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IMED2208 > 4. Reproductive choices > Flashcards

4. Reproductive choices Flashcards

1
Q

What is a reproductive choice?

A
  • Any choice concerning the outcome of the reproductive process
  • Before reproduction
  • During reproduction
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2
Q

Unplanned pregnancy
meaning and prevalence

A

Unplanned
- Around 25-40% of women in Australia have had an unplanned or unwanted pregnancy
○ Half of this population continue the pregnancy
- Around 40-50% of women in Australia with an unplanned pregnancy continue it (Rowe et al 2016; Taft et al 2018)
- ‘Unplanned’ means different things to different people
Studies on unplanned pregnancies in Australia indicate contraceptive failure as primary cause

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3
Q

Problematic pregnancy
meaning

A

Problematic
- Pregnancy can be made problematic by physical causes: poor health, pre-eclampsia, cancer
- In developed countries, pregnancy usually made problematic by a much wider range of social and economic factors:
○ fear of poverty or financial hardship
○ workplace intolerance of pregnancy
○ parental and extended family rejection
○ personal fear, shame, doubts about being a competent parent
○ anxieties about educational disruption
○ lack of accessible child-care

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4
Q

Human embryogenesis Days 1-13

A
  • Day 1: sperm meets egg - fertilisation
  • Day 2 to6
  • Day 7: blastocysts implants in the endometrium. The endo lining is hostile and serves as a screening process for any weak blastocysts body will do everything it can to continue pregnancy
  • Day 8 - 22
  • Day 23: start to see the placenta develop. A temporary organ, keeps both mother and foetus alive. Forms the mother’s blood supply and the foetal blood supply. Screen everything that passes between them because of different blood types etc
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5
Q

Fetal growth day 23 to 8 weeks (carnegie)

A
  • Usually cannot tell pregnant until stage 23
  • see diagram in notes
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6
Q

From 8 to 40 Weeks

A

see diagram in notes

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7
Q

When is neonatal viability in WA

A
  • Gestational viability in WA is currently considered to be 23 -25 weeks gestation
  • 2021 systematic review of neonates at 22 weeks’ gestation = 29% survival rate
  • 22 -week survival rates have increased from 2000 onwards
  • Earlier 2013 systematic review and meta -analysis found survival rates of <24 weeks ranging from 40 to 46%
  • Very premature neonates have higher disability rates
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8
Q

‘radical autonomy’ on abortion

A

‘radical autonomy’:
- only a pregnant person should have the right to decide to terminate, not a doctor; abortion drugs or surgical abortion on demand should be readily available for this
- See the recent WA proposal to loosen all legal restrictions on abortion until birth

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9
Q

‘safe, legal and rare’: on abortion

A

‘safe, legal and rare’:
- abortion is not the best solution, but it’s the only one for some people, and should be managed carefully by law and the medical profession
- Possibly the majority opinion?

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10
Q

‘pro-life’: on abortion

A

‘pro-life’:
- abortion is a violent/male solution that sustains the patriarchy; instead, we need to reshape society to accept and support pregnancy and all pregnant people
- Increased participation of non-religious, sexually and gender diverse, disabled people in the pro-life movement

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11
Q

Abortion in australia
Surgical abortion

A

Surgical abortion
- vacuum aspiration, dilation and curettage, late-term surgery
- vacuum curettage
- up to 14 weeks
- Dilation and curettage (below)
Takes 4-5 hours in total at clinic (procedure is very short, but prep with sedation and recovery are longer)

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12
Q

Abortion in Australia
Medical abortion

A
  • combination mifepristone/misoprostol
  • Mifepristone:
    ○ blocks progesterone, which is needed to sustain a pregnancy
    ○ Changes the lining of the uterus -> causes the pregnancy to detach from the uterine wall
    ○ Softens and opens the cervix
  • Misoprostol:
    ○ causes contractions and the cervix to soften further
    ○ pregnancy tissue expelled from the uterus
  • Clinic or hospital follow-up needed for the incomplete procedure
  • high risk of septicemia
  • Available at private family planning clinics ($400-$1000)
  • Some experimental therapeutics to reverse abortion if woman changes mind after mifepristone but before taking misoprostol
  • some risk of heavy blood loss if process is stopped
  • Must be done pre 9 weeks gestation
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13
Q

criticisms of medical abortion

A

Criticisms of medical abortion
- Reports of side effects, pain levels, incompletions vary significantly in the literature
- Anecdotally, distressing to see fetus when expelled
- Data is still being collected on incompletions and side-effects
○ Reported incompletion rates between 10% and 40%
○ Literature suggests that incompletion rate is higher in later gestation
- Some maternal deaths were reported – especially with poor instruction on correct use
- Medical contraindications include peanut allergy (and others)
- March 2022: UK government voted to keep self-administered medical abortion without in-person doctor consultation permanently available (COVID19 emergency measure)
- strong criticism of the policy:
medical abortions may weaken protections for sexually exploited minors or other women who are manipulated or coerced into abortion

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14
Q

late-term abortion

A

Late-term abortion
- Rare (less than 1% of all terminations in Australia)
- Surgical/high intervention multi-stage and multi-day process:
○ injection to stop foetus’s heart (feticide)
○ evacuation via labour or surgical extraction
○ feticide is practised to reduce the risk of live birth
○ survival rates of live births post-abortion are very low
- Provided at public hospitals like KEMH - all post 20-week abortions performed at KEMH are managed as a perinatal loss through the Perinatal Loss Service
- One private facility in Australia: MSI branch just outside Melbourne
- 2005 to 2015: 8154 Medicare-rebated late term private procedures at +13 weeks

