Introdução: O Brasil está passando por uma transição demográfica e epidemiológica, com melhorias na área da saúde. Apesar desse cenário, as taxas de baixo peso ao nascer (BPN) e a mortalidade infantil permanecem altas. O objetivo deste estudo é avaliar o impacto do uso extensivo de tecnologias, como o parto cesáreo e a concepção assistida, sobre resultados perinatais, durante os últimos 16 anos. Esse objetivo foi dividido em duas partes: (1) avaliação do impacto do aumento da taxa de parto cesáreo no BPN, de acordo com tipo de hospital (privado, público ou misto) e (2) avaliação do impacto das taxas de nascimentos múltiplos nas taxas de mortalidade infantil. Métodos: Estudo observacional de todos os nascidos vivos registrados entre 1996 e 2011, em Porto Alegre (RS). Características maternas, do parto, de assistência e do recém-nascido foram obtidas através do Sistema de Informações sobre Nascidos Vivos (SINASC). Informações sobre a mortalidade foram obtidas a partir do Sistema de Informações sobre Mortalidade (SIM), apenas no período de 1996-2010. No estudo do BPN, os nascimentos múltiplos foram excluídos. A análise de tendência foi realizada através de modelos de regressão joinpoint. A Regressão de Poisson foi utilizada para calcular o risco relativo para BPN ao longo do período, ajustado pelas covariáveis. O modelo de Equações de Estimação Generalizadas foi utilizado para avaliar o risco relativo para mortalidade infantil entre gemelares e nascimentos únicos ao longo do período, ajustado pelas covariáveis. Foi calculado o risco atribuível populacional, para avaliar o impacto dos gêmeos dizigóticos sobre taxas de mortalidade infantil (TMI) e seus componentes, taxa de mortalidade neonatal (TMN) e taxa de mortalidade pósneonatal (TMPN). Resultados: No estudo sobre baixo peso ao nascer, foram incluídos 319.597 nascidos vivos durante o período. Foi observado um aumento de 43% na cobertura do setor privado, de 14,9% em 1996 para 21,3% em 2011. As taxas de cesarianas aumentaram 52%, chegando a 86,9%, 51,0% e 37,5% em 2011, nos hospitais privados, mistos e públicos, respectivamente. As taxas de baixo peso ao nascer aumentaram significativamente nos hospitais privados e mistos, independentemente do tipo de parto. Nos hospitais públicos, diminuíram no grupo de recém-nascidos por parto cesáreo e se mantiveram estáveis para os nascidos por parto normal. Houve associação entre o aumento das taxas de cesarianas com o aumento nas taxas de baixo peso ao nascer, durante o período. Em relação aos gêmeos e à mortalidade infantil, foi observado um aumento significativo na taxa de nascimentos múltiplos, de 1,97% em 1996 para 2,45% em 2010, p<0,001, entre os quais 65% eram dizigóticos (DZ) em 2010. Houve uma redução na mortalidade infantil e seus componentes para o grupo de nascimentos únicos: a TMI caiu de 15,4‰ para 8,3‰; a TMN, de 8,3‰ para 5,04‰; e a TMPN, de 7,0‰ para 2,9‰. Entre gêmeos, essas taxas permaneceram constantes, em torno de 44‰, 33‰ e 11‰ respectivamente. Em 1996, 1,7% da TMI, 2,0% da TMN e 1,4% da TMPN podem ser atribuídos aos gêmeos DZ. Em 2010, a contribuição de gêmeos DZ subiu para 8,4% (TMI), 9,8% (TMN) e 5,7% (TMPN). Conclusão: A assistência à saúde intensa e não regulamentada fornecida pelo setor privado e as melhorias na saúde, no setor público, apresentam cenários contraditórios, sugerindo abordagens diferenciadas para esses grupos, a fim de diminuir a diferença entre as taxas de baixo peso ao nascer e a mortalidade infantil no Brasil. / Introduction: Brazil is undergoing demographic and epidemiological transitions with improvements of health care standards. Despite this scenario, low birth weight (LBW) and infant mortality (IM) rates remains elevate, mainly in more developed areas of the country. The aim of this study is to evaluate the impact of extensive use of technologies, such as cesarean section (CS) and artificial insemination rates on neonatal outcomes, during the last 16 years. At first, we will investigate the impact of the increase rate of CS in LBW, considering the changes in pattern of health insurance; and second, we will investigate the impact of multiple births in infant mortality. Methods: This is an observational study of all live births registered between 1996 and 2011, in Porto Alegre (RS). Birth weight, type of delivery, type of pregnancy (single or multiple), prenatal coverage, maternal characteristics