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Milbank Q. 1990;68(Suppl. 2):179-204.

AIDS and the future of reproductive freedom.

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Columbia University.


The specter of pediatric AIDS fundamentally challenges elements of the liberal ideological basis of women's reproductive freedom. Many public health officials hold that preventing transmission of HIV from mother to fetus requires efforts to discourage pregnancy by infected women. For over two decades, however, genetic counselors, feminists, and medical ethicists have stressed the importance of nondirective counseling in the context of reproductive choice. The question now confronted by American society is whether it will be possible to frame an ideology of reproductive choice that recognizes the limits of liberal individualism, while preserving the basic features of reproductive freedom.


The single biggest threat to the reproductive freedom of women may be the AIDs epidemic. Liberal individualism has been a philosophical foundation that a great many people have built their morality upon. The Constitution of the US is based on the principles of liberal individualism. However, the world is quite different than it was when this particular philosophical ideology became popular. Today, the results of peoples liberties can result in the transmission of AIDs. Of particular concern for women is the vertical transmission from themselves to their child. Public opinion is strongly against this occurring because the child is view as an innocent victim of its mother's premeditated action. On the other side of the issue studies have shown that knowing that one has AIDs usually does not discourage women from getting pregnant and having their child. Of course the women who do have AIDs are more likely to be poor, black, or Hispanic. This creates a bias since affluent white women have better access to contraceptives and abortion. AIDs has forced women's reproductive choices into the social realm where it is supposed to be of no legitimate public interest. A striking parallel exists between the public condemnation of mothers with AIDs and the 100,000 women of the period 1920-1973 who had genetic disorders and were sterilized. I the country could support sterilizing women who were suspected of being able to transmit genetic disorders, it is not unlikely to think that they will demand that women with AIDs be sterilized as well. However, AIDs creates even more problems. If abortion becomes mandated for women with AIDs, both side of the abortion controversy will object. The choice side will view it as an infringement upon a woman's reproductive freedom, and the life side will see it as government mandated abortion.

[Indexed for MEDLINE]

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