Reproductive Rights Prof Blog

California Mandates Reparations for Some Victims of Forced Sterilization

By K.A. Dilday (July 20, 2021)

On July 12, California governor Gavin Newsom, signed into law AB-1764, a bill to pay reparations to people who were forcibly sterilized in California during the years 1909 and 1979 when the state’s eugenic sanctions law (enacted in 1909 and honed throughout the years) was in place, and to people who were sterilized in the state's prison system after that time. California is the third state, following North Carolina and Virginia, that will compensate victims of forced sterilization.

The bill signed by Gov. Newsom is particularly noteworthy as both the issue of reparations and of forced sterilization figure prominently in national dialogue. Just last year, a nurse at a privately owned immigration jail in Georgia joined in a whistleblower complaint alleging that a doctor at the facility performed a high rate of hysterectomies on migrating women without “proper informed consent,” and bills proposing reparations for the descendants of enslaved Black Americans are regularly debated in the U.S. Congress.

According to the final text of California’s AB-1764, the forced eugenics law targeted people deemed afflicted with “mental disease,” “feeblemindedness,” and, “those suffering from perversion or marked departures from normal mentality or from disease of a syphilitic nature.”

During the 70 years that the law was in place, the reparations bill states, “more than 20,000 people were sterilized, making California the nation’s leader by far in sterilizations, a number that was more than one-third of the 60,000 persons sterilized nationwide in 32 states … between 1919 and 1952, women and girls were 14 percent more likely to be sterilized than men and boys. Male Latino patients were 23 percent more likely to be sterilized than non-Latino male patients, and female Latina patients were 59 percent more likely to be sterilized than non-Latina female patients.”

That law was finally overturned in 1979 after 10 Los Angeles women of Mexican origin brought a lawsuit in federal court against the Los Angeles County-USC Medical Center for involuntary or forced sterilization in Madrigal v. Quilligan (1978). While the judge ruled in favor of the defendants, ascribing the unwanted sterilizations to miscommunication and language barriers, the women of Madrigal v. Quilligan nonetheless reshaped history. The next year, the state legislature overturned the law. They did not win for themselves but they won for future Californians.

Or so it seemed, since, notably, while the formal eugenics law ended in 1979, a program of sterilization as birth control and for dubious medical reasons led to the sterilization of approximately 150 mostly Latina and Black women in California prisons between 2006 and 2010.

In 2014, the bill SB 1135 made sterilization for birth control in California prisons unlawful, and put in place safeguards to ensure that any sterilization deemed medically necessary for an imprisoned person actually is. However, no reparations for past sterilizations were mandated at that time. 

Eugenics-driven sterilization in the United States has always been directed at those deemed mentally infirm or undesirable, a characteristic that is often assigned to people of color and to imprisoned people. This practice was sanctioned federally by the notorious 1927 Buck v. Bell U.S. Supreme Court decision. While Buck v. Bell was discredited by the Supreme Court decision in Skinner v. Oklahoma (1942) that established procreation as a fundamental right protected by the U.S. Constitution, and has been chipped away by other protective laws, Buck v. Bell has never been overturned.

In addition to the eugenics programs in California, throughout the 19^th century and through the mid-20^th century there was mass forced sterilization of poor people (many black and Latino) in the South, Indigenous people in Western and middle-America, and of Puertoriquenos in Puerto Rico through the 1970s. But forced sterilizations were also performed on people who were deemed either mentally or morally unworthy, regardless of race.

California convened a "Task Force to Study and Develop Reparation Proposals for African Americans" this year, and while some may see AB-1764 as another step toward direct reparations, the bill only authorizes payment to individuals who were sterilized, thus avoiding the complex issue of generational injury. And, unless they adopted or had biological children before the procedure, many people who were sterilized likely do not have offspring, reducing the number of descendants who might protest the bill’s limits on eligibility to bring a claim.

The status of potential claimants who are undocumented is unclear.

The state has allocated $7.5 million to pay the victims. According to The New York Times, the limited number of living potential claimants means that each successful applicant is likely to receive approximately $25,000.

 

 

Arkansas Continues Attack on Reproductive Rights With a New Anti-Transgender Law

By Kelly Folkers (April 13, 2021)

On April 6, the Arkansas state legislature overrode a gubernatorial veto and enacted a bill (H.B. 1570) that will ban access to gender-affirming care (GAC) for people under the age of 18, the first law of its kind in the United States.

H.B. 1570 is one of 80 bills regulating transgender and gender expansive (TGE) people’s access to societal resources that were introduced in state legislatures during the first three months of 2021. Considering the already hostile landscape for reproductive rights in Arkansas, the new law further threatens reproductive rights by legalizing discrimination in healthcare.

