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As biomedicine becomes increasingly enmeshed in modern life, biomedicalization processes have implications for reproductive policy, including abortion policy. Informed consent provisions have been a prominent trend in state-level abortion lawmaking in the United States in recent years. Modeled on the practice of securing informed consent for medical procedures, informed consent provisions stipulate the information a person must receive before they can consent to an abortion. Informed consent provisions purportedly require that this information be objective, scientifically accurate, and non-judgmental. Through an analysis of informed consent provisions in Texas abortion legislation from 1993 to 2015, this chapter explores how such provisions employ medical and biomedical tropes to frame regulations that restrict access to abortion care as ostensibly protecting women’s health and safety. I find that informed consent legislation in Texas selectively borrows from medical and biomedical lexicons, cites strategic empirical evidence, and co-opts medical techniques and experts in ways that encumber abortion access.

Little is known about perceptions of medical expenditure risks despite their presumed relevance to the demand for health insurance. This is the first study to examine households’ beliefs about their future spending on health care. The study made a unique elicitation of subjective probabilities of medical expenditures from rural Ethiopians participating in a panel survey and offered the opportunity to enrol in a health insurance programme. The vast majority of respondents give logically consistent responses to the subjective probability questions. The data indicate that the cross-sectional variance of realized expenditures, which is often used to proxy risk exposure, greatly overestimate the risk faced by any single household. Consistent with the serial correlation observed in realized expenditures, expectations are positively correlated with past expenses. They are revised upward in response to an increase in realized expenditure and, to some extent, they predict expenditure incurred in the year ahead. Despite containing information on future medical expenditures, there is no evidence that expectations influence the decision to take out health insurance, although plans to insure are positively related to the perceived volatility of expenses.

These results suggest that adverse selection may not threaten the viability of voluntary health insurance. A caveat is that measurement error in the reported probabilities may weaken the test for adverse selection. Notwithstanding this limitation, measurement of household-specific distributions of future medical expenses is feasible and avoids relying on the cross-sectional variance, which provides an upwardly biased estimate of medical expenditure risk.

If rational individuals pay the full costs of their decisions about food intake and exercise, economists, policy makers, and public health officials should treat the obesity epidemic as a matter of indifference. In this paper, we show that, as long as insurance premiums are not risk rated for obesity, health insurance coverage systematically shields those covered from the full costs of physical inactivity and overeating. Since the obese consume significantly more medical resources than the non-obese, but pay the same health insurance premiums, they impose a negative externality on normal weight individuals in their insurance pool.

To estimate the size of this externality, we develop a model of weight loss and health insurance under two regimes – (1) underwriting on weight is allowed and (2) underwriting on weight is not allowed. We show that under regime (1), there is no obesity externality. Under regime (2), where there is an obesity externality, all plan participants face inefficient incentives to undertake unpleasant dieting and exercise. These reduced incentives lead to inefficient increases in bodyweight, and reduced social welfare.

Using data on medical expenditures and bodyweight from the National Health and Interview Survey and the Medical Expenditure Panel Survey, we estimate that, in a health plan with a coinsurance rate of 17.5%, the obesity externality imposes a welfare cost of about $150 per capita. Our results also indicate that the welfare loss can be reduced by technological change that lowers the pecuniary and non-pecuniary costs of losing weight, and also by increasing the coinsurance rate.

Blacks are more likely than white, in the United States, to experience a stillbirth. In this study, I use a structural perspective of race to create a heuristic model that combines medical and social epidemiological explanations to understand the racial disparity in stillbirths. Using data from the National Maternal and Infant Health Survey 1988 (NMIHS), I examine whether racial disparities in stillbirths can be explained by medical and social epidemiological variables. My findings show that medical and social epidemiological explanations do little to reduce the racial disparity. However, many medical model variables were important predictors of stillbirths including multiple gestations, being overweight, obesity, vaginal bleeding, advanced maternal age, and parity.

As maternal mortality increases in the United States, birth providers and policymakers are seeking new solutions to address what scholars have called the “C-section epidemic.” Hospital cesarean rates vary tremendously, from 7 to 70 percent of all births. Based on in-depth, semi-structured interviews with 47 obstetricians and family physicians in the United States, I explore one reason for this variation: differences in how physicians perceive and manage risk in American obstetrics. While the dominant model of risk management encourages high levels of intervention and monitoring, I argue that a significant portion of physicians are concerned about high intervention rates in childbirth and are working to reduce cesarean rates and/or the use of monitoring technologies like continuous fetal heart rate monitors. Unlike prior theories of biomedicalization, which suggest that health risks are managed through increased monitoring and intervention, I find that many physicians are resisting this model of risk management by ordering fewer interventions and collecting less information about their patients. These providers acknowledge that interventions designed to mitigate risks may only provide an illusion of control, rather than an actual mastery of risks. By limiting interventions, providers may lose this illusion of control but also mitigate the iatrogenic effects of intervention and continuous monitoring. This alternative approach to risk management is growing in many medical fields and deserves more attention from medical sociologists.

