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In the United States, the \"right to choose\" an abortion is the law of the land. But what if a woman continues her pregnancy because she didn't really have a choice? What if state laws, federal policies, stigma, and a host of other obstacles push that choice out of her reach?     Based on candid, in-depth interviews with women who considered but did not obtain an abortion, No Real Choice punctures the myth that American women have full autonomy over their reproductive choices. Focusing on the experiences of a predominantly Black and low-income group of women, sociologist Katrina Kimport finds that structural, cultural, and experiential factors can make choosing abortion impossible-especially for those who experience racism and class discrimination. From these conversations, we see the obstacles to \"choice\" these women face, such as bans on public insurance coverage of abortion and rampant antiabortion claims that abortion is harmful. Kimport's interviews reveal that even as activists fight to preserve Roe v. Wade, class and racial disparities have already curtailed many women's freedom of choice.   No Real Choice analyzes both the structural obstacles to abortion and the cultural ideologies that try to persuade women not to choose abortion. Told with care and sensitivity, No Real Choice gives voice to women whose experiences are often overlooked in debates on abortion, illustrating how real reproductive choice is denied, for whom, and at what cost. 

Wynes and Nicholas (2017) argue that the most effective action to reduce individual greenhouse gas (GHG) emissions is to have one fewer child. We raise methodological concerns about the way in which the authors attribute responsibility for emissions: they rely on multiple counting when calculating the emissions of future generations, and they exclude scenarios in which global emission trajectories become net-zero or negative. This may distort recommendations from policy makers and educators who rely on their study. We propose an alternative way of attributing responsibility that avoids multiple counting. Investigating the implications of having children under this proposal with regards to the full range of different scenarios, including likelihood analyses, calls for further studies.

Understanding women's attitudes towards wife abuse and its effects on their reproductive choices is crucial for promoting gender equality in Southern Africa. However, a paucity of research has explored this relationship. Using IPUMS Demographic and Health Surveys data from 2011-2018 across eight Southern African nations, we analyzed 17,968 women's attitudes towards wife beating and their reproductive choices through a cross-sectional design and multilevel logistic regression models. Our findings reveal that 84.9% of women expressed negative attitudes towards wife abuse, with 44.2% demonstrating autonomy in reproductive choices. Women who opposed wife beating exhibited greater autonomy in reproductive decision-making (44.6%), while those justifying wife discipline showed decreased autonomy (aOR = 0.84, 95% CI [0.78-0.91]). Older age (aOR = 1.37, 95% CI [1.19-1.58]) and higher education (aOR = 2.15, 95% CI [1.18-2.60]) increased the likelihood of autonomy. Country-level variations were evident, with Mozambique, South Africa, Zimbabwe, and Zambia showing higher autonomy odds compared to Angola. These findings emphasize the need for targeted interventions and policies to shift attitudes and promote gender equality and reproductive health in Southern Africa. Comprendre les attitudes des femmes à l'égard de la violence conjugale et ses effets sur leurs choix en matière de procréation est crucial pour promouvoir l'égalité des sexes en Afrique australe. Cependant, peu de recherches ont exploré cette relation. À l'aide des données des enquêtes démographiques et de santé IPUMS de 2011 à 2018 dans huit pays d'Afrique australe, nous avons analysé les attitudes de 17 968 femmes à l'égard de la violence conjugale et leurs choix en matière de procréation à travers une conception transversale et des modèles de régression logistique à plusieurs niveaux. Nos résultats révèlent que 84,9 % des femmes ont exprimé des attitudes négatives à l'égard de la violence conjugale, et 44,2 % d'entre elles font preuve d'autonomie dans leurs choix reproductifs. Les femmes qui s'opposaient à la violence conjugale présentaient une plus grande autonomie dans la prise de décision en matière de procréation (44,6 %), tandis que celles qui justifiaient la discipline de leur épouse présentaient une autonomie réduite (aOR = 0,84, IC à 95 % [0,78-0,91]). L'âge plus avancé (aOR = 1,37, IC à 95 % [1,19-1,58]) et l'enseignement supérieur (aOR = 2,15, IC à 95 % [1,18-2,60]) augmentaient la probabilité d'autonomie. Les variations au niveau des pays étaient évidentes, le Mozambique, l'Afrique du Sud, le Zimbabwe et la Zambie affichant des chances d'autonomie plus élevées que l'Angola. Ces résultats soulignent la nécessité d'interventions et de politiques ciblées pour changer les attitudes et promouvoir l'égalité des sexes et la santé reproductive en Afrique australe.

