Adolescent men's attitudes and decision-making in relation to an unplanned pregnancy. Responses to an interactive video drama

This study confronts a gender bias in research on adolescent pregnancy by exploring adolescent men’s decisions relating to a hypothetical unplanned pregnancy. A cross-sectional survey was conducted with adolescent men (N = 360) aged between 14 and 18 years attending schools in the Republic of Ireland. The study, the first of its kind in Europe, extends the small body of evidence on adolescent men and pregnancy decision-making by developing and examining reactions to an interactive video drama used in a comparable study in Australia. In addition, we tested a more comprehensive range of sociological and psychological determinants of adolescent men’s decisions regarding an unplanned pregnancy. Results showed that adolescent men were more likely to choose to keep the baby in preference to abortion or adoption. Adolescent men’s choice to continue the pregnancy (keep or adopt) in preference to abortion was significantly associated with anticipated feelings of regret in relation to abortion, perceived positive attitudes of own mother to keeping the baby and a feeling that a part of them might want a baby. Religiosity was also shown to underlie adolescent men’s views on the perceived consequences of an abortion in their lives.

The effect of sperm DNA fragmentation on miscarriage rates: a systematic review and meta-analysis

STUDY QUESTION Is there an association between high levels of sperm DNA damage and miscarriage?SUMMARY ANSWERMiscarriage rates are positively correlated with sperm DNA damage levels.WHAT IS KNOWN ALREADYMost ejaculates contain a subpopulation of sperm with DNA damage, also referred to as DNA fragmentation, in the form of double or single-strand breaks which have been induced in the DNA prior to or following ejaculation. This DNA damage may be particularly elevated in some subfertile men, hence several studies have examined the link between sperm DNA damage levels and conception and miscarriage rates.STUDY DESIGN, SIZE, DURATIONA systematic review and meta-analysis of studies which examined the effect of sperm DNA damage on miscarriage rates was performed. Searches were conducted on MEDLINE, EMBASE and the Cochrane Library without any language restrictions from database inception to January 2012.PARTICIPANTS/MATERIALS, SETTING, METHODSWe used the terms 'DNA damage' or 'DNA fragmentation' combined with 'miscarriage', 'abortion' or 'pregnancy' to generate a set of relevant citations. Data extraction was performed by two reviewers. Study quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis of relative risks of miscarriage was performed with a random effects model. Subgroup analyses were performed by the type of DNA damage test, whether the sperm examined were prepared or from raw semen and for pregnancies resulting from IVF or ICSI treatment.MAIN RESULTS AND THE ROLE OF CHANCEWe identified 16 cohort studies (2969 couples), 14 of which were prospective. Eight studies used acridine orange-based assays, six the TUNEL assay and two the COMET assay. Meta-analysis showed a significant increase in miscarriage in patients with high DNA damage compared with those with low DNA damage [risk ratio (RR) = 2.16 (1.54, 3.03), P <0.00001)]. A subgroup analysis showed that the miscarriage association is strongest for the TUNEL assay (RR = 3.94 (2.45, 6.32), P <0.00001).LIMITATIONS, REASONS FOR CAUTIONThere is some variation in study characteristics, including the use of different assays and different thresholds for DNA damage and the definition of pregnancy loss.WIDER IMPLICATIONS OF THE FINDINGSThe use of methods which select sperm without DNA damage for use in assisted conception treatment may reduce the risk of miscarriage. This finding indicates that assays detecting DNA damage could be considered in those suffering from recurrent pregnancy loss. Further research is necessary to study the mechanisms of DNA damage and the potential therapeutic effects of antioxidant therapy.STUDY FUNDING/COMPETING INTEREST(S)None.

Understanding Human Dignity

“Understanding Human Dignity” aims to help the reader make sense of current debates about the meaning and implications of the idea of “human dignity.” The concept of human dignity has probably never been so omni-present in everyday speech, or so deeply embedded in political and legal discourse. In debates on torture, abortion, same-sex marriage, and welfare reform, appeals to dignity are seldom hard to find. The concept of dignity is not only a prominent feature of political debate, but also, and increasingly, of legal argument. Indeed, courts tell us that human dignity is the foundation of all human rights. But the more important it is, the more contested it seems to have become. There has, as a result, been an extraordinary explosion of scholarly writing about the concept of human dignity in law, political philosophy, and theology. This book aims to reflect on these intra-disciplinary debates about dignity in law, philosophy, history, politics, and theology, through a series of edited essays from specialists in these fields, explored the contested concept in its full richness and complexity.