The Arkansas law creates a blanket ban on GAC for minors, carving out exceptions only for persons with disorders of sex development, people who are injured by or later regret GAC (an extremely rare occurrence), and people who require surgeries similar to gender-affirming operations for reasons unrelated to gender transition. Notably, the law states that medical care under these circumstances is not gender-affirming care, although patients meeting the criteria for the exceptions receive the same or similar prescription medications and surgeries. This disparate treatment among patients receiving the same or similar care raises an important question: Why is the Arkansas legislature so concerned with TGE youth specifically?

Across the board, professional medical associations consider GAC to be a safe, ethical, and a sometimes life-saving form of healthcare for minors and adults. GAC includes a wide array of psychosocial, medical, and surgical care options aimed at helping TGE people achieve a physical appearance consistent with their gender identity. (It is important to note that not all TGE people choose some or any of these options; having a TGE identity is not a medical or psychological condition that, in and of itself, requires treatment.)  

For minors who want treatment, they can start with the administration of puberty suppressing hormones, which prevent potentially distressing bodily changes like breast growth, voice deepening, or facial hair development. Medical experts say that puberty suppression is fully reversible although there is ongoing study of its long-term effects.

For those who want more treatment, gender-affirming hormone therapy involves the administration of estrogen or testosterone aimed at enabling the development of secondary sex characteristics that more closely align with an individual’s gender identity. As gender-affirming hormone treatment can affect adolescents’ fertility, professional medical guidelines state that clinicians should counsel youth on possible options for fertility preservation, which involves harvesting and storing gametes. Though fertility preservation is expensive and often not covered by insurance, the standard practice is to ensure that TGE youth and their families receive fertility counseling before starting any treatment that may affect future reproductive choices.

Even in states with liberal GAC policies for minors, gender-affirming surgical procedures are typically only accessible to individuals who have reached the age of majority, with some limited exceptions.

The Arkansas legislature claims it has a compelling government interest in “protecting the health and safety of its citizens, especially vulnerable children.” The bill’s title is the “Save Adolescents from Experimentation Act,” implying that GAC is a form of medical experimentation on unwilling youth. Bioethicists have long held that there is a distinction between clinical care and medical research, each of which requires different ethical standards and responsibilities toward patients and research participants. It is uncontroversial within the medical field that GAC is a valid form of healthcare.

Additionally, the bill perpetuates the “desistance” myth, or the erroneous notion that the majority of youth who begin puberty suppression or gender-affirming hormone therapy eventually stop treatment and identify with the gender they were assigned at birth. The conservative right wields these and other claims to justify policies that serve to exclude TGE people from accessing healthcare and other public accommodations, thinly veiling their transphobia as a “compelling government interest” to protect youth.

Combined with another recently passed Arkansas law (S.B. 289) that allows doctors to refuse to treat patients because of religious or moral objections (even though clinicians already have federal protections for conscientious objection to abortion and sterilization procedures), TGE people’s right to medical care is rapidly being eroded in the state. S.B. 289’s opponents, including the Human Rights Campaign and the American Civil Liberties Union, predict that it could allow doctors to refuse care to LGBTQ+ patients altogether in addition to further justifying limits on access to abortion, contraception, and other forms of reproductive healthcare.

This recent legislative action in Arkansas is part of an alarming nationwide policy trend of discrimination against TGE people. Anti-trans policies are continuing to diffuse throughout the United States, including state legislation restricting transgender girls from participating in sports and requiring TGE people to use bathrooms that correspond to their gender assigned at birth. This wave of new legislation is not random: the sheer volume of bills that have been introduced this year suggests a highly organized attack on the rights of transgender people that will require an equally coordinated response. 

Author’s note: The author of this article, a cisgender white woman, wishes to note that her perspective does not fully capture the variety and nuance of perspectives among TGE people.

For Black Women, Reproductive Justice Is About More Than High-Risk Pregnancies

YES! Magazine (Apr. 2, 2019): For Black Women, Reproductive Justice Is About More Than High-Risk Pregnancies, by A. Rochaun Meadows-Fernandez: 

Recently, journalists, medical professionals, and advocates have been emphasizing the discrepancy in medical care between White women and women of color. The maternal mortality rate is already abysmally low in the United States; this rate is even worse for Black women. These reports have largely focused on the medical risks of pregnancy and childbirth for women of color, but there is another, lesser-reported area of reproduction that also disproportionately burdens women of color: infertility. 

"While infertility affects roughly 12 percent of the population, Black women are twice as likely to experience challenges achieving or sustaining a pregnancy—and less likely to seek assistance." Infertility can also severely harm the mental health of someone wishing to get pregnant. 

