This thesis focuses on the use of a child welfare principle in human assisted reproduction in the UK, as contained in section 13 (5) of the Human Fertilisation and Embryology Act 1990 (as amended). Given the principle is applied prior to conception, I argue that it should be distinguished from the familiarly known child welfare principle in child law and thus my focus is on the pre-conception welfare principle (PCWP). The aim of this thesis is to provide an argument for abolition of the PCWP from UK regulation. This thesis aims to add to the debate and complement the existing body of legal and philosophical literature which has critically analysed the function of the PCWP from various perspectives. It does so by highlighting the importance of terminology throughout the work and focusing on the broader implications of the PCWP in practice. I argue that the implications of the PCWP go far beyond its position in the legislation and in order to substantiate that central argument, I separate the function of the PCWP assessment into distinct categories of harm based regulation. Before doing so, however, I critically analyse the development of the PCWP; I consider its function as a regulatory method and I challenge whether it has a defendable ethical position in the current framework. Overall, I argue against the PCWP and the harm threshold rationale underpinning it in practice. In Part I, I first set out the background to this type of research and explain why this work is important for challenging unjustified state intervention on reproductive choice. Second, I set the scene by outlining the development of the welfare principle in child law; the legislative chronology of the PCWP and the function of Principles Based Regulation (PBR) in the current regulatory framework. This entails setting out a number of assumptions, arguments and debates surrounding the concepts of welfare and harm and how these have been framed in regulation; in addition to setting out a central theme of this thesis, which is an argument that the regulation of the PCWP does not meet requisite standards of consistent, transparent, objective, proportionate and contextually-sensitive regulation. These assumptions and vii arguments are vital for understanding the basis on which this work challenges the suitability of the PCWP in the current regulatory framework. Part II of the thesis contains the papers and delivers the arguments against the PCWP in sequence. The overall aim of Part II is to present the central argument of the thesis and answer the research questions set out in the introduction. To accomplish this, the thesis first explores how the borders of child welfare have been defined by child law and judge-made law in wrongful life cases or cases involving the withdrawal or withholding of treatment from sick children. This is followed by a chronological and comparative legislative assessment of the development of the regulation of child welfare in the context of the PCWP. This develops into the main argument of the thesis which demonstrates the application of PCWP in practice departs from benchmark standards of better regulation. The thesis moves on to provoke a fresh debate on the relationship between pre-conception child welfare and the familial and genetic harm thresholds which are mandated by the PCWP assessment. The concept of harm is explored in a philosophical sense and the arguments culminate in a contention that no single philosophy underpins the PCWP, and that there is therefore no good reason to retain a principle which is problematic in both a functional and substantive sense. The thesis concludes with an overview of the progression of the main themes in this thesis, as well as identifying some promising opportunities for future research which have arisen as a result of this work.

Magister Legum - LLM / Surrogacy on many occasions is referred to a million-dollar industry. Just like many countries, South Africa has prohibited commercial surrogacy, thus South Africa only permits altruistic surrogacy. The prohibition has consequences for third parties such as surrogacy agencies and surrogacy facilitators, as their right to occupation freedom which is guaranteed by the Constitution of the Republic of South Africa, is limited. No right is absolute, any right can be limited if it can be proved that it is in the best interest of the public. The prohibition on commercial surrogacy is argued to be in the best interest of the public as it can lead to the exploitation of women and the commodification of children.

