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International aspects of ethical problems in obstetrics and gynaecology.

Until the middle of the twentieth century, family planning was commonly condemned as an immoral enterprise. This chapter argues that ethical disapproval made access to fertility regulation difficult, and that while the rich and educated were often able to access the services they needed, typically the poor could not. Thus, ethical interpretations caused much of the differential fertility observed between social classes, ethnic groups and ultimately much of the explosion in population that has characterized the last 50 years. Since the 1960s human rights have been interpreted to encompass the right to decide the number and spacing of children and as a result access to contraception has improved. Where several methods of contraception (backed up by safe abortion) are available, fertility always falls. But, unfortunately, consensus has not been reached on how to specify particular sets of rights (e.g. decision-making for adolescents), and no consensus exists on how to balance the opposing rights of the mother and fetus in the case of abortion. The ethics of the one-child family in China is also noted.