To examine the association between self-managed abortion and the self-reported experience of abortion complications in India, a country with a high incidence of self-managed abortion. The study used a cross-sectional multivariable logistic regression analysis of data from the National Family Health Survey (NFHS-4) of 2015-2016 to compare the odds of self-reported complications experienced during abortion between self-managed and clinician-managed abortions in India. On average, self-managed abortions occurred earlier in gestation than clinician-managed abortions, 7.8 weeks and 11.3 weeks, respectively (p < 0.001). Self-managed abortion was associated with fewer self-reported abortion-related complications than clinician-managed abortions when adjusted for covariates not including gestational age (Adjusted Odds Ratio (aOR) 0.82, 95% confidence interval (CI) 0.69, 0.97). However, once adjusted for gestational age, there was no longer a clinically meaningful or statistically significant difference in the odds of self-reported complications between self-managed and clinician-managed abortions (aOR = 0.98, 95% CI 0.81, 1.18). These findings suggest that people in India are using safe methods to self-manage abortions and support the hypothesis that self-managed abortion can improve access to abortion and reproductive choice without increasing risk.

In a landmark Fatwa, Saudi Arabia’s highest religious authority—The Council of Senior Scholars—declared the Islamic permissibility of oocyte cryopreservation. The fatwa sanctioned the retrieval, preservation, and future use of oocytes, ovarian tissue, and whole ovaries from cancer patients receiving gonadotoxic interventions. Although momentous, the fatwa’s specification of cancer patients effectively rendered this technology unavailable to others to whom it may be similarly beneficial, including patients with other medical conditions or patients seeking elective cryopreservation. This article argues in favor of widening reproductive choices through expanded access to oocyte cryopreservation in Saudi Arabia—regardless of the underlying cause of infertility—on three grounds: the technology’s compliance with Islamic law, as a matter of fairness in medical practice, and as a means to support the well-being and flourishing of Saudi women within the context of a national societal and economic transformation strategy closely linked to their success.

Haemoglobinopathies are among the most prevalent genetic disorders globally. In the context of these conditions, preimplantation genetic testing (PGT) plays a pivotal role in preventing genetic diseases in the offspring of carrier parents, reducing the need for pregnancy termination and enabling the selection of compatible sibling donors for potential stem cell transplantation in cases of thalassemia or sickle cell disease. This review explores the evolving role of PGT as a reproductive option for haemoglobinopathy carriers, tracing the development of PGT protocols from patient-specific to comprehensive testing enabled by advanced technologies like next-generation sequencing (NGS). We discuss key technical, biological, and practical limitations of PGT, as well as the ethical considerations specific to haemoglobinopathies, such as the complexity of interpreting genotypes. Emerging technologies, such as whole-genome sequencing, non-invasive PGT, and gene editing, hold significant promise for expanding applications but also raise new challenges that must be addressed. It will be interesting to explore how advancements in technology, along with the changing management of haemoglobinopathies, will impact reproductive choices. It is anticipated that continued research will improve genetic counseling for PGT for haemoglobinopathies, while a careful evaluation of ethical and societal implications is also required. Responsible and equitable implementation of PGT is essential for ensuring that all families at risk can make informed reproductive choices.

Background In Italy in 2004, a very restrictive law was passed on medically assisted reproduction (MAR) (Law 40/2004) that placed Italy at the most conservative end of the European spectrum. The law was widely criticized and many couples seeking MAR brought their cases before the Italian Civil Courts with regard to pre-implantation genetic diagnosis (PGD), donor insemination and the issue of consent. Ten years on, having suffered the blows of the Italian Constitutional Court, little remains of law 40/2004. Discussion In 2009, the Constitutional Court declared the maximum limit of the number of embryos to be produced and transferred for each cycle (i.e. three), as stated in the original version of the law, to be constitutionally illegitimate. In 2014, the same Court declared as unconstitutional the ban on donor insemination, thus opening the way to heterologous assisted reproduction. Heterologous MAR is therefore perfectly legitimate in Italy. Finally, in 2015 a further ruling by the Constitutional Court granted the right to access MAR to couples who are fertile but carriers of genetic diseases. However, there is still much room for criticism. Many couples and groups are still, in fact, excluded from MAR. Same-sex couples, single women and those of advanced reproductive age are, at the present time, discriminated against in that Italian law denies these subjects access to MAR. Summary The history of Law 40/2004 has been a particularly troubled one. Numerous rulings have, over the years, dismantled much of a law constructed in violation of the rights and autonomy of women and couples. However, a number of troubling issues still exist from what is left of the law and the debate is still open at national and transnational level regarding some of the contradictions and gaps in the law highlighted in this article. Only by abolishing the final prohibitions and adopting more liberal views on these controversial yet crucial issues will Law 40/2004 become what it should have been from the start, i.e. a law which outlines the ‘rules of use’ of MAR and not, as it has been until now, a law of bans which sets limits to the freedom to reproduce.

