tourism was imposed. However, some Thai physicians and surrogate mothers cross into neighboring countries to provide foreign clients with the commercial surrogacy services that are forbidden in Thailand. Under this legislation, the needs of Thai couples who are unable to conceive are accommodated by legally accessible, non-commercial surrogacy services; however, there is currently no provision in place aimed at protecting the rights and interests of surrogate mothers and children. It is widely believed that the abolition of surrogacy tourism, an industry that give rise to several major scandals, and legal access to surrogacy by Thai couples were the Thai government's primary goal in implementing this legislation.

Non-commercial surrogacy among close relatives in Vietnam: policy and ethical implications.

Altruistic surrogacy among close relatives has been legal in Vietnam since the beginning of 2015. Following the revision of the Marriage and Family Law, there have been dozens of cases of surrogacy, and instances of successful pregnancy and childbirth have also been reported. Although surrogacy was completely prohibited in 2003, numerous local brokers offered commercial surrogacy services. Today, surrogacy is permitted under very limited conditions, and commercial surrogacy is prohibited. However, brokers continue to offer illegal commercial surrogacy services, and some even present its incidence may be increasing. In terms of women's roles, Vietnamese society places the highest value on motherhood, and childless couples are stigmatized. Thus, the demand for surrogates is high in Vietnam, rendering it difficult for family members to meet the needs of all those seeking these services. This article considers the consequences and implications of the new surrogacy policy in Vietnam based on field research.

Mitochondrial manipulation in fertility clinics: Regulation and responsibility.

The clinical uses of cytoplasmic transfer and pronuclear transfer for infertility treatment have raised concerns, leading to restrictive regulatory responses in both the USA and China. In 2015, the UK legalized nuclear transfer from oocytes and zygotes to prevent the onset of serious mitochondrial disease in the children of affected mothers. A research team in the USA then performed egg nuclear transfer, with subsequent embryo transfer in Mexico, to prevent mitochondrial disease. A live birth resulted, but the cross-border activity attracted attention from regulatory authorities. In order to respond appropriately to the likelihood of the wider use of such mitochondrial manipulation techniques (MMT), the present study first surveyed countries where MMT have been clinically implemented or where such experimental procedures are advertised on the internet. Sixteen countries were selected for an analysis of the legal position regarding germline genetic modification and egg donation. It was found that regulation of the clinical use of MMT could be broken down into three categories: (i) largely prohibited (USA and China), (ii) not regulated (Northern Cyprus and Ukraine), and (iii) insufficiently regulated (the remaining 12 countries, including Mexico). The reasons for no or insufficient regulation included no intention to oversee experimental procedures, no consideration of the manipulation in eggs, unclear technical terms and ambiguous medical purposes. To protect future children, this study underscores the pressing need for regulatory frameworks with policies that cover MMT. Wider implications regarding the responsible implementation of procedures in experimental reproductive medicine are discussed.

The associations between lifestyles and mental health using the General Health Questionnaire 12-items are different dependently on age and sex: a population-based cross-sectional study in Kanazawa, Japan.

OBJECTIVES: The aim of this study was to examine potential differences of the associations between mental health and lifestyle factors across a wide range of age. METHODS: In August/September 2011, data were collected from 4693 males (age 51.6 ± 19.5) and 5678 females (age 52.4 ± 19.4) living in Kanazawa, Japan. A cross-sectional community-based survey was conducted with self-administered questionnaire including the General Health Questionnaire (GHQ) 12-item version, sociodemographic, and lifestyle factors. Associations between the GHQ scores and other variables were examined using two-way analysis of variance (ANOVA) followed by multiple comparisons and logistic regression stratified by age and gender. RESULTS: Multiple comparisons indicated that people aged 20-39 or 40-64 had higher GHQ scores than older aged. The two-way ANOVA revealed significant interaction between body mass index and age group, and between exercise and age group. Overweight or underweight males aged 40-64 had poorer mental health than those at normal weight. In the elderly, being underweight was significantly associated with poor mental health. There were no significant effects of exercise on mental health for young adults. The logistic regression showed significant negative effects of short-time sleep in adults. CONCLUSIONS: The associations between mental health and lifestyles differ across age groups. Further study is needed to reveal effects of aging on lifestyle and mental health with a longitudinal design.

