#Headlesspreggos: challenging visual imaginaries of pregnancy and reproduction.

Amid new abortion restrictions in the USA, scientific advances in genetic technologies and investigations of COVID-19 vaccinations in pregnancy, news stories about reproduction abound, often accompanied by images of what journalist Josie Glausiusz has called the "headless, legless, pregnancy bump". These images of disembodied pregnant torsos at once improve search engine optimisation for news organisations while perpetuating the view of the 'bump' as the quintessential visual representation of pregnancy.The images that accompany news articles convey meaning beyond what is included in the text and work to reinforce stereotypes about race, gender and age. In the so-called obesity epidemic, for example, psychotherapist and fat activist Charlotte Cooper documented how images of fat people with their heads cropped out view had become a visual symbol of abjection-'the headless fatty'-without a face or agency to speak of. The use of 'headless preggos' similarly divorces pregnant people from the embodied experience of their pregnancies, reducing them to a single body part.In this article, we chronicle our experiences tracking images of headless preggos via Twitter, arguing that their use works to erase pregnant people's autonomy and to construct the fetus as the central concern in reproductive interventions. We begin by tracing the evolution of visual representations of pregnancy including the increasing focus on the fetus and 'bump'. We then provide a description of our experience with the Twitter account, including our exchanges with academics, journalists and others that highlight how the continued reliance on headless preggos obscures the experiences of pregnant people by focusing all attention on the fetus, as well as how the same images might be thoughtfully deployed. We conclude by offering suggestions for those creating and selecting images that might result in more robust, creative visual representations of pregnancy and reproduction.

Lessons Learned Developing Client Navigation for People who are Trans and Gender Diverse.

BACKGROUND: People who are trans and gender diverse (PTGD) are underserved regarding healthcare in Canada, including the province of Saskatchewan. OBJECTIVES: Design and conduct a research project that will address immediate and pressing community-identified needs related to improving access to healthcare for PTGD in Saskatchewan. METHODS: A multidisciplinary, community-based collaboration was established to address the self-identified obstacles to accessing healthcare of PTGD in Saskatchewan. This resulted in a pilot study creating and evaluating a healthcare navigation program. LESSONS LEARNED: The project led to four key lessons: 1) prioritizing team building and the well-being of team members; 2) committing to community-based participatory approaches from the outset; 3) taking language seriously; and 4) acknowledging and addressing power imbalances in our team. CONCLUSIONS: The lessons we learned have enabled us to sustain a large, diverse, research team that centers the experience of PTGD in Saskatchewan and is responsive to community need.

Community Engagement in a Time of Confinement.

This article examines the significant constraints on, the necessity for, and the opportunities around community engagement in a time of confinement. We consider the compounded challenges faced by marginalized communities in the context of the coronavirus disease 2019 pandemic, and we follow this with reflections on the triumphs and tensions of emergent engagement practices. We then describe four exercises that we conducted before the onset of the pandemic in a research project exploring public engagement from the ground up in relation to policy-making, and we suggest how the lessons learned may be applied to contemporary decision making. Our overall goal is to illustrate how and why community engagement is particularly pressing in the current crisis, as pandemic restrictions have added new dimensions to long-standing practices of containment. We argue that although these most recent forms of engagement are contested and complex, they are essential to ensuring that policy-making is built on processes of equity, access, and inclusion.

Nous nous penchons sur les contraintes importantes auxquelles sont soumis l'impératif de mobilisation collective et les possibilités qui s'y greffent, en période de confinement. Nous nous intéressons aux difficultés que les collectivités marginalisées doivent affronter, exacerbées par leur situation, dans le contexte de la pandémie de maladie à coronavirus 2019 ; nous poursuivons avec des réflexions sur les succès et les tensions associés aux pratiques émergentes en matière de mobilisation. Nous décrivons ensuite quatre exercices réalisés avant le début de la pandémie dans le cadre d'un projet de recherche visant à analyser la mobilisation citoyenne à partir de la base en relation avec l'élaboration de politiques, et nous suggérons comment appliquer les leçons qui en sont tirées aux processus décisionnels contemporains. Notre objectif global est d'illustrer en quoi et pourquoi la mobilisation collective est particulièrement cruciale dans la crise actuelle, les restrictions de la pandémie ayant ajouté de nouvelles dimensions aux pratiques de confinement de longue date. Selon nous, bien que ces formes très récentes de mobilisation soient contestées et complexes, elles sont essentielles pour faire en sorte que l'élaboration de politiques repose sur des principes d'équité, d'accès et d'inclusion.

