Thanks to health care reform, beginning last month women with health insurance no longer have to pay for contraception. While I fully support this legislation, I think it has unintended negative consequences for both women and men. Specifically, I am concerned that this legislation, as well as the debate surrounding it, once again conflates reproduction with women, thereby ignoring men’s reproductive responsibility and autonomy.

This legislation is based on and buttresses our current heterosexual contraceptive arrangement in which women are largely held responsible for contraception, especially in monogamous relationships where couples are more likely to depend upon long-acting, reversible contraceptives (LARCs) or sterilization rather than barrier methods. Women today actively participate in all contraceptive methods except vasectomy, which only accounts for 9% of contraception use in the U.S. Part of the reason for this is due the disparity between the number and types of female and male contraceptives: there are eleven contraceptive options for women, including various types of LARCs, and only two for men—male condoms and vasectomy—neither of which are LARCs. Monogamous couples not ready for sterilization generally don’t delegate contraceptive responsibility to men because male condoms are not well-suited to their needs: they are not nearly as effective as female LARCs (16% versus under 3% failure rate for typical use) and they can interrupt and minimize pleasure during sex.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

A recent New York Times article shares the story of Debra Demidon, who developed severe ovarian hyperstimulation syndrome (OHSS) after undergoing IVF. This potentially life-threatening condition caused her to gain more than 30 pounds of fluid and have trouble breathing, and ultimately landed her in the hospital for 5 days. OHSS is much more common in the US and UK than in Europe and Japan because the former countries rely on high-dose hormones for IVF where the latter countries use lose-dose hormones. Although rare, OHSS following high-dose hormone IVF is now one of the leading causes of maternal mortality in parts of the UK. OHSS is not the only adverse side effect of high-dose IVF for women; there are myriad other possible side effects including increased cancer risk, memory loss, and liver disorders.  Furthermore, there can also be increased risk for children born from high-dose IVF, such as low birth rate. 

Knowing these serious potential health-related outcomes, why is high-dose IVF the dominant and default method used in the US? The main reason is that high-dose IVF produces many more eggs (often 20-30 eggs and sometimes even more) than low-dose IVF produce (8-10 eggs). Given that most insurance companies do not cover infertility treatments (only 15 states have laws mandating insurance companies to cover infertility treatments and there are many exemptions and caveats), many people pay out of pocket for IVF. In order to save money – IVF costs $15,000 - $30,000 a cycle – people are often willing to increase their risks to themselves (choosing high-dose IVF or low-dose IVF) if it means they’re likely to generate more eggs. Individuals in time pressure situations who may only have one shot at gathering eggs, such as cancer patients wanting to preserve their fertility before undergoing treatments that will hopefully save their lives but may render them infertile, may also opt for high-dose IVF.  

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

The Huffington Post recently published a blog by bioethicist and philosopher Rory E. Kraft, Jr. titled “Pregnancy as Harm?” As a friend and former colleague of Dr. Kraft, he and I have had numerous conversations about pregnancy as harm and we have presented on a conference panel together on this very topic. However, it seems—based in part on my students’ reactions and discussions I’ve had with people who don’t work in the field of reproduction—that most people find the idea of pregnancy as harm as counterintuitive or oxymoronic. 

Pregnancy is generally understood as a beautiful, special, and maybe even magical time in a woman’s life. And while it no doubt is for many women, it can simultaneously be harmful. For example, pregnancy can entail various nontrivial, though not life-threatening, discomforts, such as weight gain, back pain, edema, and morning sickness. Furthermore, pregnancy can lead to life threatening conditions, such as gestational diabetes and hypertension, and in many parts of the developing world pregnancy related complications are the leading cause of death for women in their prime. In addition to being painful, giving birth can also cause harms, like hemorrhaging, internal tearing, placental abruption, and nerve damage to the pelvic structures. In addition to physical harms, pregnancy and childbirth also have the potential to lead to mental health problems. Since being pregnant changes women’s hormone levels, it can affect women’s emotional well-being and their overall psychological balance. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

Around 10% of all people diagnosed with cancer are in their reproductive or pre-reproductive years (under age 45). This means that, each year, approximately 133,000 women, men, and children who are diagnosed with cancer are at risk for infertility due to the very treatments (e.g. chemotherapy, radiation, and surgery) that can save their lives. Given improved survivorship rates, fertility concerns have emerged as an important quality of life issue to cancer survivors and their families. Oncofertility, a new and interdisciplinary field at the intersection of cancer and fertility, is working to address potential infertility as a result of cancer treatment. 

Although more cancer patients are being offered and are using fertility preservation technology (FTP), its cost and the lack of insurance coverage for it are often the major reasons given by oncologists for why they do not provide information on fertility preservation options to their patients. One method of ensuring people in their reproductive years or children who are diagnosed with cancer have access to and insurance coverage for FPT is to create a legal mandate requiring insurance companies to cover FTP for cancer patients. 

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

On Monday, March 26th, 2012, the Supreme Court will begin hearing arguments on National Federation of Independent Business v. Sebelius and two linked cases, the lawsuits against the Patient Protection and Affordable Care Act (ACA; signed into law by President Obama on 3/23/2010). The court announced on February 21st that it would hear 6 hours of arguments over 3 days, an historic and unprecedented amount of time. The last time the Supreme Court heard more than 2 hours of arguments was when it considered the McCain-Feingold campaign finance law in 2003.

At issue in the cases before the Supreme Court is the constitutionality of federal involvement, interference, or interposition (depending on who's doing the interpreting) regarding activities of private citizens and activities of the states. The question of constitutionality of the ACA relates specifically to the Commerce Clause (U.S. Constitution Article 1, Section 8, Clause 3). The Commerce Clause states "Congress shall have power to regulate commerce with foreign nations, and among the several states, and with the Indian tribes". As with all clauses of the Constitution, the Commerce Clause must be interpreted and applied. The Supreme Court is the final arbiter and interpreter of all such applications, declaring the constitutionality (or lack thereof) of congressional and state legislation.

The challenges to the ACA state that the federal government has exceeded its constitutionally enumerated powers. The Tenth Amendment states "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." The challenges suggest that the ACA attempts to wield a federal power that does not exist under the Constitution and attempts to interfere with powers appropriately "reserved" to the states and to "the people". The challenges assert that it is the right of a citizen, rather than a prerogative of the federal government, to determine whether she will purchase health insurance. The challenges also assert that the federal government cannot dictate how a state conducts its Medicaid program.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

Contraception, women's rights, and religious freedom have dominated the headlines in recent weeks. New guidelines require new health insurance plans to fully cover women's preventive health services, including the provision of birth control pills without co-payments. The administration estimates that by 2013, 34 million American women aged 18 to 64 will receive the benefits specified in the new ruling. Naturally (also, sadly), considering that this is the United States, a firestorm of ill-will began gathering in response. Lately the anti-contraception forces have been in full cry.

The rights of women to a full range of preventive health services are the main concern of the new guidelines. Women's health requirements are not the same as those of men. Also, if we take a breath and step back from this latest manifestation of America's highly destructive "culture war", we might notice that this entire argument could be avoided by instituting a single-payer health care system.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

Women's reproductive rights are not an issue that concerns only women. A well-documented causal chain connects a woman's access to contraception and abortion services, the fertility rate, women's educational levels in a developing nation, and that nation's gross domestic product.

What do these matters have to do with women's reproductive rights? The key point is choice. No availability of reliable birth control methods directly equates to no choice. And as has been forcefully demonstrated recently, the availability of choice is deemed critical to the health and well-being of men and women in all socioeconomic groups. Witness the Susan G. Komen Foundation debacle.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.