and health care insurance according to type of hospital (private, mixed, public) were obtained from the Information System on Live Births (SINASC). Information on mortality was obtained from Information System on Mortality (SIM), only in the period of 1996 to 2010. In the study of LBW, multiple births were excluded. Trends in LBW, CS and covariates were assessed using joinpoint regression models, general and according to the type of hospital. Poisson regression was used to calculate the relative risk for LBW over the period, adjusted for covariates. Generalized Estimated Equations model was used to evaluate the relative risk for infant mortality among multiple births and sigletons, adjusted for covariates. Populational Attributable Risk was calculated to evaluate the impact of multiple births on infant mortality. Results: In the study of low birth weight, there was a total of 319,597 live births included in the analysis during the period. An intense change in the pattern of health insurance was observed with an increase of 43% in private sector coverage from 14.9% (1996) to 21.3% (2011). CS rates increased 52%, reaching 86.9%, 51.0% and 37.5% in 2011, respectively, in private, mixed and public hospitals. LBW rates increased significantly in private and mixed hospitals independently of the type of delivery. In opposition, LBW rates decreased in public hospitals for babies born by CS and remained stable for those born by vaginal delivery. Increases in CS and in prenatal coverage were associated with rising of LBW rates during the period. Reduction in the number of adolescent mothers and improvements in maternal education were the main protector factors for LBW during the period. There was a significant increase in multiple births rate from 1.97% (1996) to 2.45% (2010), p<0.001, among which 65% were dizygotic in 2010. There was a reduction in IMR and its components, in singletons: IMR fell from 15.4‰ to 8.3‰, TMN, from 8.3‰ to 5.04‰ and PNMR from 7.0‰ to 2.9‰. Between twins these rates remained constant at around 44‰, 33‰ and 11‰, respectively. In 1996, 1.7% of the infant mortality rate, 2.0% of the neonatal mortality rate 1.4% and the rate of post-neonatal mortality could be attributed to DZ twins. In 2010, the contribution of DZ twins rose to 8.4% in infant mortality, neonatal mortality 9.8% and 5.7% in the post-neonatal mortality. Conclusion: Increase in LBW was related with an intense change in patterns of health insurance associated with overuse of medical technologies. In counterpart, social improvements and increase in access to prenatal care reduced this impact in public and mixed hospitals.

Gamete donors are actively searched by companies dedicated to assisted reproduction in the Spanish State, and advertising is not only legal but rather common. This thesis provides an overview of the main themes that arise from the analysis of mostly visual materials used to promote ovum donation in public spaces in Barcelona, and critically links them to current debates in intersectional feminist cultural studies of technoscience, bodily theory and visual studies. Conceptual and affective tensions between characterisations of women’s bodies, reproductive function and desires are identified and brought forward in terms that imply tropes of sacralisation, reification of cells/organs/tissues, and fragmentation of the bodily reality. It is argued that egg donation advertisements use an imagery that deeply connects with practices well rooted in Western biomedical traditions when it comes to female bodies, physiology and reproductive function, and that such practices are to be understood against the backdrop of neoliberalism. The analysis supports the idea that the publicity discourse of the assisted reproduction industry in Spain actively engages in a legitimation of the desire of biological parenthood as a right, in ways that value lives conceived in different circumstances and geopolitical contexts in radically different ways, and that can be interpreted as paving the way to prosurrogacy and/or eugenic positions. Future research is encouraged and directed towards exploring issues of agency, particularly in vulnerable groups such as migrant, poor, uneducated or racialised women. Further research is needed in order to build the foundations of a feminist ethical reflection on reproductive technologies and particularly of ovum donation.