Adolescent men’s pregnancy resolution choices in relation to an unintended pregnancy: A comparative analysis of adolescent men in three countries.

This paper investigates adolescent men's pregnancy resolution choices in Australia, Ireland and Italy. It addresses two main gaps in the literature: the lack of research on (adolescent) men's views on unintended pregnancy and pregnancy resolution; and the lack of international comparative case studies on men and reproductive choices. Consistent with theories of the transformation of intimacies in society and the growth of individualization, the results suggest that adolescent men are interested in the effect of an unintended pregnancy on their individual biographies as well as the effect on their girlfriend's health and well-being. However, Australian male adolescents were much more likely to choose abortion than Italian or Irish adolescents, suggesting adolescent males have also internalized country level debates surrounding abortion. Methodologically, the paper demonstrates an innovative approach to data-collection using a computer-based interactive drama to facilitate participants' deliberation and responses. It was shown to engage a large number of adolescent men and is likely to have wider generalisability in developing international comparative research on the topic, as well as applications for health promotion.

A contentious subject

Abortion is a contentious subject for any nation and this is no less true of Northern Ireland (NI). Despite being part of the United Kingdom, NI has never enacted the Abortion Act 1967 and the reasons given are our historically conservative attitudes and beliefs. In April 2013 the latest in a series of draft guidelines entitled ‘The Limited Circumstances for a Lawful Termination of Pregnancy in Northern Ireland’ was issued by the Department of Health NI to clarify aspects of earlier versions that were revoked following challenges by pro-life groups on their accuracy and application. That draft guidelines exist at all is down to pressure placed on the Department of Health NI by the fpaNI through the NI Courts.

Advancing Research on Men and Reproduction

While feminist scholarship has centred reproduction in women’s lives, it has inadequately explored its meanings in men’s. If we assume that reproduction happens in relationships of one kind or another between males and females, then missing men is a considerable oversight. Although there is now much research on fatherhood,merely focussing on this end-stage assumes that women take care of all of the foreplay, leaving unanswered questions in relation, inter alia, to men’s desires for parenthood,men’s involvement in planning or lack of planning to have children, the way men struggle or cope with infertility, their encounters with new reproductive technologies and surrogate mothers, their experiences of foetal screening, their involvement in abortion decision-making, and their experiences of becoming or not becoming a father. In this article I argue that men have compelling experiences throughout the reproductive trajectory deserving of more attention. I offer a profeminist theoretical composition for advancing further enquiries on men and reproduction,which begins with the feminism-informed Critical Studies of Men and Masculinities (CSM), and then weaves this together with the theories of intimate citizenship, sociology of the body, and the sociology of science and technology. I will propose how concepts from these collective theories may be useful in opening up layered questions about gender relations, intimacy, bodies, and technologies in future studies of men and reproduction.

Reva Siegel and the Role of Religion in Constructing the Meaning of ‘Human Dignity

The “religious understanding” of dignity is a topic of considerable complexity and is the subject of extensive scholarship. In this paper, I consider understandings of dignity that are currently under discussion in Roman Catholic circles, not least because Catholic discussions of dignity are often seen as influential in public policy and legal interpretation, directly and indirectly. I shall focus on one relatively neglected issue in legal scholarship: how scholars go about the task of identifying what a particular religion’s understanding of human dignity involves.
To illustrate the methodological problems that such an enterprise raises, I shall take one attempt by a scholar writing in the field of secular legal scholarship to describe Catholic understandings of dignity in the context of abortion and same-sex marriage. The discussion is that of Reva Siegel, an academic lawyer at Yale University; her recent analysis of differing understandings of dignity illustrates some of the issues that arise when the secular scholarly community addresses religious understandings of dignity.

From the Right to Life to the Right to Livability: Radically Re-approaching ‘Life’ in Human Rights Politics

This article critically reflects on current mainstream debate on abortion in international human rights discourse and the conception of life underpinning it. The public health focus on access to safe abortion which has dominated this discourse can be detected as committed to a fundamentally liberal idea of bounded and individual subjecthood which mirrors the commitments of the liberal right to life more generally. However, feminist challenges to this frame seeking to advance wider access to reproductive freedoms appear equally underpinned by a liberal conception of life. It is asserted that feminists may offer a more radical challenge to the current impasse in international debate on abortion by engaging with the concept of livability which foregrounds life as an interdependent and conditioned process. The trope of the ‘right to livability’ developed in this article presents a means to reposition the relation between rights and life and facilitate such radical engagement which better attends to the socio-political conditions shaping our interdependent living and being.

