Science and Babies Private Decisions, Public Dilemmas (1990) / Chapter Skim
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1. Reproductive Health Issues
1. Reproductive Health Issues
Pages 1-13
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In infant mortality, a key indicator of national health, the United States ranks twentieth among industrialized nations, behind Hong Kong and Singapore. Despite our considerable research resources, American women have fewer contraceptive choices than their European counterparts.
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In the heterogeneous society of the United States, reaching a national consensus about issues tied closely to sexual and religious mores is a major task. In recent years it has been made more difficult by a lack of political leadership and the lack of an official national framework in which to discuss and resolve the many ethical and emotional issues that surround human reproduction.
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Credit: National Institute of Child Health and Human Development hand are the many pregnancies that are unplanned and economically and emotionally stressful; on the other is the substantial problem of infertility and the willingness of many infertile couples to pay thousands of dollars for help getting pregnant. Before the first test tube baby was born in 1978, the only available techniques to overcome infertility were artificial insemination, drugs to induce ovulation, and surgery to repair the reproductive tract in men and women.
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The United States is not alone in facing these new ethical and social concerns. Although most other developed countries have surpassed the United States in providing adequate family planning, improved contraception, and good prenatal care, our ethical questions and concerns arising from new reproductive technologies are the same.
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Similarly, not enough is known about the process of sperm movement through the female reproductive system or how sperm recognize, penetrate, and bond with the egg. Efforts to circumvent unknown or intractable obstacles to reproduction have led to the development of new reproductive technologies: artificial insemination, treatments for stimulating ovulation, fallopian tube reconstruction, in vitro fertilization (IVF)
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Some of the clinics so far have produced no births. Ike Office of Technology Assessment reports that only one in ten couples who undergo IVF or GRIT procedures takes home a baby.
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Outside the United States contraceptive care generally is integrated into primary health services, making it less expensive and readily available at convenient and familiar locations. Family planning clinics offer counseling, extended hours, and a broad range of contraceptive methods to the general population.
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The Norplant implantable contraceptive is expected to be available by early 1991 in the United States, and FDA requirements for testing contraceptive steroids recently were made almost identical to the testing requirements for other drugs. Increased federal funding also has been proposed.
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The infants of teenage mothers also face greater health and developmental risks." The study also noted that adolescent parents are more likely to experience chronic unemployment and inadequate income and that they and their children are "highly likely to become dependent on public assistance and to remain dependent longer...." It concluded that "in both human and monetary terms, it is less costly to prevent a pregnancy than to cope with its consequences." Consider this finding by the Alan Guttmacher Institute: In 1985 families started by a teenage birth absorbed approximately 53 percent of the total expenditures of the three major public programs for families Aid to Families with Dependent Children (AFDC) , food stamps, and Medicaid.
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ETHICAL ISSUES Research on the earliest stages of life in animals and in humans has made it possible to fertilize human eggs in the laboratory and to store frozen embryos indefinitely. Recombinant DNA technology is providing
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The commission that helped develop the regulations realized, however, that conflicts would inevitably develop between the obligation to treat all fetuses equally and the obligation to benefit individuals and society through fetal research. So the Ethics Advisory Board (EAB)
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As Kenneth Ryan emphasized at the 1988 Institute of Medicine's annual meeting, these problems regarding reproductive health raise not only major scientific and clinical care issues but also vital public concerns that can best be addressed and resolved by the development of government policy. REFERENCES Fletcher, J.C., and K.J.
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From page 13... ...
1989. Opening remarks and testimony at the Hearing on Consumer Protection Issues Involving In Vitro Fertilization Clinics, before the House Subcommittee on Regulation, Business Opportunities, and Energy, Washington, D.C.
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