The relationship between hypertension and health-related quality of life: adjusted by chronic pain, chronic diseases, and life habits in the general middle-aged population in Japan.

OBJECTIVES: The aim of this study was to examine the relationship between hypertension and health-related quality of life (HRQoL) adjusted by chronic pain, other chronic diseases, and life habits in the general middle-aged population in Japan. METHODS: This study is a population-based cross-sectional study. In this study, 1117 participants aged 40-65 years and living in Shika Town completed a self-administered questionnaire including Short Form-36 (SF-36). The scores of SF-36 among hypertensives were compared with those of normotensives. The independent association of hypertension with each SF-36 subscale was analyzed using a multiple linear regression model adjusted by age, BMI, chronic pain, chronic diseases, sleep, exercise, and occupational status. We analyzed two groups; Group 1 which contained 846 participants completed the questionnaire without coronary heart disease and cerebral vascular disease, Group 2 which contained 686 participants without coronary heart disease, cerebral vascular disease, or diseases accompanied by chronic pain (gastroduodenal ulcer, fracture, osteoarthritis, osteoporosis, rheumatoid arthritis, and disc herniation). RESULTS: In Group 2, hypertensive women had a lower general health perception than normotensive women [unstandardized coefficients; B = -8.84, 95 % confidence interval (95 % CI) = -13.3 to -4.34, standardized coefficients; ß = -0.200, p < 0.001], whereas hypertensive men had higher social functioning than normotensive men (B = 5.66, 95 % CI = 1.30-10.0, ß = 0.149, p < 0.05) after adjusting by chronic pain and life habits. CONCLUSIONS: These results may be due to the sex difference in the light of the perception for health.

A Longitudinal Study of Association between Heavy Metals and Itchy Eyes, Coughing in Chronic Cough Patients: Related with Non-Immunoglobulin E Mediated Mechanism.

The association between heavy metals exposure and respiratory diseases or allergic sensitization showing high serum immunoglobulin E (IgE) has been suggested. However, previous findings have been inconsistent and the mechanisms responsible remain unclear. We evaluated heavy metal exposure and its association with coughing, itchy eyes in chronic cough patients with different IgE levels. Ninety outpatients in Kanazawa University Hospital were recruited between January-June 2011. Subjects whose total IgE measured by radioimmunosorbent test were asked to record their daily symptoms. We collected daily total suspended particles (TSP) from which concentrations of calcium (Ca), cadmium (Cd), chromium (Cr), iron (Fe), manganese (Mn), nickel (Ni), and lead (Pb) were determined then divided into high and low level groups. Generalized estimating equations were applied to compute the relationship between concentrations of these metals and symptoms. All metals at high levels were significantly associated with itchy eyes compared with low levels, with exception of Ca, the six others were significant in patients with IgE < 250 IU/mL. Cd, Fe, Mn had association with coughing (odds ratio-OR (95% confidence interval-CI): 1.13 (1.03, 1.24), 1.22 (1.05, 1.42), and 1.13 (1.01, 1.27), respectively), this relationship remained significant for Cd (OR (95% CI): 1.14 (1.03, 1.27)) and Mn (OR (95% CI): 1.15 (1.00, 1.31)) in patients with lower IgE. Our findings demonstrate the relationship between aerial heavy metals and itchy eyes, coughing in chronic cough patients, suggesting these symptoms may be due to a non-IgE mediated mechanism.

Implications of the legalization of non-commercial surrogacy for local kinship and motherhood in Vietnamese society.

Until recently, surrogacy was banned in Vietnam for all cases. The government, however, has altered its position on reproductive technology and will soon legalize non-commercial surrogacy among relatives. Motherhood is highly venerated in Vietnamese society and, under this local kinship conception, gestational process is of paramount importance in establishing a connection between the fetus and the woman. The implications of this new government decision for local kinship, motherhood and the individuals concerned will be discussed.

