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In the context of breast cancer, women who refuse reconstruction are often portrayed as having limited agency or control over their bodies and treatment. Here we assess these assumptions by paying attention to how the local contexts and inter-relational dynamics influence women's decision-making about their mastectomized body in Central Vietnam. We situate the reconstructive decision within an under-funded public health system, but also show how the widespread perception of the surgery as merely an aesthetic practice dissuades women from seeking reconstruction. Women are shown both conform to existing gendered norms while simultaneously challenging and defying them. [ABSTRACT FROM AUTHOR]

The aim is to understand what therapies and interventions families in a low and middle income (LMIC) country, such as Vietnam resort to in their attempts to seek care for their children with ASD and why they choose these therapies. We undertook semi-structured qualitative interviews with 27 parents of children with autism and an online survey of 112 parents as part of a broader ethnographic study over one year augmented with recent interactional observations and a review of social media. There is limited access to formal interventions for families with children with ASD in Vietnam. Rather, families resort to syncretic care using an average of 6.8 different interventions per child. These included: speech therapy; physical therapy; prescribed medicines; and ABA as well as geomancy, special dietary regimes, biochemical testing, stem cell therapies and religious and cultural practices. Despite having low incomes, the families surveyed spent an average USD 345 per month on interventions, many of which are not evidence-based. Desire to care and potentially "cure" their children within a context of stigma associated with ASD drives parents to seek all possible interventions for their children. There remains a large gap in access to appropriate evidence-based interventions or trained therapists for families. Further information for parents, culturally appropriate guidelines for effective interventions, more trained rehabilitation professionals and regulation is required. Within low and middle income countries (LMIC), such as Vietnam there is a lack of intervention services, difficulties in accessing appropriate specialists, poor quality care and the costs of care. Families seek a range of formal interventions and costly informal therapies as well as culturally specific practices to care for their child/ren and require information on effective therapies. In LMIC training programs to build capacity for allied health professionals need to be implemented on the latest evidence-based therapies. It is important to develop culturally appropriate Vietnamese guidelines to support interventions for children with ASD. [ABSTRACT FROM AUTHOR]

Background: Cross‐border surrogacy and egg donor arrangements are an increasingly common means to family building. Establishing patterns of use has always been difficult in relation to Australian patients. Accurate data is stymied by lack of documentation of international third‐party reproductive care available to Australian authorities. When international travel bans came into effect, it is hypothesised that those planning to use cross‐border reproductive care had to rely significantly more on local in vitro fertilisation (IVF) clinics for services such as sperm freezing, embryo creation and gamete release procedures. Aim: To quantify and characterise the impact of the Covid‐19‐related travel ban on international and interstate gamete shipping by Australian IVF clinics. Materials and methods: Thirty‐one Australian and New Zealand IVF clinics were invited to provide de‐identified data on interstate and international gamete export applications from two 12 month time periods pre‐ and during Covid‐19‐related international travel lockdowns. Seven IVF organisations provided data on: patient age; type of gametes exported; destination country/state; and date gamete release approved. Results: Most gametes (78%) were shipped to another Australian IVF clinic and 22% internationally. Patient‐initiated shipping domestically and internationally both showed significant increases when comparing pre‐ and post‐Covid datasets. Of the 21 destination countries reported for international shipments, the US was the commonest (39%), followed by Ukraine (21%) and Canada (9%). Conclusions: The inability of involuntarily infertile patients to travel internationally, rather than halt cross‐border reproductive care, has led to a significant increase in the uptake of gamete shipping. The high proportion of internationally shipped gametes going to the US and Ukraine is likely a reflection of the availability of surrogates and donors and more amenable legal frameworks. [ABSTRACT FROM AUTHOR]

Behind the statistics forecasting millions of deaths associated with antimicrobial resistance (AMR) is an even greater burden of morbidity leaving many people with long-term chronic illnesses and disability. Despite growing recognition of the importance of inter-sectoral and inter-disciplinary knowledge in forming responses to address this global health threat, there remains a paucity of social science research to understand the social burdens of AMR. In this qualitative study we explore the experiences of people living with chronic AMR infections, their interactions with health providers and therapeutic quests for care, and the effects upon their lives and that of their families and caregivers. Our analysis reveals that the resistant infections impacted not only the physical health but also the mental health of the sufferers and their caregivers, causing major disruptions to their social and work lives. Most undertook arduous treatment regimes – of powerful antibiotics with debilitating side effects, combined a range of other complementary and alternate therapies, including travel to seek treatment overseas. Further, we question the notion of 'AMR survivorship' currently being promoted as part of a public education campaign by the World Health Organisation and whether people with the diverse AMR experience really self-identify as 'survivors' of a biosocial group. [ABSTRACT FROM AUTHOR]

Gestational surrogacy is a reproductive arrangement where a woman gestates a child for others—the "intended parents"—in order to be handed over to them after birth. Since the turn of the millennium, demands for surrogacy have continuously increased due to social and demographic changes, rising rates of infertility, and the normalization of new, non-heteronormative, family forms. Many countries prohibit surrogacy, and others that previously permitted this reproductive arrangement closed down as a result of political decisions or surrogacy scandals. Moreover, surrogacy is offered at greatly varying costs, ranging from approximately US$50,000 in countries like the Republic of Georgia to US$200,000 in fertility clinics in California. Accordingly, many of these arrangements are transnational, with intended parents who cannot access surrogacy or afford surrogacy in their home country commissioning it in countries such as the United States, until recently Ukraine, and today increasingly in the Republic of Georgia. Existing research has focused on surrogacy from different angles, such as practices of kinning and de-kinning, inequality and stratification, the political economy of the fertility industry, and its gender dimensions. We engage in, but further these debates by drawing attention to settings, accounts, experiences, and new theoretical notions that diverge from "mainstream" presentations of surrogacy. Moreover, in this Special Issue, we experimented with writing joint papers with a deliberative aim to provide comparative analyses and emphasize the links between and diversity of different cases of surrogacy. Therefore, all papers have an explicit comparative character and are all based on empirical studies from more than one field site. They provide nuanced understandings of surrogacy arrangements, grounded in empirical data rather than ideological, political, or moral assessments. [ABSTRACT FROM AUTHOR]