Globally, in low and middle-income countries 4 out of every 10 pregnancies is reported to be unintended. Having an unintended pregnancy increases the risk of maternal and infant morbidity and mortality, preterm birth, low birth weight, and decreases rates of breast-feeding. The United States (U.S.) consistently has some of the highest rates of preterm birth, infant and maternal mortality of all high-income countries and 45% of all pregnancies in the U.S. are reported to be unintended. The etiology of these outcomes and their relationship to pregnancy intention are complex and multifactorial, but we know this disproportionately effects women living in poverty both in the U.S. and globally. When couples have the knowledge, access, and power to decide when and whether to become pregnant they are more likely to seek preconception care, thus increasing the likelihood of planned pregnancies leading to improved maternal and child health outcomes. Primary prevention strategies to improve maternal/child health outcomes in the U.S. include sexual and reproductive health considerations such as increasing access to birth control. Globally, strategies include expanding access, as well as focusing on the empowerment of women and improving gender social norms. Focusing on community level norms and individual empowerment can lead to greater reproductive autonomy, which in turn leads to an increase in the uptake of birth control and family planning. This broader consideration of multiple levels of power or autonomy is often lacking in approaches taken in the U.S. More information is needed about the social context and determinants of pregnancy intention in our communities, particularly of women living in poverty. The purposes of this dissertation were to 1) to describe reproductive autonomy and family planning challenges in a population of marginalized Ecuadorian women; 2) develop a conceptual framework of reproductive autonomy from the global literature; 3) to validate a shortened form of an interpersonal violence scale used in a study of low-income pregnant women in Kentucky; and finally 4) to investigate the association between pregnancy intention and individual, interpersonal and community factors of impoverished women living in Kentucky. The qualitative study of women in Ecuador identified barriers and facilitators to family planning in a low-resource community. The major themes that emerged were that women’s autonomy was limited by men, shame was ‘keeping women quiet’, systems failed women, and as women aged they were able to build resilience in spite of these challenges. Many reported reproductive coercion, gender-based violence, and regret. Those who could leave unsupportive partners and found social support were more effective at planning their pregnancies. Evidence supports these themes are relatively common in the global literature, particularly of women living in poverty. The comprehensive review of these findings was used to develop a conceptual framework of reproductive autonomy. The Socio-Ecological Model was used to organize the data based on individual, interpersonal or community level determinants of pregnancy intention and reproductive autonomy. This new conceptual model, called the Power and Reproductive Autonomy (PARA) model, was used as a guide to analyze multiple levels of data in a secondary analysis of pregnant women living in poverty in Kentucky. Prior to this secondary analysis study, a measure used in the parent study needed to be validated. A short form of the Women’s Experience with Battering (WEB) scale was found to be psychometrically valid to measure of the impact of intimate partner violence for this population. Findings from the secondary analysis included high rates of unintended pregnancy (66%), and women with unintended pregnancy were more likely to report exposure to interpersonal violence, poor social support, and anxiety at the bivariate level. At the community (county) level those with an unintended pregnancy were more likely to live in counties with fewer social associations, and in rural communities. None of the access, gender equity, income inequality, or violence variables were correlated to pregnancy intention. In the final multilevel model, controlling for demographic variables, only being unmarried and answering the question in English were significant predictors of unintended pregnancy. The rate of social associations in a county was marginally significant with pregnancy intention, in that the presence of social associations appeared to decrease the likelihood of unintended pregnancy. Operationalizing the PARA framework to examine predictors of unintended pregnancy in Kentucky proved to not yield expected results; county level variables related to access, gender equity, and violence were not found to be significantly correlated. Women answering the question in Spanish had significantly higher rates of planned pregnancy, which is a new finding. Having opportunities for social engagement also seemed to be a protective factor in preventing unintended pregnancies. Limitations of cross-sectional data also make it a challenge to capture cumulative life stressors which could contribute to poor reproductive autonomy. Future studies may yield a greater understanding of the social context of pregnancy intention if more interpersonal data related specifically to reproductive autonomy are in the model, such as reproductive coercion, relationship power, communication, and contraceptive decision making. Additionally, further examination of structures or systems that provide economic opportunities in the community is a promising area of reproductive autonomy and pregnancy intention research.