Philosophy and Political Engagement: Reflection in the Public Sphere

Do philosophers have a responsibility to their society that is distinct from their responsibility to it as citizens? This edited volume explores both what type of contribution philosophy can make and what type of reasoning is appropriate when addressing public matters now. These questions are posed by leading international scholars working in the fields of moral and political philosophy. Each contribution also investigates the central issue of how to combine critical, rational analysis with a commitment to politically relevant public engagement. The contributions to this volume analyse issues raised in practical ethics, including abortion, embryology, and assisted suicide. They consider the role of ethical commitment in the philosophical analysis of contemporary political issues, and engage with matters of public policy such as poverty, the arts, meaningful work, as well as the evidence base for policy. They also examine the normative legitimacy of power, including the use of violence.

You Should Never Look a Gift Horse in the Mouth: One-Size-Fits-All Compensation in Wrongful Conception

This article reconsiders the House of Lords decision in Rees v. Darlington Memorial Hospital NHS Trust (2003) and the decision to award a conventional award of £15,000 in all cases of failed sterilisation resulting in the birth of an unwanted child. In so doing, it briefly recites the history of the Wrongful Conception action and the unique facts of Rees. It then goes on the consider the implications of two fundamental aspects of the judgment. Firstly, it looks at the 'conventional award' itself and considers the reasoning behind the award and the effect that it has on our understanding of (particularly women's) reproductive autonomy. Secondly, it analyses the rather 'unique' judgment of Lord Scott and his decision to evaluate these cases using the possessory analogy of an unwanted foal; particular focus is given to the notion of parental 'choice' in these cases and whether mitigation (i.e. abortion or adoption) can ever be considered "reasonable".

Factor V Leiden and Prothrombin G20210A in Portuguese Women with Recurrent Miscarriage: Is it Worthwhile to Investigate?

OBJECTIVE: To compare the prevalence of factor V Leiden (FVL) and prothrombin (PT) G20210A mutations in Portuguese women with unexplained recurrent miscarriage (RM) and a control group of parous women. MATERIALS AND METHODS: FVL and PT G20210A analysis were carried out in 100 women with three or more consecutive miscarriages and 100 controls with no history of pregnancy losses. Secondary analysis was made regarding gestational age at miscarriage (embryonic and fetal losses). RESULTS: Overall, the prevalence of FVL and PT G20210A was similar in women with RM (5 and 3%) compared with controls (5 and 1%) OR 1.36 (CI 95% 0.45-4.08). In RM embryonic subgroup, PT G20210A was observed in 1.3% of women and FVL prevalence (2.6%) was inclusively lesser than that of controls. Both polymorphisms were more prevalent in women with fetal losses than in controls, although statistical significance was not reached due to the small size of the >10 weeks' subgroup. CONCLUSION: These data indicate that neither FVL nor PT G20210A is associated with RM prior to 10 weeks of gestation. Therefore, its screening is not indicated as an initial approach in Portuguese women with embryonic RM and negative personal thromboembolic history.

Contraceptive Choices Pre and Post Pregnancy in Adolescence

STUDY OBJECTIVE: The main aim of this study is to evaluate the impact of adolescent pregnancy in the future contraceptive choices. A secondary aim is to verify whether these choices differ from those made after an abortion. DESIGN: Retrospective study. SETTING:Adolescent Unit of a tertiary care center. PARTICIPANTS:212 pregnant teenagers. INTERVENTIONS: Medical records review. MAIN OUTCOME MEASURES:Intended pregnancy rate and contraceptive methods used before and after pregnancy. For contraceptive choices after pregnancy we considered: Group 1 - teenagers who continued their pregnancy to delivery (n = 106) and Group 2 - the same number of adolescents who chose to terminate their pregnancy. RESULTS: The intended pregnancy rate was 14.2%. Prior to a pregnancy continued to delivery, the most widely used contraceptive method was the male condom (50.9%), followed by oral combined contraceptives (28.3%); 18.9% of adolescents were not using any contraceptive method. After pregnancy, contraceptive implant was chosen by 70.8% of subjects (P < .001) and the oral combined contraceptives remained the second most frequent option (17.9%, P = .058). Comparing these results with Group 2, we found that the outcome of the pregnancy was the main factor in the choices that were made. Thus, after a pregnancy continued to delivery, adolescents prefer the use of LARC [78.4% vs 40.5%, OR: 5,958 - 95% (2.914-12.181), P < .001)], especially contraceptive implants [70.8% vs 38.7%, OR: 4.371 - 95% (2.224-8.591), P < .001], to oral combined contraceptives [17.9% vs 57.5%, OR: 0.118 - 95% CI (0.054-0.258), P < .001]. CONCLUSION:Adolescent pregnancy and its outcome constitute a factor of change in future contraceptive choice.

