Introduction

This chapter discusses the implications of the development of a global marketplace in reproduction services and proposes new directions for social work action based on the perspective that reproduction is an issue of human rights. Social work engagement with issues of reproduction – family planning, fertility, pregnancy and birth – varies both within and between countries. Sometimes services focus on a particular policy such as planned parenthood and population control, sometimes on particular groups considered vulnerable or ‘dangerous’ such as young parents, sometimes on decision making, for example around termination of pregnancy, and sometimes on the support of parents and children facing particular health challenges. There is no established pattern of provision. The global commodification of reproduction exacerbates health inequalities embedded in the processes of reproduction. There are inequalities in access to services which depend on people's ability to pay and inequalities in risk in an unregulated market. Financial and social inequalities provide the context in which women can be exploited, for example, as ‘donors’ or surrogates, because of their poverty.

Estimates of the prevalence of infertility worldwide vary considerably. The World Health Organization (2003) suggests at least 186 million couples in the world's poorest countries alone experience infertility. Boivin et al (2007), analysing published population surveys, identified a global population of between 40.2 million and 120.6 million women aged 20–44 living in married or consensual relationships, failing to conceive after 12 months of unprotected sexual intercourse. Between 12 million and 90.4 million of these are likely to seek medical help for their fertility problems. In the US approximately 12% of women of childbearing age have received an infertility service at some time in their lives (Centers for Disease Control and Prevention, 2007).

The centrality of reproduction to the ‘human condition’, self-evidently essential for the long-term survival of any species, is enshrined in cultural and religious practices and human rights codes, providing a key marker for adult identity, particularly for women. A number of commentators have highlighted the central importance of ‘reproductive autonomy’ and reproductive choice for the individual's sense of identity (for example, Jackson, 2007, p 48). The reproductive rights of individuals are reflected in both international conventions (for example, the Universal Declaration of Human Rights, the American Convention on Human Rights, the European Convention on Human Rights and Fundamental Freedoms) and national laws respecting individuals’ reproductive autonomy.