Options to prevail against infertility often include the use of assisted reproductive technologies, including surrogacy. 

Surrogacy has been met with controversy from many angles over the years. Those against the practice express concerns of stigma, exacerbated classism, commodification of women's bodies, and exploitation. "Some countries, including Mexico, have banned commercial surrogacy under the guise of protecting low-income women and children from exploitation."

Advocates, however, argue that surrogacy is a viable option for many people to pursue their dreams of parenthood they otherwise have trouble achieving. 

Black women in particular are less likely to pursue surrogacy, among other reproductive technology, and are less likely to be surrogates as well.

According to the Centers for Disease Control and Prevention, from 1999 to 2016, gestational carriers resulted in 13,380 deliveries and the birth of 18,400 infants.  Although the current figures are unknown, surrogacy is helping to counter infertility struggles.

Still, the number of Black surrogates and Black intended parents remain low.

This could possibly be because of the stigma from slavery that historically frames enslaved Black women as surrogates for their White female owners. But is most likely because of the high costs normally associated with surrogacy (about $100,000, which includes medical and health care expenses for the carrier and agency or finder fees)—although some may turn to family or friends where there is no compensation—called altruistic surrogacy.

Surrogacy can occur in two ways: the traditional way in which the surrogate is impregnated by either the intended father's sperm or that of a donor, while using her own eggs; or, gestational surrogacy in which the surrogate is impregnated using the eggs of either the intended mother or an egg donor. In the former, the surrogate is genetically related to the child and the in the latter, she is not. Gestational surrogacy requires a few additional interventions, like IVF, and is generally more expensive. 

Many intending parents prefer gestational surrogacy, though, in order to lessen the likelihood that the surrogate will develop an emotional connection and assert a biological claim of custody over the resulting child. "This is an intended parent’s worst fear."

"Juli Fraga, a psychologist who specializes in women’s health, including pregnancy-related depression...suggests that it is especially important for all members of the surrogacy contract to be open to seeking mental health services."

In re Baby M is one of more famous cases illustrating potential legal battles that may arise over surrogacy. In this case, intended parents William and Elizabeth Stern fought for custody after their surrogate, Mary Beth Whitehead, invalidated their contract and attempted to claim custody over "Baby M." The court ultimately held that the surrogacy contract was entirely unenforceable, likening it to the "sale of a child." The court also held that William Stern, the child's biological father, retain custody according to the best interests of the child, but that Whitehead, the surrogate and also the child's biological mother, also retain visitation rights with the child.

Similar cases have continued to arise between surrogates and intended parents. Baby M influenced a shift in the legal protections and parameters for surrogacy, though. "It’s now suggested that intended parents prioritize entering contracts in states that support protective surrogacy legislation. But only 17 states and the District of Columbia have laws governing the conditions of surrogacy."

It is important to ensure that Black women are receiving the same medical care and equitable access to reproductive services, including reproductive technology and protections in cases of surrogacy (either as the intending parent or the surrogate), as White women. Equally as important is removing the stigma around infertility and opening conversations to all women about their reproductive options. 

In once recent case, GloZell Green, a Black woman and YouTube star, was told by a fertility specialist that she'd waited too long to have children at age 39. Green began searching for the best way to enter motherhood and ultimately had a baby girl through gestational surrogacy. Green shared her surrogacy journey with her millions of subscribers, hoping to break the stigma and open conversations. She highlights that "above all else, she doesn’t want Black women to be embarrassed about infertility."

The Glaring Exception in the Coming Battle Over Reproductive Rights

Aug. 8, 2018 (The New Republic): The Glaring Exception in the Coming Battle Over Reproductive Rights, by Emma Scornavacchi:

Justice Kennedy's retirement announcement earlier this summer immediately sparked discussion and concern over the fate of Roe v. Wade, abortion rights, and reproductive rights in general. Conservative and anti-abortion activists now feel that, depending on Trump's SCOTUS nominee, making abortion illegal in the United States is a real possibility. Further, "an emboldened anti-abortion campaign could lead to consequences for women’s health care and reproductive rights that range far beyond abortion restrictions. Contraceptive devices, such as IUDs or even the pill, could cease to be covered by insurance."

Notably, though, in-vitro fertilization (IVF), tends to be left out of the reproductive rights debate. 

A leader of the Pro-Life Action League cited that it can be too difficult to explain what is "objectionable" about IVF as a reason for focusing conservative efforts on abortion alone--despite the fact that the typical IVF cycle results in the disposal of many fertilized embryos. "IVF poses a puzzling challenge for conservative groups: How do organizations that liken embryos to people reckon with a technology that creates babies for families, but destroys embryos along the way?"