Congenital heart disease in pregnancies complicated by maternal diabetes mellitus. An international clinical collaboration, literature review, and meta-analysis.

PURPOSE: Investigation of the incidence and distribution of congenital structural cardiac malformations among the offspring of mothers with diabetes type 1 and of the influence of periconceptional glycemic control. METHODS: Multicenter retrospective clinical study, literature review, and meta-analysis. The incidence and pattern of congenital heart disease in the own study population and in the literature on the offspring of type 1 diabetic mothers were compared with the incidence and spectrum of the various cardiovascular defects in the offspring of nondiabetic mothers as registered by EUROCAT Northern Netherlands. Medical records were, in addition, reviewed for HbA(1c) during the 1st trimester. RESULTS: The distribution of congenital heart anomalies in the own diabetic study population was in accordance with the distribution encountered in the literature. This distribution differed considerably from that in the nondiabetic population. Approximately half the cardiovascular defects were conotruncal anomalies. The authors' study demonstrated a remarkable increase in the likelihood of visceral heterotaxia and variants of single ventricle among these patients. As expected, elevated HbA(1c) values during the 1st trimester were associated with offspring fetal cardiovascular defects. CONCLUSION: This study shows an increased likelihood of specific heart anomalies, namely transposition of the great arteries, persistent truncus arteriosus, visceral heterotaxia and single ventricle, among offspring of diabetic mothers. This suggests a profound teratogenic effect at a very early stage in cardiogenesis. The study emphasizes the frequency with which the offspring of diabetes-complicated pregnancies suffer from complex forms of congenital heart disease. Pregnancies with poor 1st-trimester glycemic control are more prone to the presence of fetal heart disease.

Paper 2: EUROCAT public health indicators for congenital anomalies in Europe.

OBJECTIVE: The purpose of this article is to present the specific public health indicators recently developed by EUROCAT that aim to summarize important aspects of the public health impact of congenital anomalies in a few quantitative measures. METHODS: The six indicators are: (1) congenital anomaly perinatal mortality, (2) congenital anomaly prenatal diagnosis prevalence, (3) congenital anomaly termination of pregnancy, (4) Down syndrome livebirth prevalence, (5) congenital anomaly pediatric surgery, and (6) neural tube defects (NTD) total prevalence. Data presented for this report pertained to all cases (livebirths, fetal deaths, or stillbirths after 20 weeks of gestation and terminations of pregnancy for fetal anomaly [TOPFA]) of congenital anomaly from 27 full member registries of EUROCAT that could provide data for at least 3 years during the period 2004 to 2008. Prevalence of anomalies, prenatal diagnosis, TOPFA, pediatric surgery, and perinatal mortality were calculated per 1000 births. RESULTS: The overall perinatal mortality was approximately 1.0 per 1000 births for EUROCAT registries with almost half due to fetal and the other half due to first week deaths. There were wide variations in perinatal mortality across the registries with the highest rates observed in Dublin and Malta, registries in countries where TOPFA are illegal, and in Ukraine. The overall perinatal mortality across EUROCAT registries slightly decreased between 2004 and 2008 due to a decrease in first week deaths. The prevalence of TOPFA was fairly stable at about 4 per 1000 births. There were variations in livebirth prevalence of cases typically requiring surgery across the registries; however, for most registries this prevalence was between 3 and 5 per 1000 births. Prevalence of NTD decreased by about 10% from 1.05 in 2004 to 0.94 per 1000 in 2008. CONCLUSION: It is hoped that by publishing the data on EUROCAT indicators, the public health importance of congenital anomalies can be clearly summarized to policy makers, the need for accurate data from registries emphasized, the need for primary prevention and treatment services highlighted, and the impact of current services measured.

La circoncision des femmes en Afrique : repenser les politiques de santé

Section des étudiants / Student's section