This book examines the regulation and practice of medical decision-making where the context is that of a multiple pregnancy and where the question is whether or not to carry out a fetal reduction procedure. It concerns three main lines of inquiry: first, the nature of fetal reduction and the legal ground(s) for termination typically relied upon; secondly, the extent to which legal, ethical, and professional norms guide or constrain this particular kind of decision-making; and, thirdly, the adequacy of these norms. The book uses empirical sources to develop its analysis, contributing new insight and the kind of evidence necessary to shape regulation, clinical practice, and future research. The key findings show that fetal abnormality is often given as the justifying ground; that the legal, ethical, and professional norms offer little explicit guidance for fetal reduction: and on the general question of termination, ethical norms suffer from a high level of contestation, the key norms in the UK abortion legislation are unclear and disconnected from practice, and professional norms are only marginally more adequate. Given the indeterminacy of these norms, it is no surprise that the evidence indicates that doctors are only weakly guided by them in making their decisions. Various recommendations are advanced in this book, including the need for a situational emphasis on shared decision-making and patient-centred care.

The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.

These essays explore the nature and limits of individual autonomy in law, policy and the work of regulatory agencies. Authors ask searching questions about the nature and scope of the regulation of 'private' lives, from intimacies, personal relationships and domestic lives to reproduction. They question the extent to which the law does, or should, protect individual autonomy. Recent rapid advances in the development of new technologies - particularly those concerned with human genetics and assisted reproduction - have generated new questions (practical, social, legal and ethical) about how far the state should intervene in individual decision making. Is there an inevitable tension between individual liberty and the common good? How might a workable balance between the public and the private be struck? How, indeed, should we think about 'autonomy'? The essays explore the arguments used to create and maintain the boundaries of autonomy - for example, the protection of the vulnerable, public goods of various kinds, and the maintenance of tradition and respect for cultural practices. Contributors address how those boundaries should be drawn and interventions justified. How are contemporary ethical debates about autonomy constructed, and what principles do they embody? What happens when those principles become manifest in law?

One of the most private decisions a woman can make, abortion is also one of the most contentious topics in American civic life. Protested at rallies and politicized in party platforms, terminating pregnancy is often characterized as a selfish decision by women who put their own interests above those of the fetus. This background of stigma and hostility has stifled women’s willingness to talk about abortion, which in turn distorts public and political discussion. To pry open the silence surrounding this public issue, Sanger distinguishes between abortion privacy, a form of nondisclosure based on a woman’s desire to control personal information, and abortion secrecy, a woman’s defense against the many harms of disclosure. Laws regulating abortion patients and providers treat abortion not as an acceptable medical decision—let alone a right—but as something disreputable, immoral, and chosen by mistake. Exploiting the emotional power of fetal imagery, laws require women to undergo ultrasound, a practice welcomed in wanted pregnancies but commandeered for use against women with unwanted pregnancies. Sanger takes these prejudicial views of women’s abortion decisions into the twenty-first century by uncovering new connections between abortion law and American culture and politics. New medical technologies, women’s increasing willingness to talk online and off, and the prospect of tighter judicial reins on state legislatures are shaking up the practice of abortion. As talk becomes more transparent and acceptable, women’s decisions about whether or not to become mothers will be treated more like those of other adults making significant personal choices.

Human beings have been producing more twins, triplets, and quadruplets than ever before, due to the expansion of medically assisted conception. This book analyzes the anticipatory regimes of making multiple babies. With archival documents, participant observation, in-depth interviews, and registry data, this book traces the global and local governance of the assisted reproductive technologies (ARTs) used to tackle multiple pregnancy since the 1970s, highlighting the early promotion of single embryo transfer in Belgium and Japan and the making of the world’s most lenient guidelines in Taiwan.

The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions. Preterm birth is a cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, sociodemographic and neighborhood characteristics, environmental exposure, medical conditions, infertility treatments, and biological factors. Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. While advances in perinatal and neonatal care have improved survival for preterm infants, those infants who do survive have a greater risk than infants born at term for developmental disabilities, health problems, and poor growth. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems. Preterm Birth assesses the problem with respect to both its causes and outcomes. This book addresses the need for research involving clinical, basic, behavioral, and social science disciplines. By defining and addressing the health and economic consequences of premature birth, this book will be of particular interest to health care professionals, public health officials, policy makers, professional associations and clinical, basic, behavioral, and social science researchers.

This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.