In the United States, the success rate for IVF in women under 35 hovers around 42%. To achieve that success, though, IVF cycles may produce anywhere from 3 - 25 embryos at a time. Many of the unused embryos remain frozen, some may be donated to research or to another family, and some may be "thawed" right away (that is, disposed of). 

Usually, anti-abortion arguments pertain to the right to life of unborn embryos, who do not get a say in the termination of life. "Unborn" embryos are being terminated by "thawing" across the country, as well, however, with no general outcry from conservative anti-abortion activists. "'There’s a disconnect between how public policy treats women who undergo IVF and women who have abortions,' says Margo Kaplan, a Rutgers law professor." Kaplan herself underwent IVF, and she and her husband chose to donate their unused embryos to medical research. Such research contributes to developments in treatments and cures for diseases like Parkinson's, yet Planned Parenthood was harshly targeted for participating in embryonic research partnerships.

Women who undergo IVF and choose to donate embryos do not have to read any mandated material or sit out a waiting period, both of which are required of women in many states who choose to get an abortion. “Nobody ever questioned my ability to make my own decision. And we don’t assume that women have the same ability to do that when they have an abortion,” Kaplan says.

Anti-abortion activists are hesitant to focus on the IVF issue when they see the opportunity to at least make strides criminalizing abortion, especially in light of today's Supreme Court opening. Kaplan also posits that activists are hesitant to focus on IVF as problematic, because it's a procedure that values and supports a woman's desire to be a mother, while abortion tends to implicate women who are pregnant but do not want motherhood. 

Patriarchal values combine with the stigma around abortion to explain the dichotomy in how conservatives are choosing to respond to abortion versus IVF. Further, IVF is steeped in privilege--the costs to undergo IVF cycles can exceed $20,000 and the treatments are out of reach for many people who would otherwise avail themselves of it. As such, IVF is often enjoyed exclusively by well-educated, wealthy, and white women. If it continues to thrive--even amidst anti-abortion attacks on other forms of reproductive rights--its privilege will likely bolster its continued growth and support. 

Who gets the embryos? Whoever wants to make them into babies, new law says.

The Washington Post (Jul. 17, 2018): Who gets the embryos? Whoever wants to make them into babies, new law says, by Ariana Eunjung Cha: 

New court cases cases are grappling with the decision of what to do with frozen embryos created during a marriage that later dissolves. In many cases that Cha reports on, the couples chose to create and freeze several embryos in the wake of a cancer diagnosis and treatment schedule that threatened later fertility.

When these same couples faced divorce, there were bitter divides over what should be done with the embryos: one party wanted to maintain "ownership" of the embryos for a future chance at children while the other wanted the embryos destroyed, fearing unwanted future financial or relationship obligations. 

With the number of frozen embryos in the United States soaring into the millions, disputes over who owns them are also on the rise. Judges have often — but not always — ruled in favor of the person who does not want the embryos used, sometimes ordering them destroyed, following the theory that no one should be forced to become a parent.

In Arizona, though, a "first-in-the-nation law" went into effect on July 1 that states "custody of disputed embryos must be given to the party who intends to help them 'develop to birth.'"

The legislation represents for some lawmakers the idea that frozen embryos have their own right to life, and many imagine that the implications could eventually include a delineation of when life begins and a claim to a separate set of embryonic rights of their own as human beings (rather than the discussion being centered on who "owns" the embryos). 

Some groups, like the anti-abortion Thomas More Society, advocate for that embryos to be considered "children" in the legal sense, asking judges to make decisions on disputes based on the best interest of the "child." 

Debates to extend personhood to unborn embryos and fetuses abound in anti-abortion work. Abortion rights advocates are concerned that these discussions could further disintegrate the right to abortion in the United States. "If a days-old embryo in a freezer has a right to life, why not a days-old embryo in utero?"

While judges have historically ordered disputed embryos destroyed based on the wishes of the party who does not want a child, an Arizona judge chose to balance one party's "probable inability to have a child without the embryos" against the other party's "desire to not be a father" a different way. 

Maricopa County Superior Court Judge Ronee Korbin Steiner held that Ruby Torres, who wanted the embryos in order to have biological children one day, had no right to them. The judge did not order them destroyed, though, and instead ordered that they go up for donation.

Torres appealed the decision and expects a new ruling any day. 

The new Arizona law that states embryos shall be given to the party who intends to develop them to birth was written in response to this case to "help" people in Torres' situation. It also attempts to recognize the rights of those who do not want the embryos used by providing that those parties would not be liable for child support in the future. 