In this article, we offer an analysis of the development of "repronubs": less-known locations offering small-scale, niche cross-border gestational surrogacy or surrogacy services for a regional market. This analytical category of "repronubs" is useful to describe the formation of the industry from small local sites to those offering cross-border services. Based on our work in these locations, we compare the markets, regulatory contexts, and organization of the industry in Ghana, Kazakhstan, and Laos, focusing on the "repropreneurs" or surrogacy facilitation agents as pivotal in the emergence of these sites. These "repronubs" highlight the surrogacy trade between countries of the Global South and are established next to or instead of the more well-known North–South destinations. We document how surrogacy itself is increasingly stratified between higher cost and better-regulated environments such as in certain states of the United States or Canada and lower cost, less well regulated, and regionally focused environments in the settings we describe. These locations are characterized by poor or liberal regulations, the existence of local in vitro fertilization (IVF) expertise, and the emergence of local repropreneurs driving the trade using their social networks. The growth of demand from China and the growing affluent middle class in Africa is creating further markets for such regional "nubs." Studying surrogacy in such locations is made difficult by the secrecy and confidentiality surrounding it. [ABSTRACT FROM AUTHOR]

Women in low‐ and middle‐income countries where the prevalence and mortality of breast cancer are growing rapidly are more likely to be diagnosed at advanced stages, which negatively affects their treatment outcomes and chance of survival. The current literature in those settings tends to focus largely on explaining patient delay in seeking medical attention for breast symptoms. Meanwhile, little is known as to what prompts women to attend screening and diagnostic services after discovering symptomatic breasts. Drawn upon the data from in‐depth interviews with 33 breast cancer patients in Central Vietnam conducted in 2019, this paper examines the context of women's decisions about breast screening and how the practice of seeking cancer diagnosis occurred. Our findings reveal an absence of a national screening program and that seeking medical advice was conducted on an ad hoc basis after self‐detection of breast symptoms. Women's interpretations of symptomatic breasts as suspicious signs of cancer, the co‐occurrence of important life events, or encouragement by people in their social network motivated women to seek medical attention at different public and private health facilities. Their encounters with the health sector often involved multiple visits across time and space in which they experienced various forms of diagnosis delay produced by the health system. Our study carries implications for interventions to encourage women's awareness of early cancer symptoms and prompt medical presentation after self‐discovery of symptomatic breasts. [ABSTRACT FROM AUTHOR]

The availability of women willing to donate eggs in Spain is one of the cornerstones that has led the country to become the most desirable European destination for cross-border reproductive care. The reasons for this success are usually attributed to legal and socioeconomic conditions. Much less attention has been paid to the online strategies that fertility clinics in Spain use to inform and recruit young women to become egg providers. This paper addresses this gap by analysing online communication strategies in egg donors' websites and social media. The narratives and rationalities they underpin are conceptualised as revealing 'sociotechnical imaginaries' around egg donation which coproduce new societal interests among young women. The results show that the language used recycles and repurposes egg donors' motivations towards a normative discourse that puts altruism at the core, while, at the same time, explanations of medical processes and risks generate incomplete and misleading narratives. Finally, this paper describes how these discourses are embedded in a particular kind of branding where not only the notion of altruism is produced but also a complete identity framework. In this framework, donating eggs would not just be an act of solidarity, but would also imply belonging to a community of progressive empowered women, in control over their bodies and with modern consumption capacity: a neoliberal rationality of optimization, self-care and consumerism as forms of liberation. [ABSTRACT FROM AUTHOR]

In this paper, I consider how the 'new hysteria' of uterus transplants (UTx) continues traditions of medical experimentation focussed upon the correction of the defective female body. Media accounts of 'first' UTx events in the US are analysed to describe the narrative 'anchors' used in these accounts. In Sweden and Denmark, UTx is presented within the media as a means to avoid surrogacy, while in the US UTx is constructed as an alternate choice to surrogacy in keeping with the US emphasis on neoliberal choices. These differing approaches to surrogacy and UTx reflect the different social contexts. In media accounts, risks are minimised and success is emphasised, and the potentials of UTx for non-heteronormative reproduction are not mentioned. Despite parallels with other forms of transplantation and surrogacy markets, public representations avoid the potential of a future UTx market. [ABSTRACT FROM AUTHOR]

This paper views international medical travel through the lens of medical migrations and contextualises it within regional historical linkages. Drawing from fieldwork with staff, facilitators, and Indonesian patients in two Malaysian private hospitals, it frames international medical travel as a moral endeavour, and aims to uncover the premises that make this endeavour meaningful and desirable. Understanding moralities as a field of embodied predispositions created in the dynamics of social interaction, we argue that a strand of moral logic underlies the practice of medical travel. We call this the morality of need, which dictates that people do whatever they can for themselves and their families' medical needs, including travelling abroad, as well as 'help others' by giving information and accompanying them overseas for their medical needs. This moral logic co-exists in tension with a morality of business that accepts the legitimacy of generating earnings from people's medical needs. Within this moral framework, international medical travel is seen as a necessary practice for sustaining health and well-being, and extends beyond the family as social and moral support for others facing similar predicaments. [ABSTRACT FROM AUTHOR]

The article offers information on reflections on Translations of care in International Medical Travel Hospitals in Malaysia and Thailand. Topic include practices of care are not confined to the interactions among practitioners, caregivers, and patients as they consider the rich dimensions of care, as translated through infrastructures, data collection and reporting, state politics, and emotional entanglements.

