The Alabama Embryo Decision-The Politics and Reality of Recognizing "Extrauterine Children".

This Viewpoint discusses the Alabama Supreme Court's opinion on in vitro fertilization and how it plays into a larger push for fetal and embryonic personhood.

¿Vulneración del derecho a decidir entre parto natural o cesárea?: Análisis de la Sentencia 233/2023, 22 de febrero Juzgado de lo Contencioso Administrativo número 5 de Las Palmas de Gran Canaria / [Violation of the right to decide between natural birth or cesarean section?: Analysis of Sentence 233/2023, February 22, Contentious Administrative Court number 5 of Las Palmas de Gran Canaria]

A través del presente comentario se analiza la Sentencia del Juzgado de lo Contencioso Administrativo número 5 de Las Palmas de Gran Canaria, de 22 de febrero de 2023, ECLI:ES:JCA:2023:1039; en la que se condena al Servicio Canario de Salud a indemnizar a una mujer con un millón de euros por vulnerar su derecho a decidir entre parto natural o cesárea e imponer un parto gemelar natural prolongado hasta 17 horas que tuvo como consecuencia una lesión cerebral irreversible. (AU)

Through this commentary, the Judgment of the Administrative Court number 5 of Las Palmas de Gran Canaria, dated February 22, 2023, ECLI:ES:JCA:2023:1039, is analyzed. In this judgment, the Canarian Health Service is condemned to compensate a woman with one million euros for violating her right to choose between natural childbirth or cesarean section, and imposing a prolonged natural twin birth lasting up to 17 hours, which resulted in irreversible brain damage. (AU)

Building a Progressive Reproductive Law in South Africa.

This article delves into the expansion of procreative freedom in relation to assisted reproductive technologies (ARTs) in South African law, with reference to three seminal cases. In the case of AB v. Minister of Social Development, the minority of the South African Constitutional Court held that the constitutional right to procreative freedom is applicable to ARTs. Importantly, both the minority and the majority agreed on the principle of procreative non-maleficence-the principle that harm to the prospective child constitutes a legitimate reason to limit the procreative freedom of the prospective parents. Following this, Ex Parte KF2 clarified the concept of the "prospective child" as relating to an idea, rather than an embryo. Finally, in Surrogacy Advisory Group v. Minister of Health, the controversial issue of preimplantation sex selection for non-medical reasons was examined. The court confirmed that the use of ARTs falls within the ambit of procreative freedom. While holding that preimplantation sex selection for non-medical reasons is inherently sexist, the court found that a woman's right to procreative freedom-including the sex identification of an in vitro embryo-outweighs other considerations. These landmark cases establish a robust groundwork for a progressive reproductive law in South Africa.

Advancing Birth Equity in a Post-Dobbs US.

This Viewpoint discusses the US Supreme Court's decision in Dobbs v Jackson Women's Health Organization, describes how that decision threatens birth equity for some racial and social groups, and suggests a reproductive justice approach to address racial and social inequalities and ensure reproductive freedom and autonomy for all people.

Hacia una atención de calidad integral en las maternidades con perspectiva de derechos humanos / Towards a comprehensive quality of care in birthing facilities with human rights perspective

Resumen La calidad de la atención obstétrica hoy no solo se limita a tener profesionales con competencias técnicas basadas en evidencia científica, sino que incluye la atención centrada en la mujer, persona gestante y su familia, como expresión del respeto de sus derechos humanos. Este artículo revisa cómo el tema ha sido abordado globalmente y nacionalmente desde la Conferencia de Fortaleza en 1985 hasta la presentación reciente de proyectos de ley en el parlamento chileno.

Abstract Obstetric quality of care today means not only having skilled providers with evidence-based competences but it includes woman, pregnant person and family-centered reproductive health as expression of respect of their human rights. This article reviews how this issue has been approached in a global and national level since Fortaleza Conference in 1985 until recent bills of law proposed before Chilean parliament.

In re: the disposition of frozen embryos: 2022.