Both the judicial decisions and the legislation continue to prove extremely controversial:

The Center for Arizona Policy, a conservative lobbying group that has successfully pushed antiabortion legislation in the state, supported the measure, saying the bill would “lead to more consistent rulings.”

The American Society for Reproductive Medicine, which represents doctors, nurses and other professionals who work on fertility issues, opposed the measure, arguing that it would have a profound impact on reproductive medicine.

Medical professionals foresee profound complications to stem-cell research in particular, which relies on embryos donated to science. Such research is believed essential in developing treatments for many diseases and conditions like Parkinson's and Alzheimer's. The treatment and storage of embryos as a result of the new legislation will likely make embryonic stem cells much more scarce.

In a friend-of-the-court brief in Torres' pending appellate case, the Academy of Adoption and Assisted Reproduction Attorneys urged judges in the Arizona Court of Appeals to balance the interest of each former spouse. They argue that the parties claims are not equal and that "the constitutional protection against compulsory parenthood is [generally] greater than any procreative interest in pre-embryos." 

Time will tell both if the appellate judges affirm Judge Steiner's controversial ruling (likely leading to further appeals) while we also wait for the inevitable challenges to Arizona's new embryo law.

Advanced Reproductive Technology is Here. But Who Decides Who Gets Access?

Futurism (Feb. 2, 2018): Advanced Reproductive Technology is Here. But Who Decides Who Gets Access?, by Claudia Geib: 

Reproductive technology has expanded and improved immensely over the years. The accessibility of assisted reproduction, fertility treatments, and even adoption, though, is highly limited, particularly in the United States. All of these processes can be prohibitively expensive, and, often, insurance does not cover them or organizations can arbitrarily choose not to provide them.

As reproductive technology is largely unregulated in the U.S., private organizations that manage processes such as embryo donations have full discretion when choosing who can participate in their programs. The National Embryo Donation Center (NEDC) states in its policies that they will only provide embryos to heterosexual, married couples, for example. The NEDC is founded in the Judeo-Christian worldview, and they explicitly exercise this viewpoint--or their perspective of it, at least--when selecting eligible couples for their services.  

Jeffrey Keenan, the NEDC's medical director, says that their policy is to operate based on the "biological reality" of a family and God's intention for conception.

As much as you see gay people having children, you have noticed that none of them do it on their own. It is physically and scientifically impossible for gay people to have a child. So why just because we can have someone act as a surrogate, or because we can donate into a [gay] woman, why does that make it right? It doesn’t, not in and of itself.

Civil rights communities, LGBT groups, and, increasingly, the courts oppose these views. What many consider illegal discrimination, though, endures under the protection of U.S. law since such procedures are not generally considered "medically necessary."

Basic fertility treatments are rarely covered by U.S. insurance policies, and when they are, the insurance company may first require proof and documentation of a medical reason preventing "natural" pregnancy. 

This is not the case in many other developed countries, where formal regulations, ethical requirements, and even entire administrative departments preside over reproductive technology. The United Kingdom's Human Fertilisation and Embryology Authority, for example, is solely committed to the regulation of fertility treatments and embryonic research in the U.K. 

In the U.S., there is simply "no equality of access" to reproducing, says Antonio Gargiulo, an obstetrician-gynecologist and director of robotic surgery at the Brigham and Women's Hospital in Boston. As it stands, Boston residents do  have access to fertility treatments under insurance, though; Massachusetts was the first state to pass laws requiring treatments be covered by insurance back in 1987. Just last year, New York also began requiring insurance companies to provide infertility treatments to those seeking, including homosexual couples and single women. 

Many medical professionals, though, are skeptical that the federal government--particularly under the anti-regulation Trump administration--will make any moves toward ensuring fertility treatments and reproductive technology are uniformly covered by insurance and accessible to all Americans. 

Young Women Alarmed by Falling Fertility Rates

New York Times (Feb. 13, 2018): American Fertility Is Falling Short of What Women Want, by Lyman Stone:

Fertility rates in the United States have fallen below the replacement rate, and are beginning to diverge substantially from what women state as their reproductive goals.  Whereas, women say they want on average 2.7 children, current rates show they will probably have no more than 1.8.  That gap is the highest it has been in 40 years.   

Explanations for the drop in fertility include postponing marriage, having less sex, and the decline in pregnancy rates among young women.  That low rate now affects women throughout their 20s and early 30s.  In the background is the fact that contraceptive technology has improved while reproductive technology has not.   

Falling fertility rates might portend trouble for Social Security, a graying population in need of care, and stagnant economic growth.

