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9th Postgraduate Course for Training in Reproductive Medicine and Reproductive Biology

Ethical aspects of reproductive health

Alex Mauron
Associate professor of bioethics

Today, reproductive and sexual health are major, world-wide, health objectives and human rights concerns. Furthermore, they are not just high-minded ideals but realistic objectives. For instance, family planning has made considerable world-wide progress in the last two decades, more so in fact than many observers would have anticipated in the seventies. The purpose of this lecture is two-fold:

  • to place the ethical issues of sexuality and reproduction in their historical perspective;
  • to show how reproductive rights are intimately linked to the development of human rights generally.

In every historical period and everywhere, sex and reproduction have provided an important topic of ethical reflection. In turn, ethical views on this topic reflect prevailing beliefs about:

  • the link between sexuality and reproduction,
  • the place of women and children in society,
  • the facts of prenatal life as understood by different cultures in different times.

Already in classical Antiquity, various objectives of contraception/abortion (such as limiting family size, controlling demographic growth, and dissociating sex from reproduction) were debated by physicians, philosophers and moral thinkers. Medieval views on these issues were shaped (in Europe) by the hostility of the early Christian Fathers to sexual pleasure without reproduction and also by naturalistic thinking, i.e. the idea that it is morally good to "follow nature" (see reference by Mauron). Of course, what is deemed "natural" at any one time and place is highly dependant on culturally contingent ways of viewing the "facts of life". To take a modern example, the dissociation of sex from procreation is often viewed as a radical novelty due to modern contraception. And yet one may also see it as implicit in human physiology and psychology: unlike other mammals, the sexual activity of homo sapiens is not linked to the fertile periods of the female, a clear evidence that humans have always differed from other animals in being interested in sex for its own sake.

The ethics of birth control will be analysed as it provides a good summary of the ethical issues of reproductive health generally. There are two basic ethical perspectives in this context:

1- The individual point of view, grounded in the human rights tradition. The emphasis tends to be on personal rights and welfare, and the extent to which actions and policies promote them. Ethical reasoning is mostly based on deontological arguments invoking rights and obligations.

2- The collective point of view, concerned mostly with population issues and the aggregate results of individual behaviours on health and demography. The emphasis tends to be on utilitarian ethical arguments, that approve of actions and policies to the extent that they promote "the greatest good for the greatest number".

These potentially opposing points of view correspond to two "streams of thought in history" (Dixon-Mueller).

The first perspective links reproductive issues to the human rights tradition initiated by the Enlightenment and the political revolutions of the 18th century. The establishment of personal freedoms (also called negative rights) was initially directed against the paternalist authority of monarchical states and concerned primarily with freedom of religion, of conscience, of the press, and freedom from economic intervention by the State. In other words, these liberties created limits to the overbearing interference of governments and traditional authorities with the behaviour of individuals. In time (19-20 century), this was supplemented with a concern with social rights (positive rights, or entitlement rights), in realisation that many basic liberties are moot without access to specific goods such as health care for instance. In recent times, the women’s rights movement and the progress of reproductive rights (asserted in international conferences at Tehran, 1969, Cairo, 1994, Beijing 1995) have drawn on both aspects of the human rights tradition.

The second perspective is grounded in the history of economic theories. For centuries, political thinkers have tried to analyse the interplay between population issues, economic prosperity and, when relevant, family planning practices. This goes back to 17th century mercantilist doctrines, and the rise of classical economics (Adam Smith and his followers and critics of the 18th and 19th century). Another strand of thought is malthusianism and antimalthusianism, that originate in the writings of the English cleric Thomas Malthus, who argued for the necessity of checking population growth from the diverging rates of increase of population and food resources. Malthusian arguments were influential in the early birth control movement, whereas antimalthusian, natalist policies often invoked economic arguments as well. This style of debating population issues is still evident today, for instance in the speculations about the "demographic dividend" supposedly cashed-in by certain high-growth countries.

No matter whether collective utilitarian arguments are marshalled in favour of pro-natalist or pro-family planning policies, it must be understood that they are only part of the story from an ethical point of view. A consideration of personal interests and right is indispensable and tends to be overlooked in this style of discussions.

It is essential to realise that reproductive rights are basic human rights. They result from working out the implications of the basic rights of human persons in the specific field of reproductive and sexual health. In their most compact form, reproductive rights entail three basic components:

  1. The freedom to decide whether, when and how many children to have;
  2. The right to modern family planning information and modern family planning methods;
  3. The right to control one’s own sexuality.

A more extensive discussion of reproductive and sexual rights can be found on the IPPF web site (see references).

Although the historical tradition of human rights mostly emphasised relations - and possible conflicts - between the individual and the State, reproductive rights can clash not just with national claims and government policies but also with community policies and the authority of traditional, especially patriarchal, authority figures.

REFERENCES

  1. Dixon-Mueller, R. Population Policy & Women’s Rights: Transforming Reproductive Choice. Praeger: Westport, Conn. (1993).
  2. Population Council: http://www.popcouncil.org
  3. International Planned Parenthood Federation: http://www.ippf.org
  4. Mauron, A. Biology and Ethics : The Paradoxes of the Natural. Unpublished conference, Palermo, 1995.