The global movement of people across international borders to undergo assisted reproductive treatment is common, although there is little accurate data. In this article, we synthesise findings from our own empirical research on reproductive travel in addition to a review of clinical, ethical, legal, and regulatory complexities from studies on reproductive travel since 2010. Motivations for travel include legal and religious prohibitions; resource considerations; lack of access to gametes and reproductive assistors; quality and safety concerns; and personal preferences. Higher risks to mothers and children are associated with multiple embryo transfer and subsequent multiple and higher order pregnancies and the average older age of women undertaking reproductive travel. The potential exploitation of other women as providers of oocytes or surrogacy services, the lack of equity in access to assisted reproduction and the ambiguous legal status of children conceived from international reproductive travel are important ethical considerations. A range of significant legal issues remain given variable and limited international regulation. Scholarship on this trade necessarily engages with issues of power and gender, social inequities, global capitalism and the private decision-making of individuals seeking to form families. Research gaps remain given recent changes in the organisation, demands and destinations of the trade. [ABSTRACT FROM AUTHOR]

We investigate international medical travel between Indonesia and Malaysia through the conceptual lens of sociality, transnational social space and therapeutic mobilities. Drawing upon narratives of local persons, medical traveller-patients, accompanying family members, hospital staff and medical travel facilitators, we illustrate how multifaceted linkages and processes generate and sustain the flow of patients across the border. In these narratives, we see multiple mobilities articulate and cross-cut in the building of transnational connections. This paper stretches the concept of transnational social space to apply to medical travel and contributes to the literature framing of international medical travel as a complex and multifaceted arena. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) imperils health for people across the world. This enormous challenge is being met with the rationalisation of prescription, dispensing and consumption of antimicrobials in clinical settings and in the everyday lives of members of the general population. Individuals need to be reached outside clinical settings to prepare them for the necessary changes to the pharmaceutical management of infections; efforts that depend on media and communications and, therefore, how the AMR message is mediated, received and applied. In 2016, the UK Review on Antimicrobial Resistance called on governments to support intense, worldwide media activity to promote public awareness and to further efforts to rationalise the use of antimicrobial pharmaceuticals. In this article, we consider this communications challenge in light of contemporary currents of thought on media publics, including: the tendency of health communications to cast experts and lay individuals in opposition; the blaming of individuals who appear to ‘resist’ expert advice; the challenges presented by negative stories of AMR and their circulation in public life, and; the problems of public trust tied to the construction and mediation of expert knowledge on the effective management of AMR. [ABSTRACT FROM AUTHOR]

Intra-regional medical travel by patients from Indonesia to Penang in Malaysia is embedded in and facilitated by regional circuits. Although such movement is fuelled by dissatisfaction with the health-care services offered in Indonesia, we argue that these contemporary movements for health care are also a continuation of existing exchanges for trade, education and cultural ties that have long existed. In the first part of the paper, we consider the historical interconnections between the locations of Medan and Aceh in Indonesia and Penang in Malaysia. Based upon fieldwork and interviews with 70 intra-regional patients travelling to Penang for treatment, we describe how these interconnections are now manifested in travel for medical care. We argue that the temporary exit from the Indonesian health system to pursue care in hospitals in Penang by some Chinese Indonesians and Acehnese follows patterns and logics based on social histories of discrimination and conflict as well as geographical convenience. This highlights the need to contextualise such travel not just as geographic movements across space but also through the depth of time and local histories. [ABSTRACT FROM AUTHOR]

International medical travel may be viewed as an 'assemblage' of various components such as infrastructure, hospitals, finance, transport, technologies, staff, facilitators and patients. In this paper, we focus on the articulations of medical travel facilitators (MTFs) and private hospitals in producing international medical travel in the context of the neoliberalising processes that had led to the rise of corporate hospital care in Malaysia in the 1990s. We draw from three hospital case studies for a comparative perspective. We highlight the shifting, unstable and contingent relations and interactions of the MTFs, as one component of the assemblage of international medical travel, with hospitals and medical travellers. We identify the practices of MTFs in providing patients with information and advice about hospitals and doctors as efforts to shape patients' choices in the selection of health-care providers and in decision-making. The assemblage approach allows us to see how the MTFs emerge and stabilise as a collective identity for individuals and companies performing particular functions through their multifarious articulations with other components in various sites of assemblage. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various articles within the issue on topics including framing of Indonesians' medical travel to Malaysia; construction of identity in medical travel; and warnings about travelling for stem cell treatments.