Family-related opinions and stressful situations associated with psychological distress in women undergoing infertility treatment.

The purpose of this study is to investigate how family-related opinions and stressful situations are related to psychological distress in women undergoing infertility treatment. The subjects in this cross-sectional study were recruited from female patients undergoing infertility treatment (n = 2540) at 70 infertility treatment institutions in Japan. Because of non-participation or missing data, the number of subjects included in the analysis was 635 (response rate, 25.0%). The family-related opinions and stressful situations were evaluated using the original questions. Psychological distress was assessed using a self-report measure, the Kessler Six-question Psychological Distress Scale (K6). The K6 scores of the following participants were significantly (p < 0.05) and independently high: those with more frequent miscarriage/stillbirth/abortions, those with repeated miscarriages as the cause of infertility, those with infertility of unknown causes, those living with no child, those having a low joint income with their partner, those with the opinion that "women should devote themselves to their household duties" those who had considered stopping treatment, those without the opinion that "married life without children is favorable" and those who had experienced stressful situations such as inadequate explanation by doctors, frustration of multiple failed attempts, differences of opinion with the partner, and lack of knowledge regarding when to stop treatment. Family-related opinions and stressful situations associated with psychological distress in women undergoing infertility treatment are outlined. The results of this study may contribute to the prevention of and care for psychological distress in female patients undergoing infertility treatment.

Impact of egg donation deliveries from domestic and overseas sources on maternal care: a questionnaire survey of Japanese perinatal physicians.

OBJECTIVES: Recent demographic changes, such as marriage at later ages and delayed childbearing, have contributed to the increased demand for ovum donation. The purpose of the present study was to evaluate the frequency and impact of egg donation deliveries on maternal care using a questionnaire survey of Japanese perinatal care providers. METHODS: A quantitative survey was conducted from October to November 2012 using self-administered anonymous questionnaires. We asked 2,693 obstetrics clinics/hospitals throughout Japan to complete the survey: 679 questionnaires were returned (response rate, 25.2 %). RESULTS: Of the respondents, 15.8 % answered that they had handled egg donation deliveries in the past. With regards to the country in which patients received egg donation services, the most frequent was the United States, including Hawaii. Asian countries, such as Thailand, Korea, and Singapore, were also reported; only two cases in Japan were reported. "Advanced age/menopause" was the most frequent reason for egg donation, and the mean age at egg donation delivery, because of advanced age/menopause, was 48.3 years. CONCLUSIONS: Our findings will increase public awareness of the legal issues related to assisted reproductive technology and cross-border reproductive care, as well as care of the mother and child in pregnancies resulting from reproductive technologies such as egg donation overseas. People should be aware of the issues involved in egg donation abroad and the resulting deliveries, and should implement specific care for women bearing children at later ages.

Attitudes towards cross-border reproductive care among infertile Japanese patients.

OBJECTIVES: The attitudes towards cross-border reproductive care (CBRC) held by infertile Japanese patients have not been explored. The objective of the present study was to examine interest levels, preferred destinations, motivations, and sources of information related to CBRC. Our findings provide a general outline of CBRC and the future of reproduction and assisted reproductive technology (ART) in Japan. METHODS: The study used a cross-sectional design. Data were collected from 2,007 infertile Japanese patients from 65 accredited ART clinics in Japan (response rate, 27.4 %) via anonymous questionnaires. RESULTS: Most of the infertile Japanese patients who responded denied using CBRC. However, by group, 171 (8.5 %) patients in non-donor in vitro fertilization, 150 (7.5 %) in egg donation, 145 (7.2 %) in pre-implantation genetic diagnosis, and 129 (6.4 %) in surrogacy said that, depending on the situation, they might travel abroad in the future. Older respondents were more likely to express an intention to travel overseas for egg donation in the future. The most popular destination for CBRC was the United States. Popular reasons for interest in CBRC among those considering or planning using this approach to third-party reproduction were that egg donation or surrogacy was unavailable or that obtaining ethical approval takes too long in Japan, whereas these processes are legal and affordable overseas. However, high cost was the most common reason for hesitancy regarding CBRC. Among the participants who were considering or planning to travel abroad for this purpose, TV, medical agencies, print media, and message boards on websites were popular sources of information, whereas doctors, friends, and patient self-help groups were not. CONCLUSIONS: Although CBRC among infertile Japanese patients is not at present common, the demand for and use of this approach may increase in the future in the context of the increasingly aging population. Lack of regulation and unavailability of third-party reproduction is a major cause of CBRC among Japanese patients. Health care provider faces an urgent need for giving useful information for patients regarding CBRC.

