What can be learned from the Chinese experience in response to infertility.

OBJECTIVES: The aims of the study were to reviews the history of China's population policy since 2011, and draw lessons from the Chinese experience in response to infertility. METHODS: Data from the Chinese infertility status survey report (2009) and national statistical yearbooks (2009-2019) are used to assess the severity of infertility and reproductive centers shortage in China. Lessons from China was informed by a review of existing literature. RESULTS: The proportion of couples suffering from infertility in China increased to 12.5% (166.8 million in 2009) from just 6.89% (86.6 million in 1988) two decades earlier, while the number of reproductive centers was one for every 3.1 million citizens. The total costs per live birth for medically assisted reproduction in Chinese public fertility clinics was 30,000 yuan in 2012. Among infertile couples, unemployed patients accounted for the largest proportion (21.9% in 2014). Currently in China, health regulations permit oocyte donation only from infertility patients who have 20 or more mature oocytes, of which at least 15 must be kept for their own treatment. CONCLUSION: It is necessary to integrate the reproductive health care of infertile people into the national public health service. In addition to relieving their economic burden, national policies should guide and support enterprises to guarantee employee medical leave for infertility. Growing numbers of bereaved older women who have lost their only child make it imperative to reconsider liberalizing the regulation of oocyte donation in China.

Title X Regulatory Changes and Their Impact on Adolescent Health.

Title X of the Public Health Act has provided access to confidential reproductive care for low-income adolescents and adults since 1970, helping to bring adolescent pregnancy rates to historic lows. Recent regulatory changes in program funding eligibility and provider counseling options may reverse this trend. This policy brief will address the history and impact of Title X funding on adolescent access to reproductive health care, explain the implications of these recent regulatory changes in Title X implementation, and encourage advocacy to protect health care provider practice and adolescent access to confidential care.

Industry is not the dark side, but an essential partner to make progress in reproductive health.

For the last 20 years, Thomas D'Hooghe has been coordinator of the Leuven University Fertility Center at Leuven University Hospitals, Belgium, one of the largest teaching hospitals in Europe. Since 1995, he has also been Professor of Reproductive Medicine and Biology at KU Leuven (University of Leuven) and Adjunct Professor at Yale University, USA. Since 1 October 2015, he has been the Vice President and Head of Global Medical Affairs Fertility at Merck's headquarters in Darmstadt, Germany. He has published nearly 300 papers in internationally peer-reviewed journals and has contributed to reproductive health serving major international organizations such as the WHO, the European Society of Human Reproduction and Embryology, the Society of Reproductive Investigation and the World Endometriosis Research Foundation.

The success factors of scaling-up Estonian sexual and reproductive health youth clinic network--from a grassroots initiative to a national programme 1991-2013.

BACKGROUND: A growing number of middle-income countries are scaling up youth-friendly sexual and reproductive health pilot projects to national level programmes. Yet, there are few case studies on successful national level scale-up of such programmes. Estonia is an excellent example of scale-up of a small grassroots adolescent sexual and reproductive health initiative to a national programme, which most likely contributed to improved adolescent sexual and reproductive health outcomes. This study; (1) documents the scale-up process of the Estonian youth clinic network 1991-2013, and (2) analyses factors that contributed to the successful scale-up. This research provides policy makers and programme managers with new insights to success factors of the scale-up, that can be used to support planning, implementation and scale-up of adolescent sexual and reproductive health programmes in other countries. METHODS: Information on the scale-up process and success factors were collected by conducting a literature review and interviewing key stakeholders. The findings were analysed using the WHO-ExpandNet framework, which provides a step-by-step process approach for design, implementation and assessment of the results of scaling-up health innovations. RESULTS: The scale-up was divided into two main phases: (1) planning the scale-up strategy 1991-1995 and (2) managing the scaling-up 1996-2013. The planning phase analysed innovation, user organizations (youth clinics), environment and resource team (a national NGO and international assistance). The managing phase examines strategic choices, advocacy, organization, resource mobilization, monitoring and evaluation, strategic planning and management of the scale-up. CONCLUSIONS: The main factors that contributed to the successful scale-up in Estonia were: (1) favourable social and political climate, (2) clear demonstrated need for the adolescent services, (3) a national professional organization that advocated, coordinated and represented the youth clinics, (4) enthusiasm and dedication of personnel, (5) acceptance by user organizations and (6) sustainable funding through the national health insurance system. Finally, the measurement and recognition of the remarkable improvement of adolescent SRH outcomes in Estonia would not have been possible without development of good reporting and monitoring systems, and many studies and international publications.

Medical tourism: reverse subsidy for the elite.