For individuals with autism spectrum disorder (ASD), early and accurate diagnosis enables early intervention, which leads to improved quality of life. The diagnostic label of ASD has only been recognized in Vietnam since 2000 and the number of children who have been diagnosed has increased dramatically. However, there is limited understanding about the condition. This article aims to describe the current assessment and diagnostic practices in Hanoi, Vietnam, a low resource setting. Data for this article came from in-depth interviews with parents of children with ASD and service providers, and observation at health clinics and early intervention centers that provide ASD assessment during field work from July 2011 to May 2012. This study reveals that although there is some improvement in assessment services, parents still face a number of challenges in accessing quality assessment and diagnosis of ASD in Vietnam. These include rushed and perfunctory assessment; a lack of clinical guidelines for assessment; limited communication among health professionals in assessment teams, and between professionals and parents of children with ASD. Public awareness-raising of the signs of autism, capacity building for professionals, development of practical and contextual appropriate assessment protocols are needed to enhance the accessibility and quality of assessment services. [ABSTRACT FROM AUTHOR]

International medical travel (IMT) challenges the notion of health care as a responsibility of a nation-state to its citizens, tied to the territory of a nation-state. As patients travel for medical care, they invoke not territorialised notions of citizenship, but make new claims. In this article, the authors propose the term ‘flexible bio-citizenship’ that extends the notion of ‘flexible citizenship’ to describe transnational mobilities for the accumulation of biovalue. They argue that people who travel for medical care come from a variety of backgrounds, identities and circumstances for whom the physical and economic ability to travel and cross borders is a form of flexible social capital enabling them to access levels of care otherwise inaccessible to them. The article explores the implications upon citizenship for a diverse range of people who travel for their health care: from highly mobile cosmopolitan professional expatriate workers, regional border crossers, migrant workers, those who cannot afford care at home, patients whose status makes treatments unavailable, and outsourced patients forced to travel for care. Their mobility allows them to gain biovalue but also alters their citizenship relationships and perspectives. [ABSTRACT FROM AUTHOR]

One of the challenges in doing research with individuals with autism spectrum disorder (ASD) is the difficulty in communication. This study employed a modified form of photovoice with a group of young people with ASD in Hanoi, Vietnam, to provide a means of meaningful participation in research about their lives, experiences, and needs. We describe the process of conducting photovoice with nine children with ASD from June 2011 to May 2012, many of whom had limited verbal communication skills. More than 2100 photos were taken by children. Undertaking photovoice with children with ASD required some modification of the method. In particular we consider the difficulties in analysing and interpreting the photographs produced by children with ASD. Due to the ambiguities of the visual images produced we found content analysis of photographs alone was inadequate. There was a discrepancy between our initial interpretations of the photographs and our understandings derived from information from interviews with children, parents, carers, and our own observations. Our study points to the need to understand context through multiple methods and the potential of photovoice as a means to mediate communication and participation in research for groups with communication difficulties. [ABSTRACT FROM AUTHOR]

This paper offers a critical discourse analysis of media debate over social sex selection in the Australian media from 2008 to 2014. This period coincides with a review of the National Health and Medical Research Council's Ethical Guidelines on the Use of Assisted Reproductive Technology in Clinical Practice and Research (2007), which underlie the regulation of assisted reproductive clinics and practice in Australia. I examine the discussion of the ethics of pre-implatation genetic diagnosis (PGD) within the media as 'ethical publicity' to the lay public. Sex selection through PGD is both exemplary of and interconnected with a range of debates in Australia about the legitimacy of certain reproductive choices and the extent to which procreative liberties should be restricted. Major themes emerging from media reports on PGD sex selection in Australia are described. These include: the spectre of science out of control; ramifications for the contestation over the public funding of abortion in Australia; private choices versus public authorities regulating reproduction; and the ethics of travelling overseas for the technology. It is concluded that within Australia, the issue of PGD sex selection is framed in terms of questions of individual freedom against the principle of sex discrimination - a principle enshrined in legislation - and a commitment to publically-funded medical care. [ABSTRACT FROM AUTHOR]

This paper offers a critical discourse analysis of media debate over social sex selection in the Australian media from 2008 to 2014. This period coincides with a review of the National Health and Medical Research Council'sEthical Guidelines on the Use of Assisted Reproductive Technology in Clinical Practice and Research(2007), which underlie the regulation of assisted reproductive clinics and practice in Australia. I examine the discussion of the ethics of pre-implatation genetic diagnosis (PGD) within the media as ‘ethical publicity’ to the lay public. Sex selection through PGD is both exemplary of and interconnected with a range of debates in Australia about the legitimacy of certain reproductive choices and the extent to which procreative liberties should be restricted. Major themes emerging from media reports on PGD sex selection in Australia are described. These include: the spectre of science out of control; ramifications for the contestation over the public funding of abortion in Australia; private choices versus public authorities regulating reproduction; and the ethics of travelling overseas for the technology. It is concluded that within Australia, the issue of PGD sex selection is framed in terms of questions of individual freedom against the principle of sex discrimination – a principle enshrined in legislation – and a commitment to publically-funded medical care. [ABSTRACT FROM PUBLISHER]

New synergies across anthropology, science and technology studies (STS), legal studies and sociology, bring fresh theoretical perspectives to the study of reproduction. Recent works on reproduction trace some of the changing rationalities: from the tactics of feminist self-help health movements in 1970s and 1980s in the US, to the commercialized experience of pregnancy and the various configurations, policies and legalities addressing globalized genetic and assisted reproductive technologies. Reproductive decision-making is deeply entangled with neoliberalism, welfare reforms, racial and geographic disparities, economic stratification and cultural rationalities to produce inequalities. Studies of reproduction remain central to basic anthropological questions: what it means to be human, what constitutes life, how we live our lives, and how societies value particular lives. [ABSTRACT FROM AUTHOR]