Le terme d’infanticide recouvre des homicides divers, souvent appréhendés de manière indifférenciée. Parmi eux, le néonaticide désigne le meurtre d’un nouveau-né dans les vingt-quatre heures qui suivent sa naissance. Dans les pays connaissant une forte diffusion de la contraception et de l’accès à l’avortement, cette conduite – anciennement associée à un mode de régulation des naissances – est devenue marginale. Cette recherche propose une approche sociologique de la pratique du néonaticide fondée sur ses mises en récits par la justice et par les auteures elles-mêmes en France (2005-2015). L’enquête a permis de conduire des séries d’entretiens approfondis avec cinq femmes jugées pour ces faits et d’observer cinq procès en cour d’assises. Ces matériaux ont été complétés par des entretiens avec des avocat·e·s et magistrat·e·s, des dossiers judiciaires et un corpus d’articles de presse portant sur 75 affaires jugées sur la même période. Les récits judiciaires dévoilent la prégnance d’une approche essentialiste de la maternité et de la procréation qui pèse sur les efforts de mise en intelligibilité déployés par les professionnel·le·s. L’analyse des parcours de ces femmes, de leurs processus de socialisation, de leurs situations conjugales et familiales et de leurs ressources, permet d’identifier les obstacles rencontrés pour mettre en œuvre une contraception efficace ou accéder à l’IVG. En appréhendant le néonaticide comme l’ultime moyen d’éviter une naissance jugée catastrophique, cette étude s’éloigne de la lecture individualisante imposée par le traitement judiciaire et documente l’agentivité reproductive des femmes. / The term infanticide covers diverse realities too long understood in an undifferentiated way. Among them, neonaticide refers to the murder of a newborn within twenty-four hours of birth. In countries with a high access to contraception and abortion, this behavior – formerly associated with birth control – has become marginal. This research proposes a sociological approach to the practice of neonaticide based on its narratives by the courtrooms and by the authors themselves in France (2005-2015). The investigation led to a series of in-depth interviews with five women prosecuted for these acts and to observe five trials in criminal courts. These materials were supplemented by interviews with lawyers and magistrates, court files and a corpus of press articles covering 75 cases judged over the same period. Courtrooms narratives reveal the essentialist approach to motherhood and procreation, which weighs on the intelligibility efforts made by professionals. The analysis of women's life stories, their socialization processes, their intimate partner and family situations and their resources, makes it possible to identify the obstacles encountered in implementing effective contraception or accessing abortion. By apprehending neonaticide as the ultimate means to avoid a birth deemed catastrophic, this study moves away from the individualizing interpretation imposed by the judicial treatment and documents the reproductive agency of women.

Bakgrund: Planerat kejsarsnitt på moderns önskan där inga medicinska indikationer föreligger är omtalat i medier. Indikationer för kejsarsnitt på moderns önskan anger att skälen ska vara tillräckligt tungt vägande, faktorer av betydelse är förlossningsrädsla, ålder, tidigare kejsarsnitt eller övergrepp. Men vid närmare analys finns det ingen konkret information om hur dessa indikationer ska bedömas. Ett stort missnöje hos kvinnor framgår på sociala medier och i debattartiklar angående rätten om kejsarsnitt. Detta skapar polarisering inom förlossningsvården mellan kvinnor och vårdpersonal. För att stärka den reproduktiva hälsan är det viktigt att ytterligare belysa vårdens perspektiv i denna aktuella fråga. Syfte: Syftet med studien var att belysa hur barnmorskor, obstetriker och neonataloger resonerar och beslutar angående kvinnor som önskar kejsarsnitt utan medicinska indikationer. Metod: Kvalitativ intervjustudie genomfördes med tio intervjuer med vårdpersonal. En innehållsanalys tillämpades för att analysera resultatet. Resultat: Två övergripande teman framtogs, processen och aspekter kopplat till kvinnan. Resultatet gav en djupare bild av hur bedömningar görs utifrån kartläggande samtal med kvinnan. Även vad de kort-och långsiktiga perspektiven är som vårdpersonalen måste tänka på vid beslutet. Rätten till kejsarsnitt som kvinnor uttalar höll inte vårdpersonalen med om, de refererade till lagen som säger att man inte kan kräva en operation utan medicinsk indikation. Slutsats: Tillräckligt tungt vägande skäl för kejsarsnitt på moderns önskan går inte att göra utifrån en checklista. Det görs