Good eggs? Evaluating consent forms for egg donation.

Beyond gaps in the provision of information, the informed consent process for egg donation is complicated by conflicts of interest, payment and a lack of longitudinal data about physiological and psychological risks. Recent scholarship has suggested that egg donation programmes could improve the informed consent process by revising consent documents. At a minimum, these documents should include information about eight key criteria: the nature and objectives of treatment; the benefits, risks and inconveniences of egg donation; the privacy of donors and their anonymity (where applicable); disclosure that participation is voluntary (withdrawal); the availability of counselling; financial considerations; the possibility of an unsuccessful cycle and potential uses of the eggs retrieved. This study evaluates the incorporation of these minimum criteria in consent forms for egg donation, obtained through requests to Canadian fertility clinics. Even when clinics were considered to have met criteria simply by mentioning them, among the eight consent forms assessed, none met the minimum standards. Only half of clinics addressed privacy/anonymity concerns, financial issues and the possibility of a future cycle. Improving the quality of consent documentation to meet the minimum standards established by this study may not be an onerous task. For some, this will include re-evaluating how they include one or two elements of disclosure, and for others, this will require a substantial overhaul. Using the criteria provided by this study as the minimum standard for consent could ensure that donors have the basic information they need to make informed decisions.

Patient Decision-Making About the Disposition of Surplus Cryopreserved Embryos in Canada.

OBJECTIVE: The objective of this study was to identify factors that contribute to patient decision-making for disposition of surplus cryopreserved embryos in Canada. METHODS: In 2013, interviews were conducted with 45 IVF patients from three clinic sites, representing a total of 33 households. Patients interviewed all had unused cryopreserved embryos in storage in 2010. Initial demographic data collection was followed by one in-depth semi-structured interview conducted in 2013. Data were managed and coded thematically. RESULTS: Most patients (21 patients, representing 16 households) renewed storage agreements to keep embryos in storage at the time of the interview. Among patients who did not renew their storage agreements at some point between 2010 and 2013, six patients (representing 5 households) had since used all their embryos, two patients (representing one household) had decided to keep their embryos in storage in perpetuity, three patients (representing 3 households) discarded their embryos outright, and 13 patients (representing 9 households) donated their embryos to research or clinical training. Among patients who donated to research or clinical training, three key themes emerged: a desire to "give back," to contribute to scientific progress, and to avoid "wasting" embryos. These patients were not always certain about whether they had chosen research or clinical training. CONCLUSION: This study demonstrates the applicability of international findings about embryo disposition decision-making to the Canadian setting. Moreover, it identifies that while patients making disposition decisions often choose to donate embryos to research and/or clinical training, they are not always certain about what these options entail. Clinicians, counsellors, and others must ensure that patients are not only aware of their embryo disposition options, but that they understand the nature of these options as well.

Of research and reproduction: defining embryo 'Research' in Canada.

This article traces how embryo research has been theorized in Canada from the late 1980s to the current day. We find that research on human embryos has gradually come to be viewed in dichotomous terms, with scientific research pulled apart from experimentation to improve assisted reproduction procedures within fertility clinics. This distinction has been made manifest most clearly in the federal government's 2007 consent regulations. The distinction between 'improvement of assisted reproduction procedures' and 'research' is problematic on two accounts. First, interviews reveal that many Canadian IVF patients do not distinguish between the improvement of assisted reproduction and broader conceptions of 'research'. This suggests that patients may be consenting to participate in embryo experimentation even where they do not understand its purposes. Second, the dichotomy may allow researchers and clinicians to evade research protocols that might otherwise apply in Canadian law. This could permit fertility clinics to conduct what might in other contexts fall under the category of 'research' without prescribed oversight, and may even enable clinicians and researchers to engage in practices that policymakers deliberately sought to proscribe. We call for a re-evaluation of the legal distinctions on embryo experimentation built into Canadian law, and indeed built into broader discussions of embryo research.

Frozen in perpetuity: 'abandoned embryos' in Canada.