For Nonbinary Parents, Giving Birth Can Be Especially Fraught

Rewire (Jan. 25, 2018): For Nonbinary Parents, Giving Birth Can Be Especially Fraught, by S.E. Smith

Pregnancy and childbirth are vulnerable times in any parent's life. Add to that the highly gendered-status of both pregnancy and birth, and trans and non-binary parents are finding it difficult to locate an inclusive community with educated medical staff as they, too, enter childrearing chapters.

With the trans community, conversations about birth and parenting are few and far between and often fraught with discomfort. Now, though, more parents-to-be identify as trans men or somewhere else on the non-binary spectrum of gender identity. And the medical community has not yet caught up. "And, as in any area of reproductive health-care services, this isn’t simply a matter of gender: Race, class, and geography can play a huge role in whether non-binary people are able to access inclusive, affirming birth care."

Gender-affirming care--including asking for a patient's pronouns with their name, using gender-affirming language, and regularly seeking consent before performing examinations, particularly those that require a medical professional to touch the patient's genitalia--is important.  When it is absent, patients report both physical and psychological trauma.

Many in the trans and non-binary communities are increasingly seeking home births with gender-affirming midwives in order to create the most comfortable environments for themselves. Midwifery can be prohibitively expensive though, and insurance rarely covers it. So for others, a hospital may be the safest or the only choice. Advocates say that hospitals and birth collectives would do well to invest in specialized training for medical providers "to ensure that everyone at a facility is trans-competent, or working on getting there."

This issue is likely to amplify in coming years with a more visible nonbinary community, as well as a more active movement to reframe the way we look at pregnancy and birthing. Trans people—binary and otherwise—are some of the biggest stakeholders in the conversation, and they’re contributing with inclusive birthing classes and provider training in addition to working as care providers themselves.

The trans and non-binary communities call on leaders within the medical community to initiate changes from the inside, including re-training initiatives and reframing core educational documents for inclusivity. 

Sperm Count in Western Men Has Dropped Over 50 Percent Since 1973

The New York Times (Aug. 16, 2017): Sperm Count in Western Men Has Dropped Over 50 Percent Since 1973, Paper Finds, by Maya Salam

The sperm count of men in Western countries has been declining precipitously with no signs of “leveling off,” according to new research, bolstering a school of thought that male health in the modern world is at risk, possibly threatening fertility.

By examining thousands of studies and conducting a meta-analysis of 185 — the most comprehensive effort to date — an international team of researchers ultimately looked at semen samples from 42,935 men from 50 countries from 1973 to 2011.

They found that sperm concentration — the number of sperm per milliliter of semen — had declined each year, amounting to a 52.4 percent total decline, in men from North America, Europe, Australia and New Zealand.

Possible causes that researchers have identified include exposure to cigarette smoke, alcohol, and chemicals--such as phthalates--in utero. Age, obesity, and stress also play a role in lowered sperm count and quality. While long-term consequences have yet to be identified, research shows that fertility rates in Western nations are too low to sustain the current population. 

Why the Male Pill Still Doesn't Exist

The Atlantic (July 13, 2016): Why the Male Pill Still Doesn't Exist, by Andy Extance 

While America was introduced to the female birth control pill, and the first tests in hopes of creating a pill for men were conducted as early as 1957, many lament the fact that a male 'pill' equivalent to that of female hormonal contraception still does not exist. There are a variety of issues that have delayed the development of a male pill  - there is a lack of commitment to contraception; pharmaceutical companies are less interested in making a product for men; and dangerous side effects documented from previous drug trials. But studies show that the interest, across gender identities, for a male pill is there. The article highlights the social acceptance of women bearing the responsibility of taking contraception, and researchers' worry that they may not be able to create a product that would be as easy as to administer as the female pill. Over the years, researchers have explored various hormonal and non-hormonal methods.  One of the researches believes that the answer is probably out there and the work just needs to be completed: 

 [Elaine] Lissner is adamant that the ideas that seem to have faltered are not dead, they’re just resting. “We keep collecting new methods and never finish the ones we have,” she fumes. “Pick one and make  something! Finish the job!”

 

Navigating Fertility Services On-Line

New York Times (June 11, 2016): Navigating Fertility Clinics with a Click, by Glenn Rifkin:

A heterosexual couple in San Francisco who planned to have children soon after their wedding ran into the roadblock of infertility.  They became a statistic in a common story, spending tens of thousands of dollars on treatments without results, and wound up emotionally damaged by the experience.

But this couple's story ends differently than most.  Concerned about what they felt was a lack of accountability on the clinic level, they left behind high-paying jobs and started Fertility IQ, a website that assesses fertility doctors and clinics.  The website gathers and reports information from patients about their experiences so that others are not caught in the often frustrating and disappointing cycle of seeking medical care via word-of-mouth referrals. 