In this paper, I describe the experience of ‘outsourced’ patients who are sent by their governments or insurers through contractual arrangements to a hospital in another country for treatment. I present case studies of nine patients and their accompanying families from the Gulf Cooperation Council (GCC) who were interviewed in a Thai hospital as part of a broader study of medical travel from patients' perspectives. The health systems of the GCC suffer shortages in infrastructure, human resources and management skills, and as a consequence patients with particular needs, especially in neurology, orthopaedics and oncology may be sent overseas for treatment. Patients experience long stays overseas producing a considerable burden to their families supporting them. Such patients complicate notions of medical travel but their status also contrasts markedly from stereotypes held about Gulf patients within Thailand. Despite their appreciation of government sponsoring, for many patients the experience of care in Thailand underscored perceived inadequacies of their home health systems and governments. For some, outsourcing represented a betrayal of the obligations of their states to its citizens. [ABSTRACT FROM PUBLISHER]

There is limited understanding of Autism spectrum disorder (ASD) in Vietnam. This ethnographic study aimed to explore how ASD is represented and managed in the cultural, social and economic contexts of Vietnam, and describe the experiences of families with children with ASD in Hanoi, Vietnam. This study was conducted from 2011 to 2012 in Hanoi and employed a range of methods, including participant observation, in-depth interviews with 27 parents of children with ASD and 17 key informants, and online survey. This study found that within Hanoi, Vietnam, ASD has been culturally and socially constructed as a ‘disease’, ‘karmic demerit’ and ‘family problem’ rather than a life-long developmental disorder that needs support from government. Children with ASD and their families experience various forms of stigma and discrimination. There are limitations in assessment and diagnosis of ASD. Parents of children with ASD have little access to services for their children, and the limited political and economic supports exacerbate their difficulties. This study highlights some of the ways in which the understandings and management of ASD vary cross culturally. It also suggests further attention is required to the provision of appropriate public education, low cost interventions and support for family advocacy groups. [ABSTRACT FROM AUTHOR]

Qualitative research was undertaken among Dawan people living in Fatumnasi, West Timor, to investigate the reasons for the Dawan's retention of traditional houses, ume kbubu, in the face of a national development campaign to introduce modern, 'healthy' homes (rumah sehat). Indoor smoke pollution from internal fires and poor ventilation is believed to contribute to poor respiratory health among this population. The study explored Dawan cultural constructions of health to find that ume kbubu are fundamental to the Dawan's sense of psychosocial well-being and ethnic identity. While rumah sehat are associated with prosperity, public image and social status they do not provide the warmth, security and emotional nurturance that the Dawan perceive as necessary for optimum health and to protect them from disease. [ABSTRACT FROM AUTHOR]

Abstract: Qualitative research was undertaken among Dawan people living in Fatumnasi, West Timor, to investigate the reasons for the Dawan''s retention of traditional houses, ume kbubu, in the face of a national development campaign to introduce modern, “healthy“ homes (rumah sehat). Indoor smoke pollution from internal fires and poor ventilation is believed to contribute to poor respiratory health among this population. The study explored Dawan cultural constructions of health to find that ume kbubu are fundamental to the Dawan''s sense of psychosocial well-being and ethnic identity. While rumah sehat are associated with prosperity, public image and social status they do not provide the warmth, security and emotional nurturance that the Dawan perceive as necessary for optimum health and to protect them from disease. [Copyright &y& Elsevier]

Regulatory differences between countries are an important driver of the cross-border trade in assisted reproduction as people move to seek services unavailable in their home countries. The development of a lucrative global trade in non-medical sex selection needs to be considered in ethical debates over its availability. I suggest that depictions of non-medical sex selection as a means of 'family balancing' or supportive of reproductive autonomy serve to distance the technologies rhetorically from the gender stereotyping inherent in their use and the commodification upon which they depend. They construct new social categories such as the 'unbalanced' family, the pathologization of 'gender disappointment' and a limited and highly individualized definition of reproductive freedom that permits medical interventions on healthy bodies. Orientalism pervades ethical debate depicting non-medical sex selection in the West as more acceptable to practices in 'Asia'. A case study of the interconnections between Australia and Thailand highlights the global economy sustaining the practice. [ABSTRACT FROM AUTHOR]