Magister Legum - LLM / In this research, I carefully and coherently examine Chapter 19 of the Children's Act 38 of 2005 as the first legislation to afford surrogate motherhood agreements legal recognition in South Africa. I argue that the application of Chapter 19 imposes a number of unwarranted limitations on several of the constitutional rights of the parties to a surrogacy agreement. In addition, I propose that Chapter 19 is not in accordance with the principal of the best interests of the child. I examine the history of surrogate motherhood in South Africa and establish that, prior to the enactment of Chapter 19, no legislation expressly afforded surrogate motherhood agreements legal recognition. Hence, prior to the enactment of Chapter 19, parties who entered surrogacy agreements could, first, not rely on the agreement to enforce contractual obligations, and secondly, the legal positions of the parties to the agreement were uncertain. Thirdly, a child born of a surrogacy agreement was seen as the child of the surrogate mother and not of the commissioning parents. / South Africa

Infertility politics implies a role for the state in regulating the relationships between different parties involved in the medicalized process of reproduction, namely would-be-parents (infertile couples or individuals), gamete donors, surrogate mothers, fertility specialists, etc. Policies adopted by the Canadian federal government in 2004 as regards assisted reproductive technologies (ARTs) were largely inspired by British regulations. Despite this similar start, Canadian policies never lead to implementation; the province of Quebec rapidly contested the federal Assisted Human Reproduction Act before the courts; and many issues of assisted conception were regulated in a heterogeneous manner by the provinces. Meanwhile in Britain, the implementation of the policies created many disparities among the regions of the country; the principle of the law was thoroughly contested and scrutinized; and the sites of deliberation were multiple in spite of the existence of a national regulatory agency. First, the author argues that assisted reproduction technologies cannot be taken as one policy domain, but is an umbrella label for a variety of policy issues. In that context, ARTs are unpacked in order to study, at the system level, the practices related to the overcoming of infertility. I focus on three sub-issues: access to fertility treatments, including the question of public funding and access criteria; gamete and embryo donation, including the question of filiation and donor conceived children’s right to know their biological origins; and surrogacy or the enforcement of pre-natal gestational surrogacy arrangements. Second, by mapping the variety of discourses and arenas mobilized by a range of actors, this study shows how framing and reframing dynamics influence public policies and their implementation. Third, by comparing frame mobilization and discursive dynamics between Quebec, Ontario and England this analysis demonstrates how frame alignment can be a necessary condition for a frame to be performative and influence policy outcomes. Depending on the context in which it occurs, frame transformation, amplification, extension or bridging can induce stability or trigger a cascade of events that will lead to policy change or to a change in the implementation of a policy.

Human reproduction is increasingly commodified, which paves the way for reproductive enhancement rather than just assistance. Non-medical gender/sex selection is one of the reproductive enhancement services that is offered on the fertility market, and it is a practice that raises severe concerns regarding the social and political impact of biotechnologies. Through Critical Discourse Analysis and Biomedicalization theory, I analyse how non-medical gender/sex selection is legitimised in online forum discussions. I argue that gender/sex selection is legitimized through gender- and family-conservative and neoliberal ideologies, and that gender/sex selection can be understood as a tool to enhance the family, increase privilege, and attain hypernormativity.

This study is a contribution to the bioethical debate about new and possibly emerging reproductive technologies. Its point of departure is the intuition, which many people seem to share, that using such technologies to select non-disease traits – like sex and emotional stability - in yet unborn children is morally problematic, at least more so than using the technologies to avoid giving birth to children with severe genetic diseases, or attempting to shape the non-disease traits of already existing children by environmental means, like education. The study employs philosophical analysis for the purpose of making this intuition intelligible and judging whether it is justified. Different ways in which the moral problems posed by reproductive technologies are often framed in bioethical debates are criticised as inadequate for this task. In particular, it is argued that the intuition cannot fully be made sense of in terms of harm to the children that such technologies help create. The study attempts to elaborate an alternative to that broadly consequentialist approach, by drawing on Martin Heidegger’s philosophy of technology, Hans Jonas’s ethics, and Aristotle’s practical philosophy, as it has been received and developed in the hermeneutical tradition. It is suggested that reproductive choices, unlike decisions for already born children, are characterised by a peculiar one-sidedness: the future child appears to the parents as something wholly theirs to decide about, not as a concrete other with whom they must interact in a responsive and attuned way. This is problematic because it means that such choices cannot call upon the particularised moral understanding only gained in interpersonal encounters. In particular, it makes them easily shaped by various tendencies, to which parents are always susceptible, to relate to children in instrumentalising ways, and at risk of reinforcing such tendencies. However, this does not mean that all uses of reproductive technologies are equally troubling. When selecting against severe disease the parents can rely on a widely shared illness experience to escape the dangers that one-sidedness involves. It is concluded that the intuition under discussion, thus explicated and in some ways qualified, makes sense morally. / Avhandlingen är ett bidrag till den bioetiska debatten om olika