The medical tourism sector in India has attracted global attention, given its phenomenal growth in the past decade. India is second only to Thailand in the number of medical tourists that it attracts every year. Estimates indicate that the medical tourism market in India could grow from $310 million in 2005 to $2 billion by 2012. These figures are significant when contrasted with India's overall health care expenditure - $10 billion in the public sector and $50 billion in the private sector. Factors that have contributed to this growth include the relative proficiency in English among health care providers and the cost effectiveness of medical procedures in India. Generally, most procedures in Indian hospitals cost a quarter (or less) of what they would cost in developed countries. The expansion of medical tourism has also been fueled by the growth of the private medical sector in India, a consequence of the neglect of public health by the government. India has one of the poorest records in the world regarding public financing and provisioning of health care. A growing driver of medical tourism is the attraction of facilities in India that offer access to assisted reproductive care technologies. Ironically, this is in sharp contrast with the acute neglect of the health care needs of Indian women. The Indian government is vigorously promoting medical tourism by providing tax concessions and by creating an environment enabling it to thrive. However, there is a distinct disjunction between the neglect of the health care needs of ordinary Indians and public policy that today subsidizes the health care of wealthy foreigners.

Framing the new midwifery: media narratives in Ontario and Quebec during the 1980s and 1990s.

After long periods of activism and policy debate, Ontario and Quebec were the first two provinces to integrate midwifery into their health-care services. Despite its success and growing popularity in the post-legislative era, midwifery was a highly contentious policy issue, with debates emerging at every level of policy development. In this essay, the authors explore how these debates played out in media. Specifically, the authors suggest that the frames produced by newspapers during this period served to align midwifery with broader provincial socio-political discourses, which in turn legitimized state intervention in the area of reproductive health. At the same time, however, the authors demonstrate that where Ontario media representations muted differences between midwives and physicians, representations in Quebec emphasized them. Thus, the authors show that in very different ways, media representations of midwifery in Ontario and Quebec both established a discursive context in which the state had to "act on" midwifery and midwives, and also challenged the potential of midwifery to transform women's birth experiences.

The unique role of U.S. foundations in international family planning and reproductive health.

This article reviews the unique historic and contemporary role of U.S. philanthropies in supporting international family planning and reproductive health (FPRH) programs, including how priorities are set, strategies developed, and activities funded. We then discuss the FPRH situation in sub-Saharan Africa today, where needs are the most urgent and where, increasingly, foundations are focusing their resources. We describe one case study exhibiting good philanthropic practice and conclude with thoughts about what the future holds for foundations in international FPRH. We find that as leaders in the field of FPRH, foundations have the ability to stay committed to their goals of championing the reproductive health and rights of individuals under dynamic circumstances. Although every policy environment offers opportunities and constraints, foundations, with their grantee partners, have a range of tools to foster and guide social change. As circumstances change, foundations have to be willing and able both to reassess where they provide added value and to take risks through innovative strategies.

Twenty-five years.

Having returned to Australia from the United Kingdom in late 1979, it has been my privilege to witness first-hand the quite dramatic changes in Sexual Health Medicine which have taken place during the final 25 years of my professional life. In this article I give a snapshot of my early experiences at the Melbourne Communicable Diseases Centre, highlighting some of the deficiencies that needed urgent attention. I wish I could say that this picture was an exaggeration to make the article more interesting but unfortunately that is not the case. I also attempt to examine some of the factors that brought about the much-needed improvements, especially the effect human immunodeficiency virus had on sexual health practice. It is impossible to mention all the individuals most involved in initiating change, but I have mentioned a couple of names, only because of close personal knowledge about their contribution.

Religion and reproductive health and rights.

This essay examines the relationship between religion and public policy issues concerning reproductive health and rights. It particularly focuses on how such issues affect women. Although not ignoring the sometimes oppositional stance of some religious spokepersons to birth control and attempts to mitigate the suffering caused by HIV/AIDS, early or frequent pregnancy, discrimination against female fetuses and babies, and so on, the essay seeks to identify positive responses by religiously committed people, particularly women, that parallel or reinforce UNFPA initiatives to address such problems. The essay also attempts to articulate ways in which religion should come to grips with issues of reproductive health and rights.

[The evolution of health care in the areas of reproductive and sexual health--Brazil, 20th Century]. / Trajetória assistencial no âmbito da saúde reprodutiva e sexual--Brasil, século XX.

Technical and practical works on the reproduction and sexuality processes conducted in Brazil, in the last century, are the subject of this article. Therefore, authors review the history and emphasize three moments: the first one, until the 1950's, when the basis of public responsibility is defined specially regarding maternity and medical interventions are carried out in order to moralize the sexuality field; second, between the 1950's and 1970's, when the clinical and educative health care is consolidated and directed to women reproductive process and complications on men and women sexual apparatus; third, when broader political bases are built regarding health care, reproduction and sexuality.