Debates regarding reproductive rights have waxed and waned since the early twentieth century. The current front-and-center debate draws this discussion into tighter focus. Challenges to reproductive rights, changes in definitions of personhood and a pending decision regarding Roe v Wade could change the management and options regarding the disposition of frozen embryos. This commentary outlines how changes in abortion law and reproductive rights could potentially impact the options available to both patients and clinics.

Restricted access to assisted reproductive technology and fertility preservation: legal and ethical issues.

Access to assisted reproductive technology (ART) and fertility preservation remains restricted in middle and low income countries. We sought to review the status of ART and fertility preservation in Brazil, considering social indicators and legislative issues that may hinder the universal access to these services. Although the Brazilian Constitution expressly provides the right to health, and ordinary law ensures the state is obliged to support family planning, access to services related to ART and fertility preservation is neither easy nor egalitarian in Brazil. Only a handful of public hospitals provide free ART, and their capacity far from meets demand. Health insurance does not cover ART, and the cost of private care is unaffordable to most people. Brazilian law supports, but does not command, the state provision of ART and fertility preservation to guarantee the right to family planning; therefore, the availability of state-funded treatments is still scarce, reinforcing social disparities. Economic projections suggest that including ART in the Brazilian health system is affordable and may actually become profitable to the state in the long term, not to mention the ethical imperative of recognizing infertility as a disease, with no reason to be excluded from a health system that claims to be 'universal'.

Abortion Rights after Artificial Wombs: Why Decriminalisation is Needed Ahead of Ectogenesis.

Significant scientific progress has been made toward artificial womb technology, which would allow part of human gestation to occur outside the body. Bioethical and legal scholars have argued that artificial wombs will challenge defences of abortion based in arguments for protecting bodily autonomy, for a pregnant person could have the foetus transferred to an artificial womb instead of being terminated. Drawing on examples from the common law jurisdictions of Canada, the USA, and the UK, I assess three ways scholars have argued abortion might be defended after ectogenesis (through redefining foetal viability, through a property right, and through a right to avoid genetic parenthood). I argue that while each of these proposals has strategic merit, each has significant legal and ethical limitations. Taking the normative position that abortion will remain a vital healthcare resource, I make the case for protecting abortion rights from a challenge posed by ectogenesis by focusing on decriminalisation.

What does abortion law reform mean for primary care practitioners in New Zealand?

New Zealand achieved a major sexual reproductive health and rights milestone when abortion ceased to be a crime. Introduction of the Abortion Legislation Act 2020 has significantly changed the way abortion care can be provided in New Zealand, with the potential to improve access, reduce inequities and transform the abortion experience for those people who choose to end their pregnancy. The primary care sector stands to be a key player in the provision of first-trimester abortion care. However, with issues relating to funding, training and access to medications yet to be resolved, the health sector is not yet ready to provide best-practice abortion care within the new legislative framework.

Reproductive Rights and Women's Mental Health: Essential Information for the Obstetrician-Gynecologist.

Reproductive health care is crucial to women's well-being and that of their families. State and federal laws restricting access to contraception and abortion in the United States are proliferating. Often the given rationales for these laws state or imply that access to contraception and abortion promote promiscuity, and/or that abortion is medically dangerous and causes a variety of adverse obstetric, medical, and psychological sequelae. These rationales lack scientific foundation. This article provides the evidence for the safety of abortion, for both women and girls, and encourages readers to advocate against restrictions.

Obstetricians' perspectives on trial of labor after cesarean (TOLAC) under the two-child policy in China: a cross-sectional study.