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15
Q

data on abortion in australia
who
how many
risk factors

A
  • Varying estimates of around 70,000 – 90,000 abortions a year in Australia (public and private health care)
  • Estimated 1 in 3 or 4 women will have a termination by age 45
  • Most commonly women aged 20-29 but also uptick in later age groups
  • Risk factors in the literature for adverse psychological effects are consistently identified as:
    ○ perceptions of stigma
    ○ need for secrecy
    ○ low or anticipated social support for the abortion decision
    ○ prior history of mental health problems
    ○ ambivalence about the decision
  • belief that an abortion conflicts with personal values
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16
Q

continuing a problem pregnancy

A
  • Fetal disability or serious maternal illness no longer automatically trigger the abortion pathway
  • Now possible to continue pregnancy even with some forms of cancer treatment
  • Broad network of government agencies and charities available to support new, inexperienced and struggling parents
  • Alternatives to parenting for birth parents who are in crisis include:
    ○ Adoption – open, intra-family
    ○ Fostering (temporary or long-term)
  • KEMH Perinatal Loss Service will support parents with death of a baby after birth, including anticipated death from disability (shown to have positive effects)
17
Q

Types of third-party reproduction
Sperm donation

A

Sperm donation
- earliest and most common form of third-party reproduction

18
Q

Types of third party reproduction
egg donation

A

Egg donation
- usually used for IVF treatment of parents with non-viable oocytes (age, post-cancer, genetic diseases)

19
Q

Types of third party reproduction
IVF

A

In vitro fertilisation
- used to create pregnancies by insertion of fertilised embryo

20
Q

Types of third party reproduction
Embryo donation

A
  • medical advances now allow embryo adoption
  • In Western Australia we currently have almost 30,000 embryos in storage (30 June 30 2021)
  • In WA it is permissible to:
    ○ store embryos for 10 years
    ○ at end of storage can apply for an extension, or allow embryos to succumb, or donate to infertile couple
    ○ can also donate to research - but no WA clinics have a license for this type of research
  • low actual donation rates (only 6-10% couples will donate):
    ○ concern about children brought up by strangers
    ○ likeness of relinquishing a child for adoption
    ○ unwitting sibling marriage
    concern over legal ramifications
21
Q

Types of third party reproduction
Surrogacy

A
  • Surrogacy: a woman (the birth mother) carries a child for another person or couple (the intended parent/s) with the intention that the child will be raised by the intended parents.
  • Traditional surrogacy: birth mother’s egg and intended father’s / donor’s sperm
    ○ Birth mother is genetic mother of child born
    ○ Intended father may (own sperm) or may not (donor sperm) be genetically related to child
    ○ Intended mother not genetically related to child
  • Gestational surrogacy: intended parents’ gametes and/or donor’s gametes
    ○ Birth mother is not genetic mother of child born
    Intended parents may (own gametes) or may not be genetically related to child (donor’s gametes)
22
Q

Laws around Surrogacy in AUS

A
  • Legislation governing surrogacy in all Australian States and the ACT
  • Altruistic surrogacy: no financial compensation or inducement beyond reimbursement of verifiable out-of-pocket expenses.
  • Commercial surrogacy: illegal in Australia; advertising for or making a commercial surrogacy arrangement carries a penalty (fine and/or imprisonment)
  • WA Surrogacy Act 2008 commenced on 1 March 2009
  • Eligibility limited to women who are unable to reproduce for medical reasons:
    ○ Menopause not included as medical reason
    ○ Cannot use surrogacy for social reasons, eg. work commitments
    Single men, male same-sex couples ineligible
23
Q

Developing countries and surrogacy

A
  • Surrogacy takes place in developing countries where it is delivered by local women for wealthy international individuals
  • Criticisms: Wombs for rent? Erasure of women of colour from reproductive process? Colonialism by another name?
  • Study of surrogates in India, 2020: paradoxes
    ○ Women become surrogates in response to gender constraints
    ○ but are also going against gender norms
    ○ Saw surrogacy as dirty work undertaken in order to survive
    ○ but also used for upward mobility for themselves and their children
    ○ Organising surrogacy was meant to stop exploitation
    but surrogates were dominated by the medical system and had no decision-making power
24
Q

reproductive corecion

A
  • Forced to become pregnant, continue a pregnancy, or terminate a pregnancy against the mother’s will
  • One estimate of 1 in 7? Mostly hidden population
    ○ 1 in 5 women from CALD and ATSI backgrounds (small sample)
    ○ Up to 60% in their 20s (small sample)
    ○ 74% report co-existing domestic violence and 24% sexual violence (small sample)
    ○ NZ study - Burry et al 2020 - https://anzswjournal.nz/anzsw/article/view/701
    • Physical and mental health outcomes can be catastrophic
25
Q

pregnancy from rape

A
  • Data and research literature is generally poor/non-existent
  • One older article (Holmes et al 1996) on rates and outcomes:
    ○ 5% pregnancy rate per rape per year in the US
    ○ 32% of these women continued their pregnancy
  • Different measures, eg. prevalence of rape among abortion clients; pregnancy following partner rape
  • Case in 2020: Canadian refugee adjudicator refused to believe refugee woman was raped because she chose not to terminate pregnancy
26
Q

child free by choice

A
  • Reasons to avoid pregnancy, birth and parenting among voluntarily child-free individuals remain largely unknown in the research literature
  • Anecdotally there’s lots of reasons
  • fear about the future is a major issue
  • 2022 Swedish study – qualitative study, 23 individuals:
    ○ Cannot imagine pregnancy, birth and assuming the role of a parent raising children.
    ○ Strongly value their healthy, unharmed body
    ○ Do not want to expose themselves to disease, injury and the fear reproduction could cause
    ○ Limited experience with children
    ○ Feeling that they would be unsuitable parents
    ○ Feeling that parenting children would be an inconvenience
  • High cost of living

IMED2208 (11 decks)

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