reproduktionstekniker som antingen nyligen blivit tillgängliga eller som kan komma att utvecklas i framtiden. Utgångspunkten är en intuition som många verkar dela, nämligen att användningen av sådana tekniker i syfte att välja icke-sjukdomsegenskaper – som kön och känslomässig stabilitet – hos framtida barn, är mer moraliskt problematiskt än både att forma sådana egenskaper hos redan existerande barn genom exempelvis utbildning och att använda teknikerna för att undvika att barn föds med svåra sjukdomar. Studien är ett försök att genom filosofisk analys begripliggöra denna intuition och avgöra om den är berättigad. Olika sätt på vilka man i den bioetiska debatten ofta gestaltar de moraliska problem som reproduktionstekniker ger upphov till kritiseras som otillräckliga för denna uppgift. I synnerhet framhålls att intuitionen inte helt kan förstås som en oro över att de barn som sådana tekniker sätter till världen kan komma till skada. Med avsikt att utveckla ett alternativ till detta konsekvensorienterade synsätt söker sig författaren till Martin Heideggers teknikfilosofi, Hans Jonas etik och Aristoteles praktiska filosofi, som den tolkats och utvecklats i den hermeneutiska traditionen. Med hjälp av dessa teorier betonas hur reproduktiva val, till skillnad från beslut gällande redan existerande barn, kännetecknas av en slags ensidighet. Det framtida barnet framstår för föräldrarna som föremål för beslut som är odelat deras, snarare än som en konkret andre som de måste interagera med på ett lyhört, noga avpassat sätt. Detta är problematiskt eftersom det innebär att sådana val inte kan ledsagas av det slags partikulära moraliska förståelse som bara uppnås i möten mellan människor. I synnerhet innebär det att valen lätt formas av, och i sin tur riskerar att underblåsa, olika för föräldraskapet karaktäristiska tendenser som ständigt riskerar förmå föräldrar att förhålla sig till sina barn på ett instrumentaliserande sätt. Men detta betyder inte att alla användningar av reproduktionstekniker är lika problematiska. Val som syftar till att undvika svåra sjukdomar kan undgå de faror som ensidigheten öppnar för genom att åberopa en gemensam mänsklig sjukdomserfarenhet. Avhandlingens slutsats är att intuitionen som diskuteras är berättigad, med vissa reservationer, om den förstås på detta sätt.

Des études récentes ont démontré une augmentation de la prévalence de l’infertilité au Canada ainsi qu’une augmentation fulgurante de l’utilisation de la procréation assistée. Le Québec s’est doté en 2010 d’un programme de financement de la procréation assistée visant un accès universel ainsi que la protection de la santé des mères et des enfants. Les diverses parties prenantes attribuent un certain nombre de lacunes à ce programme, incluant l’absence de mesures de prévention et de promotion de la santé visant à réduire la prévalence de l’infertilité. En effet, une proportion significative de cas d’infertilité découle de facteurs modifiables et relatifs aux modes de vie tels que le tabagisme, les infections transmises sexuellement et par le sang, les problèmes de poids, les toxines environnementales et l’âge. De plus, l’âge maternel avancé ainsi que l’usage de la procréation assistée comportent des risques pour la santé des mères et des enfants au sujet desquels la population ne possède pas une connaissance suffisante. Des approches en amont ont été proposées par diverses organisations et dans divers pays, toutefois, peu ont été adoptées. Force est de constater que ces initiatives représentent de grands défis au point de vue de l’acceptabilité sociale, en raison de la nature sensible du sujet et d’une grande valorisation sociale de l’autonomie reproductive. L’éthique des communications en santé permet d’identifier ces défis qui touchent l’usage de tactiques persuasives, le risque de stigmatisation et l’attribution indue d’une responsabilité. Si leur élaboration tient compte de ces enjeux, les campagnes de communications en santé ont le potentiel d’informer adéquatement la population afin de favoriser l’autonomie et la santé reproductive des individus, sans causer de dommage iatrogénique. L’éthique de l’ « empowerment », qui requiert l’attribution d’une responsabilité individuelle de nature prospective, l’apport de ressources concrètes et l’implication des communautés, permet d’identifier les besoins en termes de solutions législatives favorisant des contextes socioéconomiques qui soutiennent la santé reproductive et l’autonomie reproductive. / Recent studies have demonstrated an increased prevalence of infertility in Canada and a tremendous growth in assisted reproductive technologies use. In 2010, the Quebec government launched a public funding program for assisted reproductive technologies, which aims to provide equitable access and to protect the health of mothers and children. Various stakeholders have identified a number of shortcomings to this program, including the absence of prevention and health promotion measures aimed towards reducing the prevalence of infertility. Indeed, a significant proportion of infertility cases is attributable to modifiable and lifestyle related factors such as smoking, sexually transmitted infections, weight problems, environmental toxins and age. In addition, both advanced maternal age and assisted reproductive technologies utilization pose risks to the health of mothers and children, about which the population is not adequately informed. Preventative approaches have been proposed by many organizations in various countries but few have been implemented. A reason for this might be that these initiatives represent major challenges in terms of social acceptability, due to the sensitive nature of the subject and the strong social respect for reproductive autonomy. Health communication ethics highlights these issues such as the use of persuasive tactics, the risk of stigmatization, and undue attribution of responsibility. If designed effectively with these challenges in mind, health communication campaigns for infertility prevention have the potential to adequately inform the public, thus fostering reproductive autonomy and health, without causing iatrogenic damage. The ‘ethics of empowerment’, with its requirements for assigning only prospective individual responsibility, providing concrete resources and involving communities in social change, helps in identifying the needs for policy solutions that address the social context in order to enhance reproductive health and reproductive autonomy.