som individuella sammanvägda beslut utifrån kvinnans situation och framtid. Beslutet är multifaktoriellt. / Background: The wish for a planned cesarean section on maternal request where no medical indication exist is well mentioned in the media. The indications for a cesarean section on maternal request are based on if they are sufficiently important reasons, which can be fear of vaginal birth, age, a former cesarean, or experiences of sexual trauma. In a closer analysis of the indications there was no concrete information on how the decision was going to be made by health professionals. There is a big discontentment from women which can be seen on websites and social media where they talk about the right to a cesarean section. This creates a polarization between the women and the health workers at the maternity wards. To strengthen women’s health and reproduction this is an important aspect to bring forward. Aim: The aim of this study was to illustrate how mid wifes, obstetricians and neonatologist perceives and reasons about women who wishes to have a cesarean section without medical indications.  Method: Qualitative interview study was done with ten interviews with health workers. A manifest analysis has been applied to get a result from the interviews.   Results: Two overall themes were produces, the process and aspects connected to the woman. The result gave a deeper understanding of how the decisions are being made from mapping dialogue between the health workers and the woman. The results also showed what short- and long-term consequences of a cesarean that health workers have to keep in mind when deciding. The right to a cesarean section that women speak loudly about did not resonate with the health workers, they referred to what the law says about not being able to demand an operation without any medical indication.  Conclusion: Sufficiently important reason for a cesarean section on maternal request is not possible to decide on the grounds of a checklist. The decisions are being made on individual bases based on the woman’s situation and future. The decision is multifactorial.

Ce mémoire examine la pratique du dépistage prénatal et du diagnostic prénatal (désormais les tests prénataux ) en deux temps. D’abord, et après une brève mise en contexte, je présente une analyse des facteurs qui ont influencé la mise en place du Programme québécois de dépistage prénatal de la trisomie 21 (PQDPT21). En me basant sur la littérature gouvernementale, je démontre comment un ensemble de pressions politiques, éthiques et sociales a mené à l’impératif d’PQDPT21. Ensuite, je présente une revue de la recherche qualitative à propos de l’expérience de poursuivre une grossesse affectée par l’aneuploïdie fœtale, y compris la trisomie 21. Les principaux résultats de cette revue suggèrent que la ‘rhétorique’ du choix n’est pas toujours démontrée lorsque les parents amènent à terme un fœtus diagnostiqué avec aneuploïdie. Ensuite, je discuterai de l’ensemble de ces travaux selon le concept foucaldien de biopolitique, où les normes et la normalisation agissent sur la régulation politique et sociale. En conclusion, des recommandations pour la recherche et la pratique sont proposées, principalement la nécessité de documenter l’expérience vécue des personnes qui participent aux tests prénataux et d’intégrer ces constatations dans les décisions politiques et dans l’éducation des professionnels de la santé. / This thesis examines the practice of prenatal screening and prenatal diagnosis (henceforth “prenatal testing”) from two angles. Firstly, following a brief introduction to provide context, I present a framework analysis of the factors that influenced the implementation of the Trisomy 21 Prenatal Screening Program of Québec (T21PSPQ). Using governmental literature, I demonstrate how a combination of political, ethical and social pressures led to the imperative of the T21PSPQ. I then present a scoping review of primary empirical qualitative research regarding the experiences of continuing a pregnancy affected by fetal aneuploidy, including trisomy 21. The main findings of this review suggest the ‘rhetoric’ of choice is not always demonstrated in cases where prospective parents bring to term a fetus diagnosed with aneuploidy. The results of this work are then discussed through the Foucauldian concept of biopolitics, where norms and normalization are the principal forms of social and political regulation. Finally, recommendations for research and practice are offered, mainly the need to document the lived experience of those participating in prenatal testing and to incorporate those findings into policy making and into education for health care professionals.