Exploring narratives and advocating support and peer mentorship to improve HIV-positive adolescent mothers' lives in South Africa.

Research on adolescent sexuality, health and parenting has gained much attention in recent years. This growing body of research, however, has arguably limited qualitative outputs on HIV-positive adolescent mothers' sexual and reproductive health choices, needs, and rights in South Africa that could lead to informed policymaking. Through in-depth interviews conducted with a select group of ten HIV-positive adolescents and three key informants, the article explores the sexual, motherhood, risk discourses and reproductive health issues and rights of HIV-positive adolescent mothers as they come to terms with choices they have made and the challenges ahead. The findings highlight the dominant narratives on what are deemed to be the forces that shape these adolescent mothers' new social realities. With existing policies in place for adolescents, it is argued that a "one-size-fits-all" policy approach does not work, especially for HIV-positive adolescent mothers. Drawing on this identified gap and the tensions between individual needs, and the public welfare provision, the article highlights the need for tailored policy that will accommodate and promote the overall well-being of HIV-positive adolescent mothers and their children.

Ethical Issues Arising from Marijuana Use by Nursing Mothers in a Changing Legal and Cultural Context.

In the early 2000s, several states legalized marijuana for medicinal uses. Since then, more and more states have either decriminalized or legalized marijuana use for medical or recreational purposes. Federal law has remained unchanged. The state-level decriminalization of marijuana and the concomitant de-stigmatizing and mainstreaming is likely to lead to greater use among the general population, including among nursing mothers. Marijuana is already one of the most widely used illicit substances among lactating women. There exist few studies demonstrating the effects of marijuana in breast milk on nursing babies. In the present context of a changing legal landscape, shifting cultural beliefs, and the absence of clear professional guidelines, healthcare professionals are faced with ethical questions around how best to support nursing mothers and their babies when marijuana use is a factor. This paper first presents an overview of the law, science, and professional guidelines as they relate to marijuana and breastfeeding. Then, I offer an assessment of the relevant ethical issues providers and their patients may need to navigate.

Baby M Turns 30: The Law and Policy of Surrogate Motherhood.

This article marks the 30th anniversary of the Supreme Court of New Jersey's Baby M decision by offering a critical analysis of surrogacy policy in the United States. Despite fundamental changes in both science and society since the case was decided, state courts and legislatures remain bitterly divided on the legality of surrogacy. In arguing for a more uniform, permissive legal posture toward surrogacy, the article addresses five central debates in the surrogacy literature. First, should the legal system accommodate those seeking conception through surrogacy, or should it prohibit such arrangements? Second, if surrogacy is permitted, what steps can be taken to minimize the potential exploitation of women who are willing to rent their wombs for income? Third, what criteria should govern the eligibility to serve as a surrogate mother and an intended parent? Fourth, what principle(s) should serve as the basis for determining the parentage of children born through surrogacy? Fifth, is regulatory uniformity in the surrogacy realm desirable? Is it achievable? The article concludes that courts and legislatures should accept the validity of surrogacy contracts, determine parentage according to intent, and identify transparent criteria for the eligibility of both surrogates and intended parents.

"Wrongful Birth" Claims and the Paradox of Parenting a Child with a Disability.

"Wrongful birth" is a controversial medical malpractice claim raised by the mother of a child born with a disability against a medical professional whose failure to provide adequate prenatal information denied her the chance to abort. Plaintiff-mothers are required to testify that, but for the defendant's negligence, they would have terminated their pregnancy. Accordingly, alongside pro-life activists, disability rights advocates have opposed "wrongful birth" claims for stigmatizing and discriminating against people with disabilities by framing their very existence as a harm. Despite plaintiff-mothers' need for caretaking resources, scholars have recommended solutions ranging from the wholesale elimination of the wrongful birth claim to the curtailment of damages. To the extent scholars and the media have acknowledged mothers in the wrongful birth discourse at all, often it has been to blame and shame them for allegedly rejecting their children. They have paid little attention to the ways wrongful birth jurisprudence forces mothers to disavow their children in court, and thereby to forfeit the "good mother" ideal, in exchange for the possibility of securing necessary resources for their children. Commentators who question plaintiff-mothers' maternal devotion exacerbate the psychological toll the law already imposes. This Article shifts the blame from mothers to the legal system. While wrongful birth proceedings portray mothers' feelings about their children as categorically negative, real life accounts and social science findings reveal the true paradoxical experiences of all mothers, including plaintiff-mothers raising children with disabilities. To acknowledge this complex reality and mitigate the emotional strain of bringing a wrongful birth claim, this Article proposes several legal reforms: (1) broadening the analysis of emotional distress to reflect and legitimize mothers' paradoxical feelings about their children; (2) reframing the harm to mothers as loss of reproductive choice rather than as the birth of a flawed child and, accordingly, expanding available economic damages to include plaintiff-mothers' unexpected childcare responsibilities; and (3) educating plaintiffs' attorneys to empathize with the emotional aspects of mothers' litigation experiences and to counsel mothers accordingly. Today's approach to "wrongful birth" claims, which both stigmatizes disability and strains caretakers, demands urgent reform.