Decreased activity of daily living produced by the combination of Alzheimer's disease and lower limb fracture in elderly requiring nursing care.

OBJECTIVES: Alzheimer's disease (AD) impairs cognitive functions, subsequently decreasing activity of daily living (ADL), and is frequently accompanied by lower limb fracture including hip fracture in the elderly. However, there have been few studies on what kinds of physical functions are affected or what degrees of dysfunction are produced by this combination. This study aims to clarify the relationship between decreased ADL and the combination of AD and lower limb fracture. METHODS: We examined present illness and ADL in 4340 elderly aged 82.8 ± 9.36 years [average ± standard deviation (SD)] requiring nursing care and compared ADL between elderly with and without AD or lower limb fracture treated with surgery or conservatively using analysis of covariance (ANCOVA), with age and sex as covariants. RESULTS: We recognized that activities of cognitive function (p < 0.001), eating (dysphagia) (p < 0.001), eating (feeding) (p < 0.001), and toilet use (p < 0.001) in the elderly with AD were significantly lower than in those without the disease, even after adjusting for sex and age. Activities of bed mobility (p < 0.05), transfer and locomotion (p < 0.001), and bathing (p < 0.05) in the elderly with a fracture treated with surgery were significantly lower, which differed from the results of AD. Significant interactions of AD and fracture treated with surgery on the ADL scores for bed mobility (p < 0.001), dysphagia (p < 0.01), feeding (p < 0.001), and toilet use (p < 0.05) show that the combination had a much more profound influence on the ADL scores than AD or fracture alone. We obtained almost the same results for fractures treated conservatively as for fractures treated with surgery. CONCLUSIONS: These results demonstrated that the combined effects of AD and lower limb fracture were significantly greater than expected additive effects of AD and fracture, suggesting that the combination of AD and lower limb fracture has synergistic effects on almost all types of ADL except cognitive functions.

The relationship between social capital and self-rated health in a Japanese population: a multilevel analysis.

OBJECTIVE: The aim of this study was to use a multilevel analysis to examine whether cognitive and structural dimensions of regional social capital were associated with individual health outcomes after adjusting for compositional factors. METHODS: Data from the Japanese General Social Surveys project, a nationwide study with a two-stage stratified random sampling method conducted in 2000, 2001, 2002, 2005, and 2006, were aggregated and used for the multilevel analysis (n = 11,702). We examined whether both cognitive and structural aspects of social capital (social trust, neighborhood safety, and social participation) were associated with the self-rated health (SRH) of residents from 118 regions after adjustment for compositional factors. RESULTS: Social trust and existing neighborhood safety were negatively associated with poor SRH, whereas the effect of social participation was not significant. Social trust was still negatively associated with poor SRH after adjusting for individual demographic factors and socioeconomic status (p = 0.001). In contrast, neighborhood safety and social participation did not reach significance after adjusting for compositional factors. CONCLUSION: Based on the results of this study, social trust was associated with health outcomes. Further study is needed to clarify the path linking regional trust in others to individual health outcomes in the Japanese population.

The differences in the involvements of loci of promoter region and Ile50Val in interleukin-4 receptor α chain gene between atopic dermatitis and Japanese cedar pollinosis.