This paper gives an overview of the global commercialised market in assisted reproduction treatment in low-resource countries in Asia and raises concerns about access and equity, the potential commercial exploitation of the bodies of subaltern women to service the demand for donated ova and surrogate pregnancy, and the need for protections through regulations. A lack of systematic data about cross-border reproductive care is a significant obstacle to debate and policy intervention. Little is known about the extent, experience or conditions of cross-border reproductive care outside of Europe and the United States. Further research is needed in Asia on the local effects of this trade upon local health systems, couples seeking care, and those women whose body tissues and nurturing capacities facilitate it. More attention needs to be paid to the provision of publicly funded reproductive health services to address the inequitable distribution of treatment and to investigate means to regulate this trade by governments, international NGOs, professional organisations and civil society groups in developing countries. The global trade in assisted reproduction challenges us to balance the rights of individuals to pursue health care across national borders with the rights of those providing services to meet their needs, especially vulnerable groups in situations of economic disparity. Cet article donne un aperçu du marché mondial de la procréation médicalement assistée dans les pays à faibles ressources d'Asie. Il s'inquiète de l'accès et l'équité, la potentielle exploitation commerciale du corps des femmes subalternes qui satisfont la demande de dons d'ovules et de mères porteuses, et la nécessité de réglementations de protection. Un manque de données systématiques sur les soins génésiques transfrontaliers est un obstacle majeur au débat et aux interventions politiques. On sait peu de choses de l'étendue, de l'expérience ou des conditions des soins génésiques transfrontaliers hors de l'Europe et des États-Unis. De nouvelles recherches sont nécessaires en Asie sur les conséquences de ce commerce sur les systèmes locaux de santé, les couples demandant des soins, et les femmes dont les tissus corporels et les capacités porteuses les facilitent. Il faut accorder davantage d'attention à la prestation de services de santé génésique financés par les pouvoirs publics pour corriger la répartition inéquitable des traitements et prospecter des moyens de faire réguler ce commerce par les gouvernements, les ONG internationales, les organisations professionnelles et les groupes de la société civile dans les pays en développement. Le commerce mondial en procréation assistée nous met au défi de concilier les droits des individus à rechercher des soins de santé à travers les frontières avec les droits de ceux qui assurent des services pour répondre à ces besoins, en particulier les groupes vulnérables se trouvant dans une situation de disparité économique. En este artículo se expone una visión general del mercado comercializado internacional en el tratamiento de reproducción asistida en países asiáticos de bajos recursos, y se plantean inquietudes en cuanto al acceso y la equidad, la posible explotación comercial del cuerpo de mujeres subalternas para atender la demanda de óvulos donados y maternidad subrogada y la necesidad de protecciones mediante reglamentos. La falta de datos sistemáticos sobre el turismo reproductivo es un obstáculo significativo para el debate y la intervención de políticas. No se sabe mucho acerca del alcance, la experiencia o las condiciones del turismo reproductivo fuera de Europa y Estados Unidos. Aún es necesario realizar más investigaciones en Asia sobre los efectos de este comercio en los sistemas de salud locales, en parejas que buscan atención médica, y en aquellas mujeres cuyo cuerpo y capacidad para nutrir lo facilitan. Se debe prestar más atención a la prestación de servicios de salud reproductiva financiados públicamente, a fin de eliminar la injusta distribución de tratamiento e investigar los medios para la regulación de este comercio por gobiernos, ONG internacionales, organizaciones profesionales y grupos de la sociedad civil en países en desarrollo. El comercio mundial en reproducción asistida nos reta a sopesar los derechos de las personas de buscar servicios de salud en otros países y los derechos de los prestadores de servicios de atender sus necesidades, especialmente grupos vulnerables en situaciones de disparidad económica. [ABSTRACT FROM AUTHOR]

This article explores the challenges medical travel poses for the development and implementation of health regulation in Asia. Cross-border reproductive travel in Asia is used to exemplify some of the ethical, legal and regulatory complexities such travel poses. A number of countries in the region lack regulatory frameworks regarding controversial procedures such as preimplantation genetic diagnosis for sex selection, commercial donor and surrogacy procedures to ensure protections for donors and surrogates or children born of such procedures. The particular challenge of reproductive travel arises when people travel for services because they wish to undertake a treatment requiring the embodied services or biological materials of other people in ways that are not legal or considered unethical in their home country. The final part of the article examines prospects for a global response towards the regulation of such trade. Such a response will require cooperation across sectors, international government organizations, state, and non-state actors to deal with the transnational interdependence it involves and to protect the rights of vulnerable groups. The challenge is to determine the mechanisms for regulating the trade, as well as the basis upon which global regulation is undertaken. [ABSTRACT FROM PUBLISHER]

The article discusses various reports published within the issue including one by Beth Kangas on the ethnographical study of medical travelers from Yemen, one by Chee Heng Leng on the role of the state in advancing medical tourism, and one by Sallie Yea on the commercial kidney providers in the Philippines.

Cross-border reproductive travel involves the movement of patients to undertake assisted reproductive treatment through technologies, such as in vitro fertilization and associated procedures otherwise denied to them due to cost, access, or regulatory restrictions. Based on fieldwork in Thailand, the United States, and the Czech Republic, we explore the commodification of reproductive bodies within this trade and the reduction of the nurturing affective labor of reproduction to exchange value. Second, we examine the intensification and globalization of the stratification of reproduction. These inequalities are illustrated though discussion of the trade in poor women's bodies for surrogacy and ova donation. Even reproductive body parts, ova, sperm, and embryos are stratified-marketed according to place of origin, the characteristics of their donors, and gender. [ABSTRACT FROM AUTHOR]

The rapidly growing medical travel industry has implications for the health sytems of both sending and receiving countries. This article outlines the political economy of the industry and the potential opportunities and disadvantages it poses for access, equity, and the right to health. Although the trade carries economic benefits for countries receiving foreign medical patients, it comes at a cost to the provision of public health, through distortions in the health workforce and the development of two-tiered health systems. Inequalities and failures in the health systems of sending countries largely drive the need to travel for care. [ABSTRACT FROM AUTHOR]

Abstract: The new Penal Code in 2009 was an opportunity for Timor-Leste to allow some legal grounds for abortion, which was highly restricted under Indonesian rule. Public debate was contentious before ratification of the new code, which allowed abortion to save a woman’s life and health. A month later, 13 amendments to the code were passed, highly restricting abortion again. This paper describes the socio-legal context of unsafe abortion in Timor-Leste, based on research in 2006–08 on national laws and policies and interviews with legal professionals, police, doctors and midwives, and community-based focus group discussions. Data on unsafe abortions in Timor-Leste are rarely recorded. A small number of cases of abortion and infanticide are reported but are rarely prosecuted, due to deficiencies in evidence and procedure. While there are voices supporting law reform, the Roman Catholic church heavily influences public policy and opinion. Professional views on when abortion should be legal varied, but in the community people believed that saving women’s lives was paramount and came before the law. The revised Penal Code is insufficient to reduce unsafe abortion and maternal mortality. Change will be slow, but access to safe abortion and modern contraception are crucial to women’s ability to participate fully as citizens in Timor-Leste. [Copyright &y& Elsevier]

The article presents an exploration into the intersections between assisted reproductive technology in Thailand, geopolitical mobility, and the social dynamics of transnational migrant couples. The concept of "globalized reproduction" is defined and examined, linking the social implications and constructions of globalization with that of reproductive practices. Trends in cross-cultural marriage and transnational relationships are then described and social research quantifying and analyzing the elements of these trends is presented.

