Embryo Project Encyclopedia

Endometriosis is a condition characterized by the growth of the endometrium, or the tissue that lines the uterus, outside of the uterus, and it is diagnosed through the presence of endometriotic lesions in the pelvic region. The disease is most often associated with abnormal and painful vaginal bleeding. Currently, minimal literature exists concerning the management of endometriosis in low and middle-income countries (LMICs), which may influence the lack of a cultural competent understanding of menstruation in LMICs and, therefore, a lack of evidence-based policies concerning menstruation.

In their 2014 article “A Comparison of the Menstruation and Education Experiences of Girls in Tanzania, Ghana, Cambodia, and Ethiopia,” hereafter “Comparison of Menstruation,” researchers Marni Sommer, T. Mokoah Nana Ackatia-Armah, Susan Connolly, and Dana Smiles examined various physical and social barriers impacting women’s management of menstrual health across Ghana, Cambodia, and Ethiopia. The authors examined barriers such as misinformation about menstruation and how schools limit girls’ ability to manage their menstrual cycles. They then compared their findings to a previous study led by Sommer on similar experiences shared by girls living in Tanzania. “Comparison of Menstruation” provides insight into the physical and social barriers to managing menstruation in low-resource contexts and serves as a precursor to the creation of educational resources intended to improve menstruation health management for women and girls.

In 2007, Françoise Baylis and Jason Scott Robert published “Part-Human Chimeras: Worrying the Facts, Probing the Ethics” in The American Journal of Bioethics. Within their article, hereafter “Part-Human Chimeras,” the authors offer corrections on “Thinking About the Human Neuron Mouse,” a report published in The American Journal of Bioethics in 2007 by Henry Greely, Mildred K. Cho, Linda F. Hogle, and Debra M. Satz, which discussed the debate on the ethics of creating part-human chimeras. Chimeras are organisms that contain two or more genetically distinct cell lines. Both publications discuss chimeras with DNA from different species, specifically in response to studies in which scientists injected human brain cells into mice. “Part-Human Chimeras,” contributes to a chain of ethical and scientific discussion that occurred in the mid-2000s on whether people should be able to conduct research on chimeras, especially in embryos.

In April 1994, Elizabeth Raymond, Sven Cnattingius, and John Kiely published “Effects of Maternal Age, Parity, and Smoking on the Risk of Stillbirth” in the British Journal of Obstetrics and Gynecology, now known as BJOG: An International Journal of Obstetrics and Gynecology. The article examines how advanced maternal age, defined as delivery at thirty-five years old or older, cigarette smoking, and nulliparity, or the state of never having given birth, can negatively impact pregnancy. At the time of publication, according to Raymond and colleagues, stillbirths comprised over half of all perinatal, or close to birth, deaths and more than one-third of total fetal and infant deaths in Europe and North America. In the article, Raymond and her coauthors demonstrate how certain risk factors may increase the risk of stillbirth at different stages of pregnancy, which helped set a foundation for future research in interventions to prevent stillbirth.

In 2006, bioethicist Jason Scott Robert published “The Science and Ethics of Making Part-Human Animals in Stem Cell Biology” in The FASEB Journal. There, he reviews the scientific and ethical justifications and restrictions on creating part-human animals. Robert describes part-human animals, otherwise known as chimeras, as those resulting from the intentional combination of human and nonhuman cells, tissues, or organs at any stage of development. He specifically criticizes restrictions against creating part-human animals made by the National Academy of Sciences, or NAS, in 2005, arguing that while they ensure that such research is morally justifiable, they might limit scientists from conducting useful science using part-human animals or entities. Robert challenges the moral rationales behind prohibiting chimera research, arguing that they may impede scientists from conducting research that could have important benefits to biology and medicine, and suggests how to balance the conflicting moral and scientific needs of such science.

On 5 April 2018, the documentary Period. End of Sentence. premiered at the Cleveland International Film Festival in Cleveland, Ohio. In the documentary, Rayka Zehtabchi, the director of the film, documents the stigma surrounding menstruation in India and follows a group of women in Kathikhera, a rural village in the Hapur district of India, as they manufacture and distribute sanitary pads. A group of high school students at Oakwood High School in Los Angeles, California, raised money to produce the documentary after one student was inspired by her visit to the United Nations Commission on the Status of Women in New York City, New York, which focused on the stigma surrounding menstruation in low-income countries. Period. End of Sentence. draws attention to the obstacles impeding proper menstrual health management in low-income contexts by documenting the women of Kathikhera’s journey to manufacture and sell sanitary pads.

In July 2015, Marni Sommer and colleagues published “Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue,” hereafter “Defining MHM,” in American Journal of Public Health. The authors discuss that growing interest in the gender gap in education raised awareness about girls’ obstacles to managing menstruation, especially in low-income countries. Increased focus on MHM pushed menstruation to be redefined as a public issue rather than a private one. That transition made MHM the responsibility of national governments instead of just the responsibility of young girls, because it became more widely recognized that girls could only appropriately manage menstruation if they had access to the necessary resources through public infrastructure. “Defining MHM” outlines how defining MHM as a public health issue brought much-needed attention to the obstacles to MHM young girls face and emphasizes that other underrepresented public health issues could use similar tactics as the MHM movement to gain global attention and funding.

In 2006, the United States Food and Drug Administration, or FDA, published the “Requirements on Content and Format of Labeling for Human Prescription Drug and Biological Products,” also called the Physician Labeling Rule, to improve the safety and efficacy of prescription drugs and drug products. Within the Physician Labeling Rule, the FDA includes a section titled “Use in Specific Populations” or Section 8, which refers to drugs used by pregnant women, lactating women, and people of reproductive capacity. The FDA stated that the purpose of the Physician Labeling Rule was to make drug labels easier for physicians to understand and use when prescribing drugs to pregnant women. With the Physician Labeling Rule, the FDA improved patient-physician communication and the safety of drug use during pregnancy.

In 1987, the World Health Organization, or WHO, took action to improve the quality of maternal health around the world through the declaration of the Safe Motherhood Initiative, or the SMI, at an international conference concerning maternal mortality in Nairobi, Kenya. Initially, the SMI aimed to reduce the prevalence of maternal mortality around the world, as over 500,000 women died during pregnancy and childbirth annually at the time of its inception, while about 98 percent of those deaths occurred in low-income countries. While WHO led the initiative, many organizations in various countries participated in additional programs in order to implement the goals of the SMI. WHO developed the SMI in order to reduce the prevalence of maternal death, developing one of the first proposals that brought attention to maternal health on a global basis at a time when global maternal mortality was high.