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SKI 111~1) Illil~llIS Private Decisions, Public Dilemmas Suzanne Wymelenberg for the INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, DC 1990

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National Academy Press 2101 Constitution Avenue, N.W. Washington, D.C. 20418 This publication is based on presentations at the annual meeting of the Institute of Medicine held in Washington, D.C., on October 19, 1988. The views expressed are those of the participants and do not necessarily reflect those of the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts both under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care? research, and education. This project was supported by a grant from the R. W. Johnson Pharmaceutical Research Institute, fonned in a recent reorganization of the research and development divisions of Ortho Pharmaceutical Corp., Ortho Biotech, McNeil Pharmaceutical, and Cilag International. Library of Congress Cataloging-in-Publication Data Wymelenberg, Suzanne. Science and babies: private decisions, public dilemmas l Suzanne Wymelenberg. p. cm. Includes bibliographical references. ISBN 0-309-04140-6. ISBN 0-309-04136-8 (pbk.) 1. Human reproduction Social aspects. 2. Contraception Social aspects. 3 Teenage pregnancy Social aspects. 4. Human reproductive technologyMoral and ethical aspects. I. Title. RG133.W96 1990 176 dc20 Copyright (A 1990 by the National Academy of Sciences Printed in the United States of America 90-35 1 1 1 CIP

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Preface Discussion of personal reproductive health is generally reserved for the most private of settings: between partners, or between health provider and patient. Yet in the past decade, new developments in reproductive science and ongoing political conflict have increasingly thrust matters of conception and contraception squarely into the public spotlight. At its Annual Meeting, October 19-20, 198S, the Institute of Medicine devoted a daylong symposium to ``Advances in Reproductive Biology: Implications for Research, Application, aIld Policy Development." This book, authored by Suzanne Wymelenberg, draws on that meeting of experts. It describes the state of our unders~ding of human fertility and allied issues, such as teenage pregnancy and prenatal care. It is clear throughout that both evolutionary and revolutionary advances in reproductive research lie ahead. The book concludes with chapters highlighting ethical concerns raised by interventions in human reproduction and public policy issues- difficult choices that America faces in the 1990s. Forthright public discussion of sexual topics usually confined to private conversations will be necessary, if exciting gains in our understanding of reproductive biol- ogy are to be sensibly translated into gains in reproductive health. This book is directed toward energizing that process. SAMUEL O. THIER President Institute of Medicine . . .

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