The website is a work-in-progress that some have compared with Yelp given its subjectivity.  But at least one patient found it to be "invaluable and game-changing."

More Progressive Reproductive Policies from the Pentagon

New York Times (Feb. 4, 2016): Pentagon to Offer Plan to Store Eggs and Sperm to Retain Young Troops, by Michael S. Schmidt:

In an effort to retain troops on active duty by making the military more family friendly, the Pentagon wants to reassure those who fear injury to their reproductive organs or who want to pursue a military career before having children.  Given the expense (an estimate is that the program will cost the Pentagon $150 million per year), almost no employers offer egg and sperm freezing to their employees.  Legal and ethical questions related to this service have yet to be resolved.

The Pentagon has recently improved the lives of service members in various ways related to having children, including longer maternity leaves, improved child care and the creation of lactation rooms at military facilities.  The initiatives are meant to address the greater emphasis that millenials place on work-life balance than did previous generations.   

 

Britain Becomes First Country to Allow So-Called "Three-Person Babies"

The Guardian: Britain's House of Lords approves conception of three person babies, by Hannah Devlin:

Britain has become the first country in the world to permit the use of “three-person IVF” to prevent incurable genetic diseases.

The House of Lords voted by 280 votes to 48 on Tuesday evening to approve changes to the law allowing fertility clinics to carry out mitochondrial donation. Babies conceived through this IVF technique would have biological material from three different people – a mother, father and a female donor. . . . 

Technically the baby would have three biological parents, with 99.8% of genetic material coming from the mother and father and 0.2% coming from the mitochondrial donor. . . .

PBS: Why the term 'three-person baby' makes doctors wince, by Rebecca Johnson: 

MELAS is one of about 200 known mitochondrial diseases, a subject that has featured prominently in the news since the British Parliament’s House of Commons on Feb. 3 approved further testing and research on mitochondrial replacement IVF. The procedure has beencommonly referred to in news stories as “three-person babies” or “three-parent babies.”

But it’s a term that makes doctors wince. . . .

Should Single-Embryo Transfer Be the Standard of Care for IVF?

Newsweek: Twins: The Fetal Paradox, by Amy Klein:

In 2004, Danielle Decrette went in for in vitro fertilization. It wasn’t her first time—she and her husband had a 3-year-old daughter conceived through IVF—and she knew what she was getting into. Just as he had four years before, Decrette’s doctor stimulated her with hormones, extracted her eggs from her ovaries, fertilized them with sperm in the lab and placed the resulting embryo in her uterus. But this time the process failed. So the doctor decided to transfer two embryos in the next round to increase her odds of getting pregnant.

“You know you could have twins,” the doctor warned her before the procedure. . . .

That was 10 years ago. Today, fertility doctors would almost certainly have pushed her away from the idea of a two-embryo implant . . . .

Time-Lapse Video Helps in Embryo Selection for IVF

CNN:  Time-lapse video reveals secret life of an embryo, helps women conceive, by Kieron Monks & Samantha Bresnahan:

It is estimated that around one in four couples around the world have trouble conceiving. For a small proportion of them, In Vitro Fertilisation (IVF) is a technology that can restore the dream of parenthood.

IVF is the fertilization of an egg by sperm outside the body, where it is cultivated in a lab environment, and if an embryo results it is implanted into the mother's womb. Now the chances of IVF treatment being successful are being boosted by a machine called the Embryoscope. . . .

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The commonly accepted practice of selecting only certain embryos for implantation in IVF illustrates that most do not believe embryos have the moral status of persons.

-CEB

Study Finds that Men's "Biological Clock" Means Higher Risk of Mental Illness in Children Born to Older Fathers

The New York Times:  Mental Illness Risk Higher for Children of Older Fathers, Study Finds, by Benedict Carey:

Children born to middle-aged men are more likely than those born to younger fathers to develop any of a range of mental difficulties, including attention deficits, bipolar disorder, autism and schizophrenia, according to the most comprehensive study to date of paternal age and offspring mental health. . . . 

. . . Men have a biological clock of sorts because of random mutations in sperm over time, the report suggests, and the risks associated with later fatherhood may be higher than previously thought. The findings were published on Wednesday in the journal JAMA Psychiatry. . . . 