Beyond Balancing: Rethinking the Law of Embryo Disposition.

Actress Sofia Vergara became the center of a new round of conflict about the disposition of embryos created using assisted reproductive technologies (ART): the conflict about the difference that abortion jurisprudence should make to case law on ART. This Article argues that the history of abortion jurisprudence sheds light on the problems with the leading approach to embryo-disposition cases like Vergara's. In many instances, courts first look for a clear, binding agreement and look to a balancing analysis if no such agreement exists. As this Article shows, this is not the first time that courts have applied a balancing analysis to deal with clashing rights to seek and avoid genetic parenthood. The Article explores the history of two balancing approaches that have played a pivotal role in abortion law. These approaches have led to inconsistent results and cater to the prejudices of judges who are asked to weigh the relative merits of individual parties' views on reproduction. This Article recommends that states adopt legislation detailing the requirements of an enforceable embryo disposition similar to the Uniform Premarital and Marital Agreements Act (UPMAA). In the embryo-disposition context, states should require parties to disclose legal rights and responsibilities rather than only finances. These disclosures should cover the preservation, implantation, or destruction of the embryos and the financial and legal responsibility for any resulting child. States should enforce an embryo-disposition agreement if it is voluntary, if the parties had counsel or the opportunity to access counsel, and if the parties had a full disclosure of the constitutional and common law rights implicated by the agreement.

The Maternal Dilemma.

The Family and Medical Leave Act (FMLA) aims to protect the right to be free from gender-based discrimination in the workplace . . . . By creating an across-the-board, routine employment benefit for all eligible employees, Congress sought to ensure that family-care leave would no longer be stigmatized as an inordinate drain on the workplace caused by female employees, and that employers could not evade leave obligations simply by hiring men. "By setting a minimum standard of family leave for all eligible employees, irrespective of gender, the FMLA attacks the formerly state-sanctioned stereotype that all women are responsible for family caregiving, thereby reducing employers' incentives to engage in discrimination by basing hiring and promotion decisions on stereotypes."

Welfare Reform and Labor Force Exit by Young, Low-Skilled Single Males.

While the labor market woes of low-skilled male workers in the United States over the past several decades have been well documented, the academic literature identifying causal factors leading to declines in labor force participation (LFP) by young, low-skilled males remains scant. To address this gap, I use the timing and characteristics of welfare-reform policies implemented during the 1990s and fixed-effects, instrumental variable regression modeling to show that policies seeking to increase LFP rates for low-skilled single mothers inadvertently led to labor force exit by young, low-skilled single males. Using data from the Current Population Survey and a bundle of work inducements enacted by states throughout the 1990s as exogenous variation in a quasi-experimental design, I find that the roughly 10 percentage point increase in LFP for low-skilled single mothers facilitated by welfare reform resulted in a statistically significant 2.8 percentage point decline in LFP for young, low-skilled single males. After conducting a series of robustness checks, I conclude that this result is driven entirely by white males, who responded to welfare-reform policies with a 3.7 percentage point decline in labor supply. Young black males, as well as other groups of potentially affected workers, appear to be uninfluenced by the labor supply response of less-educated single mothers to welfare reform. Impacts on young, single white males are large and economically significant, suggesting that nearly 150,000 males departed the formal labor market in response to directed welfare-reform policies.

Maternal transmission of HIV infection: a crime against my child?