BACKGROUND: Atopic dermatitis (AD) and Japanese cedar pollinosis (JCP) are common chronically allergic diseases associated with the activation of T-helper 2 cells. Recent studies have shown that polymorphisms in the genes for IL-4 receptor α chain (IL4RA) may contribute to susceptibility of AD and JCP, although the differences in the involvements of loci of IL4RA gene between AD and JCP are unclear. In this study, we investigated the role of polymorphisms in IL-4RA gene in conferring susceptibility to the development of AD and/or JCP using a family analysis and an association analysis in a Japanese population. METHODS: Five polymorphisms in the IL-4RA gene, C-3223T, T-1914C, T-890C, Ile50Val and Glu375Ala, have been genotyped using PCR-based methods in 75 trios families, including 15 AD families, 30 JCP families, and 30 families with combination of AD and JCP in the family analysis. Forty-five AD, 60 JCP and 125 control children constituted the association study. RESULTS: The transmission disequilibrium test showed that the allele of Ile50 was significantly transmitted to children with JCP alone (p < 0.05). Haplotype analysis showed that the -3223T/Ile50 haplotype was preferentially transmitted to both AD (p < 0.01) and JCP children (p < 0.01), while that the C-3223/Ile50 haplotype was preferentially transmitted to only JCP children (p < 0.01). The association study showed that -3223T and haplotype of -3223T/Ile50 were associated with AD children, but not with JCP. Ile50 was associated with both AD and JCP. CONCLUSIONS: Our data suggest that -3223T and the -3223T/Ile50 haplotype were risk factors for AD. Ile50 allele seems to be involved in both JCP and AD. Interactions of the IL-4RA loci may play a role both conferring susceptibility and modulating severity of AD.

Possible health-protecting effects of feeling useful to others on symptoms of depression and sleep disturbance in the workplace.

OBJECTIVES: The aim of this study was to examine the health-protecting effects of feeling useful to others on symptoms of depression and sleep disturbance in the workplace, as well as its buffering effects on associations between stressful work environments and symptoms of depression and sleep disturbance. METHODS: The subjects of this cross-sectional survey were 773 Japanese workers (response rate: 64.8%) of five organizations. Feelings of being useful to others were assessed with one simple question used in a previous study. Psychosocial work environment, sleep disturbance, and depressive symptoms were assessed using the Japanese versions of the Effort-Reward Imbalance Questionnaire, the Pittsburgh Sleep Quality Index, and the 28-item General Health Questionnaire, respectively. We tested for linear and interactive effects with hierarchical regression analyses. RESULTS: Feeling useful to others was significantly (p<0.05) and negatively associated with scores of depression and sleep disturbance both in the univariate analyses and after adjusting for age in both genders. Significant (p<0.05) interactions showed that, in both genders, as the effort-reward balance worsened, symptoms of depression increased, but feeling useful to others buffered the associations. CONCLUSIONS: The results support the notion that feeling useful to others in both genders in the workplace has possible health-protecting effects.

Association between the incidence of premature rupture of membranes in pregnant women and seismic intensity of the Noto Peninsula earthquake.

OBJECTIVES: The Noto Peninsula earthquake struck the coast of the Noto Peninsula, Japan on March 25, 2007, resulting in the death of one woman and injury to 356 people. A total of 684 houses were totally destroyed by this earthquake, and more than 2,500 people were forced to live at shelters. In this study, we have evaluated the association between the incidence of peripartum abnormalities and seismic intensity of the Noto Peninsula earthquake. METHODS: Demographic data, births, seismic intensity of the earthquake and the incidence of peripartum abnormalities between June 25, 2007 and January 31, 2008 were surveyed. The dataset included 126 pregnant women who lived in the disaster area. The seismic intensity of the earthquake was expressed on the scale (0-7, with 7 being the strongest measure) used by the Japan Meteorological Agency. The subjects of the analysis included 19.7% of the pregnant women affected by the disaster. RESULTS: Of the pregnant women included in this study, 7.9% had a premature rupture of membranes (PROM), with the percentage being significantly higher in the group that experienced a seismic intensity of 6 than in that experienced a seismic intensity of 5. CONCLUSIONS: Our epidemiologic study shows that the PROM among our study cohort was associated with seismic intensity, suggesting that the physical outcome was due to aftershocks of the earthquake at a seismic intensity ≥6. This outcome may result from the psychological stress caused by the earthquakes.