Preconception care for all and medicalization; an interdisciplinary study...


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Title Preconception care for all and medicalization; an interdisciplinary study into the ethics of preconception care in practice
Period 02 / 2007 - unknown
Status Completed
Research number OND1326557
Data Supplier Website ZonMw


The proposed project will provide an overview of ethical issues regarding preconception care and systematically analyse those issues in order to further the debate on the implementation of such care on a wide scale. Special attention will be given to the concept of medicalization in the planning of pregnancy as medicalization has been brought forward as a barrier to preconception care. An inventory of ideas and ideals on becoming pregnant will help to understand why and to what extent medicalization plays a role. The overview and analysis will be based on empirical findings, the study of the relevant ethical literature and discussions between scientific experts of different disciplines. The objectives are 1. To further the debate among professionals, ethicists and policymakers on the ethical acceptability of preconception care in general, and 2. To provide concrete suggestions with regard to conditions necessary for ethically sound preconception care on a wide scale. Long before our children are even conceived, their health is influenced by our lifestyle, by our genetic constitution, and our choices in planning pregnancy. Approximately 30 % of preconceptional women smoke or consume alcohol regularly. These are examples of behavioural risk factors for adverse pregnancy outcome. (see figure attachment 1) Fifty percent of women planning pregnancy do not take folic acid pills during the correct period of time. Despite continuing efforts to improve antenatal care, in recent years the incidences of adverse pregnancy outcome, including low birth weight, pre-term delivery, and birth defects have not decreased (STEEGERS 2005). Furthermore maternal mortality does not decline in the Netherlands. Addressing risk factors for adverse pregnancy outcomes before conception is thought to be a good new approach to improve both maternal and child outcomes. Therefore a program for preconception care for the general population, consisting of 1. risk assessment, 2. health promotion, 3. interventions to modify or eliminate risk factors and 4. counselling, will start in Rotterdam in March 2006, supported by the municipal government and health authority. The health insurance company Achmea has agreed to cover part of the costs of preparation and implementation. Women between 18 and 40 years will be informed about the program. Special attention will be given to immigrant populations as they are at increased risk for perinatal and maternal mortality and morbidity. The municipal health authority will put immigrant health care counsellers in place to facilitate this. It is expected that such a program will contribute significantly to the prevention of disease in pregnant women and their children. It is preventive medicine par excellence . Preconception care has to do with personal responsibility for health, the freedom to create a family, parental responsibility, societal and medical influence on reproductive decisions, and justice. Is care available for all who need it, and especially for those who need it most? So, inevitably, ethical questions arise. They can be framed as follows: will discussing risks even before there is a pregnancy spoil the idea of natural conception, and lead to the feeling that some precious innocence has been lost? Is becoming pregnant to be a medical issue, and will women ever be free from medical advice on reproduction? How do women experience preconceptionally given health focused messages regarding lifestyle (such as those regarding smoking, drinking, diet)? Will preconception care influence feelings of guilt? Will refusing such care result in guilt? Does care tailored for the individual make an ethical difference compared to providing very general information only: You should start using folic acid now. versus Women planning a pregnancy should use folic acid. (DE WEERD e.a. 2002.a) This interdisciplinary project aims at a systematic analysis of the ethical questions hand in hand with the preconception care program as it develops. Ethical analysis is not lagging behind, but closely following the new practice. We will focus on the argument of the medicalization of the process of becoming pregnant. Why? Firstly the argument of medicalization is brought up in the debate as an ethical barrier to wide spread implementation of preconception care (It is bad enough that already there is so much interference with pregnancy, so do not worry women before they are pregnant). Secondly the argument has different meanings and corresponding justifications. Careful analysis and clarity are called for. Thirdly the argument is based on underlying images and ideals of the planning of pregnancy that have not before been subject of analysis. What do people have in mind regarding natural (romantic, risk free, undisturbed, secret?) conception? In the Netherlands we have a tradition of prenatal care and home-deliveries that is associated with strong positive views regarding the naturalness of pregnancy and childbirth. In this interdisciplinary project methods from different disciplines involved will be used. Participant observation is essential in the practice of preconception care. We will analyse different interpretations of medicalization in the literature. We will invite experts from the sociological, medical, psychological realm to discuss their views. A central part of the project is the interviewing of women in Rotterdam who accepted the offer, women who have not taken up the offer, women who did not receive such an offer, and women from immigrant populations, in order to gather information on their views on becoming pregnant and their experiences with the health care surrounding it, in particular with preconception care. In an international workshop our findings will be compared with international debates. These different parts will lead to an analysis of the ethical issues that will be important for the actual practice of preconception care, and for future implementation of programs of preconception care on a national level.

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D24200 Health education, prevention
D32000 Philosophy

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