For this project I describe the socio-historical development of a particular application of genetic prenatal diagnosis, in terms of changing social relations that govern an ethics of reproductive choice. I examine ways that medicine and government articulate prenatal diagnosis to problematise the maternal body and govern women's reproductive choices about chromosomal abnormality in the fetus. Since its introduction in the early 1970s, the major use of prenatal diagnosis has been to detect chromosomal abnormalities-in particular, Down syndrome-in the fetus. Medico-scientific knowledge claims negotiated in everyday practices in the genetic counselling clinic between health professionals and their clients are situated within broader social relations. Negotiations between medicine and government have produced technoscientific possibilities, realised with greater or lesser success in the co-construction of a workable prenatal diagnosis standardised package. I describe how these socio-technical relations have produced similarities and differences across time, and national and professional boundaries. My analysis draws on observations in three genetic counselling clinics, and of the health professionals' other work activities. I also draw on interviews with them and other actors in that arena, as well as claims made about prenatal diagnosis technologies in the medico-scientific literature. I analyse my data using concepts developed in social worlds/arenas theory within a Foucauldian framework of social relations that govern the body. Since the early formation of a standardised package of genetic counselling about amniocentesis, ethical decisions about prenatal diagnosis have identified multiple parts of the self to be governed. This ethics has relied on a duty to make genetically responsible decisions as a particular way to relate to oneself, although it has been expressed in different ways. Newer technologies have articulated greater ethical possibilities for governing the self by co-constructing new ways of assembling the constituent components. Throughout, there have been tensions between two major aims for governing the self: that of giving birth to a healthy baby, and that of managing maternal rationality in order to act as an autonomous rational individual. I have thus described how a woman's use of prenatal diagnosis is not simply one of individual choice. Her decision is a complex ethical one that is historically and socially contingent on relations between medicine and government that present the maternal body in certain ways for her to act upon herself.

I use a brand of social contract theory derived from David Gauthier to delimit precisely what might be permissible in the methods of conception and gestation of a child. More specifically, Gauthier posits a rule that is supposed to govern behavior among individuals prior to but in anticipation of the rise of social interaction. I argue that this rule can be appropriately applied to the interactions between a parent and her unborn child. I review other social contract models in an effort to show that Gauthier's is preferable to these. I also address other accounts concerned with parental obligations to the unborn, to see how these fare against Gauthier's. I conclude that, because of its breadth of applicability, as well as its plausibility, Gauthier's model is a powerful force for guiding us through these issues.

No description available.

M.A. (Philosophy) / Consider a couple planning to have children. There are many reasons one could offer these potential parents for reconsidering bringing new people into existence. One could for instance say to them that they currently lack the finances, or maturity, to adequately take care of any children they produce. If it were almost certain that this couple would pass on a terrible genetic disease to their offspring, one could see it as one’s duty to warn them against reproduction. One could even draw attention to the plight of orphans, and suggest to these (and other) potential parents that a more pressing responsibility lies not in planning to give homes to persons not yet in existence, but in attempting to give homes to those already in existence. However, when deciding whether or not to create children, rarely does one consider, over and above the preceding considerations, whether there might be some fundamental wrongness to the very act of procreation. In other words, rarely does one consider the possibility that creating people might, all things considered, never be permissible. At its extreme, “anti-natalism” implies the view that coming into existence is always a harm that outweighs any of its benefits. This position is defended by David Benatar (Benatar 1997, 2006). However, one need not believe that coming into existence is always an overall harm in order to favour an anti-natal perspective; one need only believe that it is morally problematic to inflict serious, preventable harms upon others without their consent. Such a consent-based anti-natal position can be derived from the argument put forth by Seana Shiffrin (1999). To be clear, according to either of these versions of anti-natalism, creating a new person is considered an impermissible harm. When I refer to “anti-natalism” in this dissertation, I will be referring to this negative judgement regarding procreation. Anti-natalism has a rich philosophical heritage, with its roots stretching back to antiquity. For instance, Ecclesiastes (1:1-18) of the Hebrew Bible bemoans the apparent meaninglessness and futility of existence—a state of affairs with which any number of generations of humans must cope. Not until very recently, however, has the anti-natal position been given due consideration by philosophers. Arthur Schopenhauer (1851), for instance, is perhaps best known for advocating a pessimistic philosophy that is, broadly speaking, anti-natal in its implications. The key figure in this field, however, is Benatar, who defends an unequivocally anti-natal position.

