Reproductive rights and the medical care system: a plea for rational health policy

Abstract

Recently, there have been many challenges to women's reproductive rights and freedoms: court-ordered cesarean sections; criminal cases against women for prenatal child abuse; and attempts to limit the practice of mid-wifery, home birth, and the operation of alternative birth centers. In these cases, medicine has been complicit or proactive in attempts to control the behavior or health care options of pregnant women. We discuss medicine's role as an agent of social control, the medical reconstruction of problems that are social in nature, and the need for a more coherent policy framework to guide physician practices.

PIP: Reproduction issues are highly controversial. Women's legal right to abortion continues to be challenged, women's rights are being pitted against fetal rights, and there is concern about teen pregnancy, the appropriate use of reproductive technology, and drug and alcohol use during pregnancy. There has been, however, little attention to medicine's role as an agent of social control and arbiter of reproductive behavior, the medical reconstruction of and intervention in problems which are essentially social in nature, or of equity and social justice in reproductive health care. The authors discuss these latter issues in light of historical and more recent attempts to control the behavior of pregnant women. In the absence of current reproductive health policy, the medical profession makes arbitrary decisions in individual cases which may or may not reflect patient or community wishes. A more coherent policy framework and regulatory mechanisms to guide physician practice are needed. The authors discuss the problem in context, key questions, social discrimination in reproductive health care, choosing which services to provide, coercion and choice, and reproductive health policy as a solution.