BACKGROUND: As the birth policy has been adjusted from one-child-one-couple to universal two-child-one-couple in China, there is an increasing number of women undergoing a second pregnancy after a previous cesarean section (CS). Undertaking an elective repeat CS (ERCS) has been taken for granted and has thus become a major contributor to the increasing CS rate in China. Promoting trial of labor after CS (TOLAC) can reduce the CS rate without compromising delivery outcomes. This study aimed to investigate Chinese obstetricians' perspectives regarding TOLAC, and the factors associated with their decision-making regarding recommending TOLAC to pregnant women with a history of CS under the two-child policy. METHODS: A cross-sectional survey was carried out between May and July 2018. Binary logistic regression was used to determine the factors associated with the obstetricians' intention to recommend TOLAC to pregnant women with a history of CS. The independent variables included sociodemographic factors and perceptions regarding TOLAC (selection criteria for TOLAC, basis underlying the selection criteria for TOLAC, and perceived challenges regarding promoting TOLAC). RESULTS: A total of 426 obstetricians were surveyed, with a response rate of ≥83%. The results showed that 31.0% of the obstetricians had no intention to recommend TOLAC to pregnant women with a history of CS. Their decisions were associated with the perceived lack of confidence regarding undergoing TOLAC among pregnant women with a history of CS and their families (odds ratio [OR] = 2.31; 95% CI: 1.38-1.38); obstetricians' uncertainty about the safety of TOLAC for pregnant women with a history of CS (OR = 0.49; 95% CI: 0.27-0.96), and worries about medical lawsuits due to adverse delivery outcomes (OR = 0.14; 95% CI: 0.07-0.31). The main reported challenges regarding performing TOLAC were lack of clear guidelines for predicting or avoiding the risks associated with TOLAC (83.4%), obstetricians' uncertainty about the safety of TOLAC for women with a history of CS (81.2%), pregnant women's unwillingness to accept the risks associated with TOLAC (81.0%) or demand for ERCS (80.7%), and the perceived lack of confidence (77.5%) or understanding (69.7%) regarding undergoing TOLAC among pregnant women and their families. CONCLUSION: A proportion of Chinese obstetricians did not intend to recommend TOLAC to pregnant women with a history of CS. This phenomenon was closely associated with obstetricians' concerns about TOLAC safety and perceived attitudes of the pregnant women and their families regarding TOLAC. Effective measures are needed to help obstetricians predict and reduce the risks associated with TOLAC, clearly specify the indications for TOLAC, improve labor management, and popularize TOLAC in China. Additionally, public health education on TOLAC is necessary to improve the understanding of TOLAC among pregnant women with a history of CS and their families, and to improve their interactions with their obstetricians regarding shared decision making.

Fertility-a human right worthy of mandated insurance coverage: the evolution, limitations, and future of access to care.

We review the history, current status, and potential future of state infertility mandates and focus on the business implications of mandates and on the inadequacies and reproductive injustice resulting from gaps between legislative intent and practical implementation. Nineteen states have passed laws that require insurers to either cover or offer coverage for infertility diagnoses and treatment. The qualifications for coverage, extent of coverage, and exemptions vary drastically from one state to another, resulting in deficiencies in access to care even within mandated states for certain groups, such as single individuals, patients in same-sex relationships, and patients pursuing fertility preservation. Although insurance coverage of fertility services in the United States has expanded as an increasing number of states have enacted infertility mandates, significant gaps in implementation and access remain even among states with existing mandates. Provider, patient, and legislative advocacy is warranted in the name of reproductive justice to expand insurance coverage and, in turn, maximize reproductive outcomes, which have been shown to improve as financial barriers are lifted.

Confidentiality and treatment refusal: Conservative shifts on reproductive rights by Brazilian medical boards.

Brazil has witnessed a conservative shift in recent years, reflected in setbacks in the field of reproductive rights. Commentators have drawn attention to changes in public policies and legislation that follow this shift. However, due attention has not been paid to changes in the professional standards regulating medical practice and their subsequent consequences for reproductive rights. Against this backdrop, this article examines two recent resolutions enacted by Brazilian medical boards, which violate ethical duties and the law. The first imposes a duty for doctors to disclose confidential medical information about their patients in sexual abuse cases. The second one determines that a pregnant woman's right to refuse medical treatment should be evaluated considering the fetus. This article argues that conservative setbacks operate not only through visible means, such as enacted legislation, but also furtively - through professional medical resolutions. It also asserts that, in such a context, the debate about women's bodily autonomy shifts once again from the human rights ground to the medical field, where it has traditionally been subjected to control and coercion. Finally, it points out the risk that these rules might be used to legitimize new conservative laws and public policies.