This paper considers whether section 20 of the Offences Against the Person Act 1861, which has been used to prosecute those who transmit the HIV virus in sexual relationships (eg, R v Konzani), could be used to prosecute women (in England and Wales) who transmit the virus to their child during pregnancy, delivery or via breast feeding. The discussion concludes that prosecution for transmission in pregnancy/delivery is unlikely. However, it is argued that there might be scope to prosecute the transmission of the virus via breast feeding in the event that there was sufficient evidence. However, this would also be subject to the Crown Prosecution Service deeming such a prosecution to be in the public interest. The paper does not seek to examine the ethical issues involved. However, it acknowledges that this issue is part of a broader debate as to whether, and if so, when, it is appropriate to criminalise the transmission of disease.

One mum too few: maternal status in host surrogate motherhood arrangements.

In a host surrogate motherhood arrangement, the surrogate agrees to be implanted with, and carry to term, an embryo created from the commissioning couple's gametes. When the surrogate child is born, it is the surrogate mother who, according to UK law, holds the legal status of mother. By contrast, the commissioning mother possesses no maternal status and she can only attain it once the surrogate agrees to the completion of the arrangement. One consequence of this is that, in the event that a host arrangement fails, the commissioning mother is left without maternal status. In this paper, I argue that this denial of maternal status misrepresents the commissioning mother's role in the host arrangement and her relationship with the surrogate child. Consequently, I suggest that commissioning mothers participating in host surrogacy arrangements ought to be granted the status of mother in the event that the arrangement fails.

Strengthening the Role of Unmarried Fathers: Findings from the Co-Parent Court Project.

While the importance of fathers in unmarried coparent families is a strong area of social and political interest, a dearth of community-based interventions exists for supporting the role of fathers in at-risk families. The Co-Parent Court (CPC) was a 3-year demonstration project evaluating the effectiveness of a collaborative intervention to support unmarried coparents establishing paternity and improving their coparenting relationships and paternal involvement in their child's life. A randomized-control experimental design was employed. The paper will explore father involvement and coparent relationship outcomes.

Who is the mother? Negotiating identity in an Irish surrogacy case.

An Irish surrogacy case from 2013 illustrates how negotiations of the mother's identity in a given national and legal context are drawing on novel scientific perspectives, at a time when the use of new biotechnological possibilities (such as IVF) is becoming more widespread and commonplace. The Roman dictum, 'Mater Semper Certa Est' (the mother is always certain, i.e. proven by giving birth) is contested by the finding of this Irish court, in which the judge made a declaration of parentage stating that the genetic parents of twins born using a surrogate (the mother's sister) were the parents. This article critically examines the normative background assumptions involved in this ruling. It will argue that the particular deployment of arguments from genetics and epigenetics in this court case produces a naturalization of the mother's identity that is inherently reductive. A second surrogacy case is also examined, this time regarding the rights of a woman of Irish nationality to receive paid maternity leave or paid leave similar to adoptive leave after the birth of her daughter to a surrogate mother in the US state of California. This case, which was brought to the Equality Tribunal in Ireland and decided by the Court of Justice of the European Union, is used to illustrate the possible ramifications of conflicting definitions of motherhood in the legal system. In concluding, this article argues for the development and deployment of a more complex understanding of the evolving state of motherhood within the courts, in keeping with developments in the IVF industry and the various new mother-relations it makes possible.

Comparison of southern Chinese Han and Brazilian Caucasian mutation rates at autosomal short tandem repeat loci used in human forensic genetics.

The short tandem repeat (STR) loci used in human genetic studies are characterized by having relatively high mutation rates. In particular, to ensure an appropriate evaluation of genetic evidence in parentage and forensic analyses, it is essential to have accurate estimates of the mutation rates associated with the commonly used autosomal and sex chromosome STR loci. Differences in STR mutation rates between different ethnic groups should also be determined. Mutation data from two laboratories working with different ethnic groups were extracted from many meiotic transmissions ascertained for 15 autosomal STR loci currently used in forensic routine. Forty-five thousand and eighty-five trios were checked for the biological consistency of maternity and paternity through the analysis of a minimum of 15 loci. Mutations were scored as paternal, maternal, or ambiguous according to the most parsimonious explanation for the inconsistency, using always the least requiring hypothesis in terms of number of repeat differences. The main findings are: (a) the overall mutation rate across the 15 loci was 9.78 × 10(-4) per gamete per generation (95% CI = 9.30 × 10(-4)-1.03 × 10(-3)), and with just 48 (out of 1,587) exceptions, all of the mutations were single-step; (b) repeat gains were more frequent than losses; (c) longer alleles were found to be more mutable; and (d) the mutation rates differ at some loci between the two ethnic groups. Large worldwide meiotic transmission datasets are still needed to measure allele-specific mutation rates at the STR loci consensually used in forensic genetics.

