Family planning: bioethical dilemmas found in the literature

Laura Xavier de Moraes – PhD student – lauraxaviermoraes@gmail.com

Carla Andreia Alves de Andrade – PhD student – carlandrya2@yahoo.com.br

Fernanda da Mata Vasconcelos Silva – PhD student – nandadamata34@gmail.com

Aurélio Molina da Costa – PhD – aumolina55@gmail.com

Fatima Maria da Silva Abrão – PhD – abraofatima@gmail.com

Francisco Stélio de Sousa – PhD – stelio_uepb@yahoo.com.br

The authors declare no conflict of interest.

Authors’ contribution

All authors participated in the study planning. Laura Xavier de Moraes contributed at all stages. Carla Andreia Alves de Andrade and Fernanda da Mata Vasconcelos Silva participated in data collection and manuscript writing. Aurélio Molina da Costa, Fátima Maria da Silva Abrão and Francisco Stélio de Sousa advised the study and reviewed the final version of the manuscript.

Author, year	Country	Methodological design
Sanches, Simão-Silva; 2016¹²	Brazil	Qualitative, reflexive in nature.
Mai, Ripke; 2017¹³	Brazil	Qualitative, descriptive and exploratory.
Lin; 2011¹⁴	Taiwan	Qualitative, reflexive in nature.
Aloosh, Saghai; 2016¹⁵	Iran	Qualitative, descriptive and exploratory.
Guiahi; 2018¹⁶	USA	Qualitative, reflexive in nature.
Serour; 2013¹⁷	Egypt	Qualitative, reflexive in nature.
Tonkens; 2011¹⁸	Canada	Qualitative, reflexive in nature.

Author	Results
Sanches, Simão-Silva; 2016¹²	“Family planning” is a multifaceted term that refers to a relevant tool for female empowerment due to the emergence of effective contraceptive methods. It is important to distinguish this technique from birth rate control policies, which aim to reduce the number of births for the benefit of a government. Religion also influences family planning due to possible conservative dogmas. New reproductive technologies have been changing the bioethical discussions on this topic.
Mai, Ripke; 2017¹³	Technological advances in conception range from how fertilization takes place to the number and profile of individuals involved. Such advances make it possible to cure genetic diseases but bring the issue of eugenics back into the debate. It is necessary to broaden the discussions on the topic in academic, scientific, professional, and social circles.
Lin; 2011¹⁴	Autonomy in reproductive decision-making has seen significant gains with the development of long-acting contraceptives, giving women more freedom. However, female empowerment still requires the promotion of education on family planning since autonomy must be strengthened by providing information.
Aloosh; Saghai, 2016¹⁵	Family planning is extremely sensitive to public health policies since the social development of the population seems to be directly related to this practice. Health education is necessary to prevent the increase in rates of unwanted pregnancy, illegal abortion, sexually transmitted diseases, and poverty.
Guiahi; 2018¹⁶	Religious health units can be a barrier to reproductive planning when they interfere with decision-making and oppose contraceptive use. Religious dogmas still permeate the structure of traditional marriage with a very patriarchal vision, for which the exercise of sexuality is not always free.
Serour; 2013¹⁷	Women’s autonomy within family planning must be respected after providing contextualized, evidence-based information. Thus, public policies must be rethought to provide health information free from external interference. However, conservative religions (such as Islam) can undermine family planning by preventing decision-making from being truly autonomous.
Tonkens; 2011¹⁸	Prenatal genetic improvement seems to be a revolutionary tool in family planning, making it possible to cure genetic diseases still in vitro. However, these techniques must be discussed in light of bioethics, having parental guidance as its axis, especially in the face of the first wave of genetically altered humans.

Initial category	Guiding concept	Intermediate category
1. Women empowerment	Highlights the gains in female reproductive and sexual freedom after the discovery of effective contraceptives.	1. Women as active subjects in reproductive choice
2. Autonomy	Asserts the right to decide free from pressure and authoritarianism.	2. Sexual and reproductive independence
3. Free exercise of sexuality	Enables individuals to experience sexuality without risking an unwanted pregnancy.
4. Reproductive decision-making	Right to reproductive decision based on contextualized information.
5. Reproductive freedom	Emphasizes the right to freedom of reproductive choice.
6. Health education	Points out the importance of sexual and reproductive education actions.	3. Public health policies
7. Reproductive planning	Asserts the right to plan (when, where and how) to have or not have children.
8. Contraceptive methods	Defines methods (artificial or natural) that allow individuals to avoid conception.
9. Social development	Reproductive planning enables economic and sociocultural advances.
10. Unwanted pregnancy	Pregnancy in inadequate personal, sanitary, and social situations.	4. Consequences of the absence of effective public policies
11. Illegal abortion	Termination of pregnancy without the support of regulated health services.
12. Disease transmission	Disease transmission due to unprotected sexual activity.
13. Population control	Seeks to reduce the number of births by non-consensual means.	5. State oppression
14. Conservative principles	Defends the maintenance of the traditional family and women’s traditional role.	6. Sociocultural and religious stigmas
15. Religious doctrines	Points to certain religions as a barrier to reproductive planning.	6. Sociocultural and religious stigmas
16. Reproductive technologies	Scientific techniques that aid human reproduction.	7. Heredity control
17. Prevention of genetic diseases	In vitro gamete selection to prevent genetic diseases.	7. Heredity control
18. Genetic improvement	Gamete selection based on the genes one wants to express.	8. Eugenics
19. Heal or create people	See human identity based solely on their genes.	8. Eugenics

Intermediate category	Guiding concept	Final category
1. Women as active subjects in reproductive choice	Points to contraceptive gains as tools for female sexual/reproductive freedom.	1. Right to sexual/reproductive freedom and autonomy
2. Sexual and reproductive independence	Emphasizes sexuality as a universal human right, which must be exercised without external pressures.	1. Right to sexual/reproductive freedom and autonomy
3. Public health policies	Offer of government actions and programs geared towards reproductive planning.	2. Government interference in family and reproductive planning
4. Consequences of the absence of effective public policies	Shows the existing flaws in structuring public policies aimed at reproductive planning.
5. State oppression	Possible control exercised by certain governments to prevent or encourage population growth.
6. Sociocultural and religious stigmas	Influence of sociocultural and religious factors on sexuality and reproductive planning.	3. Sociocultural and religious barriers to family planning
7. Heredity control	Selection of gamete genes so the embryo formed follow certain patterns.	4. Improvement of technologies for pre-embryo handling
8. Eugenics	Search for human improvement based on hereditary characteristics to improve future generations.	4. Improvement of technologies for pre-embryo handling

[1] Correspondence: Laura Xavier de Moraes – Rua Dr. Otávio Coutinho, s/n, Santo Amaro CEP 52171-011. Recife/PE, Brasil.

Brasil

Brasil

Family planning: bioethical dilemmas found in the literature

Abstract