Life Is All About Choices.

Abstract

As we attempt to move on from the Covid-19 pandemic, the mounting pressures on health and social care are striking for all to see. Many of the articles in this issue speak to this theme: access to treatment, standards of care and practice and what it means to deliver patient-centred care. Pike’s article helps to bring some valuable insight to the collective understanding concerning Reproductive Coercion (RC). Much has been written in the literature about reproductive autonomy and how this can be influenced and impeded by others, but use of the term RC has opened up the discussion still further concerning decision making in the realm of reproductive health. As Pike notes, whilst research in the field is helpful in illuminating the extent of the issue, it is complicated by the inclusion of behaviours that do not necessarily involve an intention to influence reproduction, such as contraceptive sabotage. Pike helpfully unpacks and explores the fact that coercion and reproductive autonomy are each ‘conceptually complex ideas as much as they are pragmatically complex ones’. Discussion cannot simply be reduced to stating that one is good or bad. More precision is needed as to the severity and detail of the coercion to better understand the extent of the problem. To this end, Pike argues that to do this survey questions should aim not only to equally address all elements of RC, but also to distinguish between actions that intentionally coerce someone into pregnancy and those that override autonomy but without intent to induce pregnancy. In cases where contraceptive interference takes place, with no intention to induce pregnancy, it may even be better understood not as RC, but instead as behaviours impinging on sexual consent and openness between partners and deserving separate consideration. The degree of recognition and understanding of RC as pregnancy pressure and contraceptive sabotage has improved, yet the same cannot be said of coerced abortion. It is hoped that a response to this takes place far quicker than the time it has taken to recognize and respond to coerced adoption. As Pike comments, ‘The first step is to recognize that it does happen, that it is relatively common, and that it not only leads to more adverse outcomes than when coercion is absent, but also denies women their fundamental right to informed consent.’ Keeping with this theme of reproductive health, if the arrival of the first ‘test tube’ baby in 1978 is recognized as transforming human fertility, then advances in In Vitro Gametogenesis (IVG) look set to usher in a new era of assisted reproduction. the new bioethics, Vol. 29 No. 2, 2023, 81–84