The association of state law to breastfeeding practices in the US.

We assessed the relationship between breastfeeding initiation and duration with laws supportive of breastfeeding enacted at the state level. We analyzed breastfeeding practices using the 2003-2010 National Health and Nutrition Examination Survey. We evaluated three measures of breastfeeding practices: Mother's reported breastfeeding initiation, a proxy report of infants ever being breastfeed, and a proxy report of infants being breastfeed for at least 6 months. Survey data were linked to eight laws supportive of breastfeeding enacted at the state level. The most robust laws associated with increased infant breastfeeding at 6 months were an enforcement provision for workplace pumping laws [OR (95 % CI) 2.0 (1.6, 2.6)] and a jury duty exemption for breastfeeding mothers [OR (95 % CI) 1.7 (1.3, 2.1)]. Having a private area in the workplace to express breast milk [OR (95 % CI) 1.3 (1.1, 1.7)] and having break time to breastfeed or pump [OR (95 % CI) 1.2 (1.0, 1.5)] were also important for infant breastfeeding at 6 months. This research responds to breastfeeding advocates' calls for evidence-based data to generate the necessary political action to enact legislation and laws to protect, promote, and support breastfeeding. We identify the laws with the greatest potential to reach the Healthy People 2020 targets for breastfeeding initiation and duration.

Mater semper incertus est: who's your mummy?

In English law, the legal term for father has been given a broad definition but the definition of mother remains rooted in biology with the Roman law principle mater semper certa est (the mother is always certain) remaining the norm. However, motherhood may be acquired through giving birth to a child, by donation of gametes or by caring and nurturing a child so that the identity of the mother is no longer certain particularly in the case of surrogacy arrangements. While the law in the UK may automatically recognise the parental status of a commissioning father in a traditional surrogacy arrangement, the parental status of the commissioning mother is not automatically recognised in either a traditional or a gestational surrogacy arrangement. Thus the maxim mater est quam gestation demonstrat (meaning the mother is demonstrated by gestation) is also not approached consistently in the legal interpretation of parentage or motherhood in surrogacy as against other assisted reproduction methods. This raises questions about the extent to which motherhood should be affected by the method of reproduction and whether the sociological and philosophical concept of motherhood should, in the case of surrogacy, give rise to a new principle of 'mater semper incertus est' (the mother is uncertain). This article will argue that the time has come to move away from a legal definition of 'mother' that is based on biology to one that recognises the different forms of motherhood.

The involvement of parents in healthcare decisions where adult children are at risk of lacking decision-making capacity: a qualitative study of treatment decisions in epilepsy.

BACKGROUND: Patients with intellectual disabilities (ID) receive health care by proxy. It is family members and/or paid support staff who must recognise health problems, communicate with clinicians, and report the benefits, if any, of a particular treatment. At the same time international and national statutes protect and promote the right of people with disabilities to access the highest attainable standards of health on the basis of free and informed consent. METHODS: To consider the role of parent-proxies in the management of epilepsy in adult children with ID who are at risk of lacking capacity to make decisions about their health care we interviewed 21 mothers. FINDINGS: These mothers are not pursuing changes in treatment that might improve their son or daughter's epilepsy, nor are they willing to countenance changes in treatment. Clinicians concerned to build and sustain therapeutic alliances with these mothers, our evidence suggests, may well avoid going against their wishes. DISCUSSION: Our research highlights the interactional contingencies of a hitherto neglected three-way clinical relationship comprising parent-proxy, an adult at risk of lacking decision-making capacity, and a treating clinician. This is a relationship, our findings suggest, where little importance is attached to either patient consent, or involvement in treatment decisions.

[The profile of neonaticide mothers in legal expertise]. / Le portrait des mères néonaticides dans les expertises judiciaires.