The advent of ARTs has enabled many individuals to have children and build families. Although ARTs have from the start been designated to serve as alternative way for heterosexual infertile individuals and couples to have genetically related children, ARTs are nowadays widely used by gays and lesbians to have even genetically unrelated children and build their families. This study addresses the well-being of children born as a result of ARTs and growing up in homosexual families in South Africa. South Africa has legalised homosexual unions, granting gays and lesbians several rights, including the right to marry, use ARTs to reproduce, and build families in which they raise their children. South Africa has also provided constitutional and statutory protection of children’s rights and has further required that the child’s best interests be considered as paramount in every matter concerning the child. Although ARTs may have allowed people to have children, they have proven to put the child’s interests at risk. ARTs are associated with several physical and psychological problems for resulting children. The legal protection provided for those children seems to be inadequate in respect of their best interests. Unlike Australian statutes that have provided strong protection for the child’s best interests, South African legislations regulating ARTs are far from protecting ART-born children’s interests. The application of the child’s best interests criterion to ART procedures has revealed that in the USA and Australia efforts of the state, ART providers and parents have been centred on the transfer of the custody of the ART-born child to the commissioning parent(s). Although in South Africa the application of the child’s best interests in the context of surrogacy procedures has revealed the protection of the child’s interests, it should be noted that that protection seems to focus on the child’s post-birth period. This situation leaves ART-born children without any protection, especially before their birth. In order to give effect to section 28 of the Constitution of the Republic of South Africa, 1996 and protect ART-born children’s interests, I make certain proposals for law reform in the final chapter of this thesis. / Private Law / LL. D

Text in English / INTRODUCTION: Late in HIV epidemic while HIV program is maturing studies in rich and resource limited setting have shown controversial results with regard to whether childbearing desire and intention are changed after the expansion of ART and PMTCT services. There are few studies in Ethiopia which tried to find out fertility preferences after the decentralized ART and PMTCT services. PURPOSE: The objective of the study is to determine the prevalence of fertility desire, intention and associated factors among HIV positive males and females at health facilities in Hawassa city with chronic HIV care. METHOD: The study used quantitative, observational, analytic and cross-sectional study design. It was structured on Trait-Desire-Intention-Behaviour theoretical frame work. A gender based stratification followed by random sampling method was applied. An interviewer-administered structured data collection approach using the pre-tested questionnaire was applied in the study. The Microsoft Office Excel 2007 and Epi-Info version 3.5.3 were utilized for data analysis. In addition to descriptive statistics, both bivariate and multivariable logistic regressions were used to analyse the data. RESULT: With a respondent rate of 93%, a total of 460 PLHIV participated in the study with equal number of males and females. The majority of the participants were from urban (85%), in relationship (70.9%), and on ART (80%). The reported fertility desire, 43.9% (45.2% in males; 42.6% in females), and fertility intention, 44.9% (46.4% in males; 43.4% in females), were high. The median number of intended children was 2. About 54% of PLHIV were using at least one of the contraceptives with 32.4% of unmet need of family planning. Participants with overall experinece of 2 births or less (AOR: 2.4 95% CI 1.32-4.32; p-value=0.0042), without birth experience after HIV diagnosis (AOR:0.52 95% CI 0.28-0.98; p-value=0.0424) and whose partner also desired for childbearing (AOR: 19.73 95%CI 10.81-35.99; p-value=0.0000) were more likely to intend for a/another child.They wished and planned to get birth because; they did not have a/children before or fear of childless stigma (25.3%), ART could help to have negative child (21.8%), importance of parenthood (17.8%) and the desire of once partner (16.8%). The study participants had consulted health care workers (34.2%), approached their partner or their partner had already approached them (27.6%), tried to get a partner or married (17.6%) and stop using family planning (6%) to get pregnant. CONCLUSION: This study highlights high fertility desire and intention in the background of high unmet need for family planning among PLHIV. A development of comprehensive male partner-involved couple counseling protocol, improving the communication HCWs have with PLHIV to emphasize safer conception methods and strengthening all the components of PMCT integrating with other SRH services at chronic HIV clinic are critical. / Health Studies / M.A. (Public Health)

Social Work / M. A. (Social Science)

Social Work / M. A. (Social Science)