In the near future developments in non-invasive prenatal testing (NIPT) may soon provide couples with the opportunity to test for and diagnose a much broader range of heritable and congenital conditions than has previously been possible. Inevitably, this has prompted much ethical debate on the possible implications of NIPT for providing couples with opportunities for reproductive choice by way of routine prenatal screening. In view of the possibility to test for a significantly broader range of genetic conditions with NIPT, the European Society of Human Genetics (ESHG) and American Society of Human Genetics (ASHG) recommend that, pending further debate, prenatal screening for reproductive choice should only be offered where concerning serious congenital conditions and childhood disorders. In support of this recommendation, the ESHG and ASHG discuss a number of ethical issues on which they prompt further debate: the informational privacy of the future child, the trivialization of abortion, the risk of information overload, and issues of distributive justice. This paper responds to this call with further reflection on each ethical issue and how it relates to the moral justification of providing couples with opportunities for meaningful reproductive choice. The paper concludes that whilst there may be good reasons for qualifying the scope of any unsolicited prenatal screening offer to serious congenital conditions and childhood disorders, if prenatal screening is justified for providing couples with opportunities for meaningful reproductive choice, then health services may have obligations to empower couples with the same opportunity where concerning other conditions.

The stagnation in the unmet need for family planning and rise in contraceptive discontinuation rates are major concerns among researchers and policymakers in India. This study attempts to investigate the association between method information received by the users at the time of initiation and the switching of contraceptive methods in India. Using the fourth round of National Family Health Survey (NFHS) data (2015–2016), a multinomial logistic regression model has been applied to assess the net effects of method information received by the users on switching of contraceptive methods. The reuse of contraceptive methods is higher among those who were not provided any method information. The reuse is also higher among those who were informed only about the side effects. Overall, the users who received comprehensive method information are more likely to switch. Particularly, the users who were informed about how to manage side effects either alone or along with other method information have a higher likelihood of switching especially to long-acting reversible contraceptives (LARC). The findings call for program intervention to provide comprehensive method information to the users because it gives them the freedom to switch to more suitable methods. Thus, it would help in achieving the sustainable development goal (3.7) of informed choice of contraceptive methods.

Background There is global recognition of the reproductive health rights of people living with HIV (PLHIV). The aim of this research study was to explore the reproductive choices, and the factors influencing these choices, of HIV positive patients attending primary health care (PHC) facilities in the Ekurhuleni health district of the Gauteng Province of South Africa. Methods During 2013, a cross-sectional survey was conducted in the Ekurhuleni health district. At each of three randomly selected community health centres, a random sample of HIV positive patients was selected. After informed consent was obtained, trained fieldworkers administered a structured questionnaire that elicited information on socio-demographics, reproductive choices and knowledge of reproductive options. Survey data were analysed using STATA® 13. Results The majority of survey participants ( n  = 430) were female (70%) and unemployed (57%). The mean age of participants was 36.4 years (SD 8.6): 40.8 years (SD 8.7) for men and 34.5 years (SD7.8) for women. Among survey participants, 46% expressed a desire for children (95% CI: 41.4–50.9). In the multiple logistic regression analysis, predictors of desire for children were age less than 49 years, marriage or living together, and no biological children. The odds of wanting children was 16.48 [95% CI: 5.94–45.74] times higher for PLHIV without children, compared with those with two or more children, while for those less than 25 years, the odds of wanting children was 0.78 [95% CI: 0.23–2.59] compared with those older than 50 years. The PLHIV knowledge on the available reproductive options was limited, with the majority relying on the guidance of the health workers. Conclusion Health care providers at PHC level should be educated to address the reproductive health needs of PLHIV. These aspects should be reflected in provincial and national health policies.