This paper mines data from in-depth interviews on family formation with 115 women, men and couples of family-forming age in eastern Australia to examine aspects of the complex phenomenon of living together unmarried. Sixty-five percent of interviews yielded evidence of one or more such relationships entered over approximately a 20-year period. Informants had rarely made considered 'decisions' to cohabit. Moving in had rather 'just happened', often after couples were 'sort of' living together anyway through regularly staying over with one another. What tended to be transitions rather than datable events were widely perceived to be 'natural progressions', and motives for them were typically more pragmatic than emotional. The notion of cohabitation as trial marriage did not resonate widely among cohabiters, but did appear to have aided increasing parental acceptance of the lifestyle. Non-cohabiters mostly cited religious belief, a desire not to offend parents or a view that by marrying directly they had shown greater commitment as reasons for not having lived together. Youthful entry to cohabiting relationships seems frequently to presage their dissolution as 'growing up' relationships in a climate that increasingly eschews serious family formation until some years later in life. Transitions to marriage, which remains a highly symbolic act of commitment despite being seen in some quarters as irrelevant, have a variety of triggers. Prominent among them are decisions to have children (notwithstanding widespread childbearing within cohabiting unions) and the age-old prerogative of a male to propose marriage as the mood takes him. [ABSTRACT FROM AUTHOR]

Abstract: Forced migrants face particular reproductive health problems. Migrant Burmese women in Thailand often need to work to support themselves and their families, and mistimed and unwanted pregnancies are a common problem. They have limited access to culturally appropriate reproductive health services and no access to safe elective abortion. They are at risk of deportation or at least harassment by Thai authorities if they travel. They use traditional methods such as herbal medicines, and employ lay midwives to provide pummelling and stick abortions to end their pregnancies. This ethnographic study used various methods to collect data over 10 months in Tak Province, Thailand. The authors describe the women''s motives and means of ending their pregnancies and some of the difficulties in obtaining reliable modern methods of contraception. This study highlights the need for reproductive health care for displaced populations. [Copyright &y& Elsevier]

Contemporary management of diabetes places heavy emphasis on control, particularly control of blood sugars and of food consumption. Interviews with people living with diabetes type 2 show how identity and social relationships are negotiated through what is often a contradictory language of control, surveillance, discipline and responsibility. People frequently discuss diabetes-related behaviour in terms that position themselves or others as disobedient children, or as wicked or foolish adults. These references occur alongside appraisals of the physical and social complexity of “compliance” with diabetic regimes and in some instances the difficulty of achieving effective control over blood sugar levels. Efforts to protect themselves from the stigmatising potential of diabetes may inadvertently undermine the agency of people who are already coping with a demanding discipline and a potentially disabling or life-threatening disease. [Copyright &y& Elsevier]

Numerous attempts have been made to reform Thailand's restrictive abortion laws. Andrea Whittaker outlines key organizations and institutions involved in reform advocacy and reviews current strategies and prospects for change. Current advocacy networks are active and increasingly effective at lobbying for reform and present an alternate model of advocacy within a conservative political climate. She finds that the push for reform has been argued on public health grounds, but most recently the notion of reproductive rights is being used to argue for the links between the abortion issue and broader health and social issues facing women. [ABSTRACT FROM AUTHOR]

Obtaining reliable information about induced abortion is notoriously difficult, especially where abortion is illegal. This article describes methods used in a study of illegal induced abortion among village women in Northeast Thailand. A variety of methods were used to gather in-depth qualitative data on abortion experiences including a randomized interview survey on reproductive health, in-depth interviews with women who had experienced an induced abortion in the last two years, and the use of vignettes in focus group discussions with men and women. The survey provided a broad overview of the extent of the experience of abortion. In-depth interviews through social networks proved more successful for obtaining reliable accounts of abortions and suggest that survey results were underestimates. Focus groups discussed the situational ethics involved in abortion decisions. Within an appropriate context and study design, it is possible to obtain highly sensitive information while respecting the privacy of informants. [ABSTRACT FROM AUTHOR]

Examines the abortion policy and practice in Thailand. Techniques to induce abortion; Experiences of women who have undergone illegal abortions; Public support for the reform of the abortion laws.

Introduces a series of articles pertaining to ways in which women's health is situated within the social, cultural and economic context in Southeastern Asia. Effect of social change on health; Health problems experienced by women workers in electronic factories in Thailand; Reproductive health; Family planning; Meanings of menstruation and menstrual regulation.