Guttmacher Study Suggests Women Often Mistakenly Underestimate Their Risk of Pregnancy

Guttmacher Institute: A Year of Magical Thinking Leads to...Unintended Pregnancy, by Rebecca Wind:

Qualitative Study Explores Women's Perceptions of Pregnancy Risk

In-depth interviews with 49 women obtaining abortions in the United States found that most of the study participants perceived themselves to be at low risk of becoming pregnant at the time that it happened. According to "Perceptions of Susceptibility to Pregnancy Among U.S. Women Obtaining Abortions," by Lori Frohwirth of the Guttmacher Institute et al., the most common reasons women gave for thinking they were at low risk of pregnancy included a perception of invulnerability, a belief that they were infertile, self-described inattention to the possibility of pregnancy and a belief that they were protected by their (often incorrect) use of a contraceptive method. Most participants gave more than one response. . . .

Today is Intersex Awareness Day

In recognition of Intersex Awareness Day, I'm pleased to publish this commentary by Courtney Fraser, Fall Intern at Advocates for Informed Choice (’15, University of California, Berkeley School of Law): 

There’s no “I” in LGBT: How Reproductive Justice can (and must) end intersex invisibility

“Intersex? What’s that?” – so begins a series of questions I have become quite accustomed to fielding in my Civil Externship seminar. My classmates, some of whom are avid social justice advocates, are all familiar with reproductive rights; many of them even support LGBT causes, but few have ever heard the word “intersex” before. Most people probably haven’t. In honor of International Intersex Awareness Day, October 26, I’d say there’s no time like the present.

“Intersex” describes those who are born with ambiguous genitalia, or bodies that otherwise do not match societal ideas of “typical” male or female configurations. My externship this fall is with Advocates for Informed Choice, an (read: THE) organization working to protect the rights of intersex people. Right now, I have the honor of being involved with AIC’s groundbreaking litigation on behalf of a child (identified as M.C.) who suffered unnecessary genital surgery while he was still a baby. When I am called upon to explain my work to the class, invariably someone is shocked. That happens? All the time. To how many people? As many as 1 percent of live births are intersex, and 0.1 or 0.2 percent become victims of “normalizing” surgical mutilation.

So why aren’t more people outraged? Why do so few people even know about this?

 

Continue reading

Catholic/Secular Hospital Mergers Threaten Access to Reproductive Health Care

The New York Times: Hospital Mergers Reset Abortion-Access Battle, by Kirk Johnson:

Politicians seeking to restrict access to abortion, a marked trend this year from North Dakota to Arkansas, tend not to get much traction in this part of the country.

Washington is heavily Democratic, leaning left especially on social issues. A majority of voters even put into law a statutory right to abortion in 1970 — the only state ever to do that. The governor, Jay Inslee, a Democrat, is pushing the Legislature even now to pass a law at a special session on Monday requiring health insurers to pay for elective abortions, another first for the state if it makes it to Mr. Inslee’s desk.

But now a wave of proposed and completed mergers between secular and Roman Catholic hospitals, which are barred by church doctrine from performing procedures that could harm the unborn, is raising the prospect that unelected health care administrators could go where politicians could not. . . .

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H/T: Grayson Barber

In addition to prohibiting abortions and certain kinds of end-of-life care, Catholic hospitals also refuse to provide contraception (often including emergency contraception for rape survivors), sterilizations, and infertility services.  For more about the threats posed by these mergers, see the MergerWatch website.

Maneesha Deckha on Legislating Respect for the Embryo in Canada

Maneesha Deckha (University of Victoria – Faculty of Law) has posted Legislating Respect: A Pro-Choice Feminist Analysis of Embryo Research Restrictions in Canada on SSRN. Here is the abstract:  

This article investigates the impact of legislating respect and dignity for the embryo in vitro on the legal and cultural status of the embryo in utero. It evaluates the restrictions on embryo re-search in Canada’s Assisted Human Reproduction Act (AHRA) to consider whether they should receive pro-choice feminist support. Specifically, the article explores whether it is possible for feminists to accord respect to the in vitro embryo, as the AHRA attempts to do, without jeopardizing sup-port for abortion. The article canvasses the theoretical possibilities of this position by comparing the compatibility of feminist articulations of a right to abortion (bodily integrity and equality) with feminist arguments against the expansive use of embryos in research (commodification and exploitation). The article argues that it is logically compatible for feminists to promote “respect” and “dignity” for in vitro embryos while maintaining a pro-choice position on abortion. The article nevertheless cautions against feminist support for AHRA as it currently stands given that, on a practical basis, a feminist understanding of the AHRA’s restricted embryo research regime is difficult to achieve in the public sphere. The article explains why the more likely result for the public sphere will be an unqualified discourse of respect and dignity for embryos in general, which could then problematically revive the abortion debate and destabilize the non-personhood status of the in utero embryo. As a remedy, the article provides recommendations for how AHRA should be amended so as to better ensure that legislative restrictions on embryo research signal a legislative intent that respects women’s reproductive autonomy.