Que l’on parle de « technosemen », de « cyborg babies » ou de « techno-birth », force est de constater que le recours aux nouvelles technologies de reproduction participe d’une reconfiguration des processus biologiques. On assiste à une technicisation du corps qui entraine sa parcellisation et rend possibles son exploitation et sa commercialisation en pièces détachées. Or, la mise en valeur des substances biologiques est souvent accompagnée de leur rematérialisation dans l’imaginaire social. En nous intéressant à l’industrie du don de gamètes, nous cherchons à comprendre comment elle marchandise les substances reproductives en reconstituant le corps du donneur. La littérature est abondante sur la participation des nouvelles technologies de reproduction au renouveau identitaire et sociétal. Nous souhaitons donc décaler le regard et réfléchir sur la manière avec laquelle la sélection génétique opérée en clinique de reproduction nous révèle des schémas sociaux qui interviennent dans la dimension identitaire du corps. Dans le cadre de ce mémoire, il s’agira d’analyser les discours entourant le recrutement et la présentation des donneurs sur les sites internet de banques de gamètes au Canada et aux États-Unis. Nous montrerons que l’industrie du don de sperme et d’ovules, qui s’insère dans ce que l’on appelle la bioéconomie, participe à la reproduction d’une vision des formations sociales qui est à la fois genrée, racialisée et stratifiée par classes sociales. / Whether we talk about “technosemen”, “cyborg babies” or “techno-birth”, it all comes down to one thing: the use of the latest reproductive technologies is part of a redesign of the biological processes. What we are witnessing is that the body is being technified and ultimately broken down in such a way that it can be exploited and marketed in spare parts. However, because they’re being valued, the biological substances are often also rematerialized in the social consciousness. In looking at the gamete donation industry, we are trying to understand how it treats the reproductive substances as commodities in reconstructing the donor’s body. There is plenty of literature on how the new reproductive technologies are contributing to the identity and societal renewal. Our goal is therefore to look beyond and reflect on how much the genetic selection performed in fertility clinics says about the social patterns that enter in the identity dimension of the body. This thesis analyses the rhetoric used on the websites of sperm and egg banks in Canada and in the United States to recruit and present the donors. We will show that sperm and egg donations, which come within what is now called the bioeconomy, replicate a certain vision of social groups which are altogether classified by gender, race and social class.

Face au projet de l’utérus artificiel, ce mémoire est consacré à comprendre et expliquer les tenants sociohistoriques bornant son développement. Employant une méthode de « cartographie du présent », nous établissons en premier lieu la solidité empirique de l’ectogenèse, telle qu’exprimée en laboratoire et par les discours experts actuels. Cette analyse préliminaire permet de dégager la question névralgique de l’effacement du corps maternel dans la procréation, ce que nous problématisons suivant une perspective sociohistorique et anthropologique. L’hypothèse principale de ce mémoire est que l’utérus artificiel constitue l’extension radicale de représentations et pratiques existantes qui effacent de maintes façons le corps; ainsi nous cherchons à repérer le cheminement de cette radicalisation. En fouillant l’archéologie de l’assistance à la procréation – des accoucheuses médiévales à la techno-maternité contemporaine en passant par l’obstétrique moderne – notre objectif est de bien identifier la généalogie de la médicalisation, de la pathologisation et de la technicisation croissantes du corps maternel et de l’engendrement afin de caractériser la construction sociale d’une maternité machinique. Autrement dit, il s’agit de jalonner les représentations et pratiques sociales à l’oeuvre dans l’approche contemporaine de la procréation qui participent à l’oblitération du corps et ainsi créent un terreau fertile pour l’implantation de l’UA. / Faced with the present development of artificial womb technology, this master thesis aims to comprehend its sociohistorical origins and logic. Making use of a « cartography of the present » method of analysis, we start off by establishing the empirical constitution of ectogenesis, such as it is expressed in laboratory research and actual expert discourses on the subject. This preliminary analysis enables us to draw the problematic question of the erasure of the maternal body from the scene of reproduction, which we frame in a sociohistorical and anthropological perspective. Our principal hypothesis states that the artificial womb represents a radical outcome of current social representations and practices. Therefore, we try to trace the path of this radicalization by scrutinizing assisted procreation, from the medieval midwives’ practice to modern obstetrics and contemporary techno-maternity. Thus the genealogy of the increasing medicalization, pathologization, and technicization of the maternal body serves to identify the social construction of a mechanical maternity. In other words, we argue that our present mode of procreation continually erases the body and thus sets the scene for the implantation of the artificial womb.