In Thailand abortion is against the law except in cases of risk to a woman's health or if the pregnancy is the result of rape or other sexual crimes. This paper presents an overview of the history of the abortion debate in Thailand based upon research conducted from 1997–2001 for an ethnographic and historical study. Information was taken from media reports from 1950 in the Thai and English language press, a review of parliamentary records and interviews with 10 key informants. The debate over legal reform started in 1973. A reform bill was passed in 1981 in the House of Representatives but defeated in the Senate, primarily due to the lobbying efforts of Chamlong Srimuang, the leader of a broad-based religious coalition, who has been central in the anti-reform movement since then. The current democratically elected government in Thailand offers the best hope yet for reform, though abortion remains a politically sensitive issue, sensationalised in the press to counter reform efforts. A new advocacy network has recently been formed, including a range of women's organisations, public health advocates, academics and journalists. Current proposals from governmental and medical profession bodies may make abortions available to some women, but most, who seek abortions due to socio-economic and family planning reasons, will continue to have to find abortions by whatever means they can. En Thaı̈lande, l'avortement est contraire à la loi sauf en cas de risque pour la santé de la femme ou si la grossesse résulte d'un viol ou d'autres crimes sexuels. Cet article retrace l'histoire du débat sur l'avortement en Thaı̈lande grâce aux recherches menées de 1997 à 2001 pour une étude ethnographique et historique. Les recherches ont utilisé des articles parus depuis 1950 dans la presse en langue anglaise et thaı̈, un examen des travaux parlementaires et des entretiens avec dix informateurs clés. Le débat sur la réforme juridique a commencé en 1973. Un projet de réforme a été adopté en 1981 par la Chambre des députés mais refusé au Sénat, essentiellement du fait des pressions de Chamlong Srimuang, chef d'une vaste coalition religieuse, qui est depuis au centre du mouvement anti-réforme. Le gouvernement actuel élu démocratiquement offre le meilleur espoir de réforme, même si l'avortement demeure une question politiquement sensible, traitée avec sensationnalisme dans la presse pour contrer les efforts de réforme. Un nouveau réseau de plaidoyer a récemment été formé, avec des organisations de femmes, des défenseurs de la santé publique, des chercheurs et des journalistes. Les propositions actuelles des organes gouvernementaux et médicaux peuvent donner accès à l'avortement à certaines femmes, mais la plupart, qui veulent avorter pour des raisons socio-économiques et de planification familiale, devront continuer à se débrouiller pour y parvenir. En Tailandia el aborto es ilegal al menos que el embarazo constituya un riesgo para la salud de la mujer o es resultado de una violación u otro crimen sexual. Este artı́culo revisa la historia del debate en torno al aborto en Tailandia, basado en una investigación realizada entre 1997–2001 para un estudio etnográfico e histórico. La información fue recopilada de notas periodı́sticas desde 1950 en la prensa en lengua thai e inglés, de los archivos parlamentarios, y entrevistas con diez informantes claves. El debate acerca de la reforma legal comenzó en 1973. Una ley de reforma fue aprobada por la Cámara de Representantes en 1981 pero rechazada por el Senado, debido principalmente a la influencia de Chamlong Strimuang, el dirigente de una coalición religiosa amplia, quien ha estado al centro del movimiento en contra de la reforma legal desde entonces. El actual gobierno democrático de Tailandia ofrece la mayor esperanza conocida hasta ahora para hacer efectiva la reforma, aunque el aborto sigue siendo un tema polı́ticamente sensible, tratado con sensacionalismo por la prensa en contra de los intentos de reforma. Se ha formado recientemente una nueva red de defensa y promoción que incluye una gama de organizaciones de mujeres, activistas de la salud pública, académicos y periodistas. Algunas propuestas planteadas actualmente por algunos organismos gubernamentales y sociedades profesionales médicas pueden dar acceso al aborto a ciertas mujeres, pero la mayorı́a, quienes buscan abortar por razones socioeconómicas y de planificación familiar, tendrán que seguir recurriendo a cualquier medio que tengan a su alcance. [ABSTRACT FROM AUTHOR]

Abortion decision making by rural villagers in Thailand must be understood within its broader economic, social and ideological context. Abortion laws are highly restrictive in Thailand, yet abortions remain common. This paper examines rural villagers' normative constructions of the act of abortion and the 'socially embedded morality' they bring to discussions about abortion. The paper is based upon seven focus group discussions with women and men and long-term ethnographic fieldwork in rural north-east Thailand. Vignettes based upon real stories of women stimulated detailed discussion in the focus groups of the circumstances under which abortion is acceptable. The paper first discusses the social construction of abortion in Thailand, definitions of abortion as Buddhist sin and ethnomedical categorizations of the foetus. Then it describes the major themes that emerged from focus group discussions and interviews on abortion decision making. The material conditions of women and men's lives, changing constructions of children and motherhood, and gender relations were all found to influence reproductive health decisions. Abortion is described through social idioms that allow villagers to reconcile the practice of abortion with acceptable social norms. [ABSTRACT FROM AUTHOR]

Provides information on the abortion law in Thailand. Regulations on health and family planning; Status of women in the country; Comparison between the Buddhist belief and abortion; Public opinion on the termination of pregnancy; Events and situations when abortion is allowed.

Discusses content literacy or the reading and writing instruction used in teaching physical education (PE). Incorporation of psychomotor and cognitive ability; Instruction on journal writing for PE classes; Details on the programs and aids which could be used by PE instructors.

The People First conference, which was held in Edinburgh, UK, in 1997, passed the following motion: ‘Day centres should not waste people’s time or people's lives'. This is a challenging statement which will be echoed by many people involved in providing and supporting day services for people with learning difficulties. The present article outlines how the King's Fund Changing Days project has tried to respond to this challenge over the past 5 years. More detailed accounts can be found in the publications which have resulted from the work. [ABSTRACT FROM AUTHOR]