INTRODUCTION: Neonaticide is the term used to refer to the killing of newborn infants within the first 24 hours of life. A recent study conducted by Inserm Unit 750 found a frequency of 2.1 cases of neonaticide for 100,000 births in France. The persistence of these crimes raises serious issues, and scientists have attempted to explain this by the profile of neonaticidal mothers: young, or even teenage, single, primiparous, and socially deprived. The present study sought to question this profile, and to suggest a new profile for neonaticidal mothers. DATA AND METHODS: This retrospective study over the years 1996-2000 comprised 32 cases of neonaticide perpetrated in three French regions. Seventeen solved cases of these 32 cases generated 54 documents by expert consultants, mainly psychiatric and psychological expertise, studied and analysed here using Modalisa software for quantitative analyses and Nvivo software for qualitative data. RESULTS: No single socio-demographic profile was observed. The mothers were in contrasting situations at the time of the event. There were few psychotic profiles. The other psychopathological disturbances detected were very often related to the event. The most surprising feature in the expert reports describing the neonaticidal mothers was the existence of what we have termed "descriptive absent-factors". These mothers had not experienced major trauma in childhood such as the death of persons close or foster care. They were not living in an environment of family violence. They did not exhibit addictive or self-harm behaviour. Their parents before them had similar profiles, except three cases of alcoholism. Their parentage, and that of the infants, was not an issue. The most widely described personality features were immaturity, dependency on others, withdrawal, inhibition, emptiness, lack of affectivity, non-expressiveness, and devaluation of self-image. The very impoverished relational environment of these mothers also appears in the expertise data. Their affective and relational foundations were insecure. DISCUSSION: The "classic" profile of the neonaticidal mother as being young, single, and primiparous is not confirmed in this study. Recent American and European studies reach similar conclusions. More than half of these mothers already had other children; more than half were living with a partner. Nor did these mothers have an evident psychopathological profile, and even less so a psychopathic profile. This study suggests a "psycho-relational" profile for the neonaticidal mother: immature, affectively dependent, expressing herself very little, and experiencing considerable affective isolation. CONCLUSION: These neonaticidal mothers did not present any specific socio-demographic or evident psychopathological profile. The study nevertheless enabled definition of a "psycho-relational" profile.

[Protection of working mothers: operational guide document. The Marche Regional Section of the Italian Society of Occupational Health and Industrial Hygiene (SIMLII) ]. / Tutela delle lavoratrici madri: documento di indirizzo operativo.

Protection of working mothers: operational guide document. The aim of this operational guide document is to protect the health of working mothers and their babies during pregnancy, puerperium and breastfeeding. The project was developed by a technical working group which included professionals in the pertinent fields from the Workplace Prevention and Safety Services of the local Vasta-2 Area of the Marche Regional Health Service:physicians, health assistants, and nurses. It is considered to be a useful tool for risk assessment at the workplace aimed at professionals who are involved, with various duties and responsibilities, in the health care of the working mother. This paper consists of two functionally related sections, "Table of risks" and "Technical specifications". In the "Table of Risks" section, the occupational hazards for women during pregnancy or postpartum were analyzed with the highest possible degree of care. To this end the technical group provided, for each occupational hazard, its own operational suggestions, in relation to legislation, current scientific knowledge and Guidelines of other Italian Regions. The Marche Regional Section of the Italian Society of Occupational Health and Industrial Hygiene (SIMLII) participated in the final draft of the entire document. The second section, "Technical Specifications", illustrates the main tasks and any risks involved in the 34 manufacturing sectors most prevalent in this area. This operational guide document is intended to be the beginning of a common strategy in public health to achieve a wider field of action in promotion and information aimed at protecting the reproductive health of working mothers.

[Infanticide or murder in a forensic psychiatric assessment. A case study 5-fold infanticide--the search of psychopathology]. / Dzieciobójstwo czy zabójstwo? Studium przypadku 5-krotnego zabójstwa wlasnych dzieci--poszukiwanie psychopatologii.

OBJECTIVE: The difficulties to distinguish between infanticide and murder of the woman own child, experienced by both experts and the court, have been discussed on the example of the psychopathological description of the perpetrator killing five of her children, and data from the literature. CASE: This paper describes an extremely rare case of the woman who has killed five of her children immediately after their birth over several years. COMMENT: It is very difficult to decide whether the seemingly rational motivation to kill her own child shortly after their birth can be a proof of specific psychopathological state which is a consequence of childbirth or an assassination planned in cold blood. The act of killing a child by their own mother is so contrary to nature that it seems easy to find the ground for psychosis or a state of emergency. However, when neither of them has been proven the experts are left with the conviction of both diagnostic deficiency and inexplicability of human behaviour.