The matter of 'abandoned embryos' arises when surplus IVF embryos are frozen and stored for later use. If the fertility clinic or storage facility in question does not have clear direction about what to do with these embryos, and/or payment for storage ceases, and/or the embryo providers cannot be reached, the embryos raise an ethical and practical challenge. On the one hand, there is a commitment to respect the autonomy of embryo providers to determine what should happen to their frozen embryos. On the other hand, there are weighty reasons why fertility clinics and storage facilities do not want responsibility, potentially in perpetuity, for other people's frozen embryos. This article examines the matter of 'abandoned embryos' - the emergence of the term, its use in policy and law, and its implications in the Canadian case. We demonstrate that despite an intricate legislative framework, there are important gaps that leave fertility clinics and storage facilities in the tenuous position of discarding 'abandoned embryos' without clear authorization, or storing them indefinitely. We argue that clarity in consent procedures coupled with flexible time limits on embryo storage provide an approach that can best serve the interests of all involved.

The devil we know: the implications of bill C-38 for assisted human reproduction in Canada.

In June 2012, the Canadian House of Commons passed the so-called omnibus budget bill, making several important changes to the governance of assisted reproduction in Canada. The bill (Bill C-38) was widely criticized for its unwieldy size and rapid passage through Parliament, preventing adequate parliamentary debate and public scrutiny. Given the substantive nature of the amendments to the Assisted Human Reproduction Act made by Bill C-38, and the lack of relevant discussion about these changes both before and following its passage, this commentary is intended to identify how Bill C-38 may alter the governance of reproductive technologies in Canada. In this commentary, we address some of the more significant changes made by Bill C-38 to the regulation of reproductive medicine in Canada. We identify the benefits and challenges of closing Assisted Human Reproduction Canada, noting that doing so eliminates a much-needed forum for stakeholder consultation in this field. Further, we explore the implications of moving the regulation of donor semen from the Food and Drugs Act to the Assisted Human Reproduction Act; these include increased liability for physicians, and opportunities to expand the existing regulations to account for the needs of lesbian, gay, bisexual, trans, and queer Canadians using donor gametes and recent advances in reproductive technologies. Overall, we argue that although the implementation of a policy framework in this field remains highly dependent on yet-to-be written regulations, the changes to the Assisted Human Reproduction Act enabled by Bill C-38 may significantly alter how Canadians interact with reproductive technologies.

En juin 2012, la Chambre des communes du Canada a adopté le projet de loi omnibus sur le budget, apportant ainsi plusieurs modifications importantes à la gouvernance de la procréation assistée au Canada. Ce projet de loi (C-38) a été vastement critiqué en raison de sa taille problématique et de la rapidité de son adoption au Parlement, empêchant ainsi la tenue d'un débat parlementaire adéquat et d'un examen de la part du public. Compte tenu de la nature substantielle des modifications apportées à la Loi sur la procréation assistée par le projet de loi C-38 et de l'absence d'une discussion pertinente au sujet de ces modifications, tant avant qu'après leur adoption, ce commentaire a pour but de cerner la façon dont le projet de loi C-38 pourrait altérer la gouvernance des technologies génésiques au Canada. Dans le cadre de ce commentaire, nous traitons de certaines des modifications les plus importantes apportées à la réglementation de la médecine génésique au Canada par le projet de loi C-38. Nous identifions les avantages et les défis qui accompagnent la fermeture de Procréation assistée Canada, en soulignant que cette fermeture met fin à un forum fort utile qui permettait de consulter les intervenants du domaine. De surcroît, nous explorons les conséquences du passage de la réglementation des dons de sperme de la Loi sur les aliments et drogues à la Loi sur la procréation assistée; parmi ces conséquences, on trouve l'accentuation de la responsabilité des médecins, ainsi que des occasions d'élargir les règlements existants en vue de pouvoir répondre aux besoins des Canadiennes lesbiennes, gaies, bisexuelles, transgenres et allosexuelles qui font appel à des gamètes issus de donneurs et qui utilisent les percées récentes dans le domaine des technologies génésiques. De façon globale, nous avançons que, bien que la mise en œuvre d'un cadre stratégique dans ce domaine dépende encore grandement de règlements qui restent à rédiger, les modifications apportées à la Loi sur la procréation assistée par le projet de loi C-38 pourraient considérablement altérer la façon dont les Canadiens interagissent avec les technologies génésiques.