Des études récentes ont démontré une augmentation de la prévalence de l’infertilité au Canada ainsi qu’une augmentation fulgurante de l’utilisation de la procréation assistée. Le Québec s’est doté en 2010 d’un programme de financement de la procréation assistée visant un accès universel ainsi que la protection de la santé des mères et des enfants. Les diverses parties prenantes attribuent un certain nombre de lacunes à ce programme, incluant l’absence de mesures de prévention et de promotion de la santé visant à réduire la prévalence de l’infertilité. En effet, une proportion significative de cas d’infertilité découle de facteurs modifiables et relatifs aux modes de vie tels que le tabagisme, les infections transmises sexuellement et par le sang, les problèmes de poids, les toxines environnementales et l’âge. De plus, l’âge maternel avancé ainsi que l’usage de la procréation assistée comportent des risques pour la santé des mères et des enfants au sujet desquels la population ne possède pas une connaissance suffisante. Des approches en amont ont été proposées par diverses organisations et dans divers pays, toutefois, peu ont été adoptées. Force est de constater que ces initiatives représentent de grands défis au point de vue de l’acceptabilité sociale, en raison de la nature sensible du sujet et d’une grande valorisation sociale de l’autonomie reproductive. L’éthique des communications en santé permet d’identifier ces défis qui touchent l’usage de tactiques persuasives, le risque de stigmatisation et l’attribution indue d’une responsabilité. Si leur élaboration tient compte de ces enjeux, les campagnes de communications en santé ont le potentiel d’informer adéquatement la population afin de favoriser l’autonomie et la santé reproductive des individus, sans causer de dommage iatrogénique. L’éthique de l’ « empowerment », qui requiert l’attribution d’une responsabilité individuelle de nature prospective, l’apport de ressources concrètes et l’implication des communautés, permet d’identifier les besoins en termes de solutions législatives favorisant des contextes socioéconomiques qui soutiennent la santé reproductive et l’autonomie reproductive. / Recent studies have demonstrated an increased prevalence of infertility in Canada and a tremendous growth in assisted reproductive technologies use. In 2010, the Quebec government launched a public funding program for assisted reproductive technologies, which aims to provide equitable access and to protect the health of mothers and children. Various stakeholders have identified a number of shortcomings to this program, including the absence of prevention and health promotion measures aimed towards reducing the prevalence of infertility. Indeed, a significant proportion of infertility cases is attributable to modifiable and lifestyle related factors such as smoking, sexually transmitted infections, weight problems, environmental toxins and age. In addition, both advanced maternal age and assisted reproductive technologies utilization pose risks to the health of mothers and children, about which the population is not adequately informed. Preventative approaches have been proposed by many organizations in various countries but few have been implemented. A reason for this might be that these initiatives represent major challenges in terms of social acceptability, due to the sensitive nature of the subject and the strong social respect for reproductive autonomy. Health communication ethics highlights these issues such as the use of persuasive tactics, the risk of stigmatization, and undue attribution of responsibility. If designed effectively with these challenges in mind, health communication campaigns for infertility prevention have the potential to adequately inform the public, thus fostering reproductive autonomy and health, without causing iatrogenic damage. The ‘ethics of empowerment’, with its requirements for assigning only prospective individual responsibility, providing concrete resources and involving communities in social change, helps in identifying the needs for policy solutions that address the social context in order to enhance reproductive health and reproductive autonomy.