Purpose – Using elective egg and sperm freezing as a case to compare representations of men and women as agents of biological reproduction, this chapter aims to understand how gender and risk are co-produced in the context of new reproductive technologies (NRTs).

Methodology – Through a content analysis of newspaper articles published between 1980 and 2016 about egg and sperm freezing, the author traces how fertility risks facing men and women are portrayed in the media.

Findings – Candidates for egg freezing were portrayed in one of the three ways: as cancer patients, career women, or single and waiting for a partner. The ideal users of sperm freezing are depicted in primarily two ways: as cancer patients and as employees in professions with hazardous working conditions. Threats to future fertility for women pursuing careers uninterrupted by pregnancy and child-rearing and women seeking romantic partners are largely portrayed as the result of internal risks. However, threats to future fertility for men working in dangerous professions are largely portrayed as external to them.

Research Limitations – Race and class did not emerge as dominant themes in these data; given the lack of accessibility to NRTs by class and race, this silence must be interrogated by further research.

Value – By comparing the constructions of at-risk groups, the author argues the medicalization of reproduction is gendered as fertility risks portrayed in the media take on a different character between men and women. This research shows how the gendered construction of infertility risk reinforces normative expectations around child-rearing and perpetuates gender inequity in parenting norms.

To examine the ways in which sports-related brain injury (concussion and subconcussion) is both similar to and different from other injuries and to set out a sociological understanding of the injury, its manifestation and management.

There is a broad contextualization of the ‘issue’ of concussion and the processes that have brought this to the fore, an examination of the ways in which concussion has been figuratively clouded from plain view, and an outline of the main contributions of the social sciences to understanding this injury – the culture of risk and the mediating effect of social relationships. The chapter concludes by questioning whether the emergence of concerns over chronic traumatic encephalopathy has stimulated a fundamental change in attitudes towards sport injuries, and if this has had a significant impact on the social visibility of concussion.

The two available sociological studies of the lived experiences of concussion are situated within a broader analysis of the politicization of sports medicine and the emergence of a particular social discourse around sports-related brain injury.

The difficulties emanating from the dominance of a biomedical approach to concussion are discussed along with the need for further research, incorporating a more holistic view of concussion, as a bio-psycho-social phenomenon.

Research examining the experiences of women in the workplace has, to a large extent, neglected the unique stressors pregnant employees may experience. Stress during pregnancy has been shown consistently to lead to detrimental consequences for the mother and her baby. Using job stress theories, we develop an expanded theoretical model of experienced stress during pregnancy and the potential detrimental health outcomes for the mother and her baby. Our theoretical model includes factors from multiple levels (i.e., individual, interpersonal, sociocultural, and community) and the role they play on the health and well-being of the pregnant employee and her baby. In order to gain a deeper understanding of job stress during pregnancy, we examine three pregnancy-specific organizational stressors (i.e., perceived pregnancy discrimination, pregnancy disclosure, and identity-role conflict) that are unique to pregnant employees. These stressors are argued to be over and above the normal job stressors experienced and they are proposed to result in elevated levels of experienced stress leading to detrimental health outcomes for the mother and baby. The role of resilience resources and learning in reducing some of the negative outcomes from job stressors is also explored.

This paper first reviews the history of social insurance policy and coverage in urban China, documenting the evolution in the coverage of pensions, medical and unemployment insurance for both local residents and migrants, and highlighting obstacles to expanding coverage. The paper then uses two waves of the China Urban Labor Survey, conducted in 2005 and 2010, to examine the correlates of social insurance participation before and after implementation of the 2008 Labor Contract Law. A higher labor tax wedge is associated with a lower probability that local employed residents participate in social insurance programs, but is not associated with participation of wage-earning migrants, who are more likely to be dissuaded by fragmentation of the social insurance system. The existing gender gap in social insurance coverage is explained by differences in coverage across industrial sectors and firm ownership classes in which men and women work.

This chapter investigates knowledge and practices relating to the ‘right timing’ in reproductive biomedicine in Switzerland. More precisely, it focuses on the effects of an anticipatory regime (Adams, Murphy, & Clarke, 2009) on women's experiences of age-related infertility. As assisted reproductive technologies (ARTs) promise to intervene in the fixed ‘biological facts’ of fertility decline to render reproduction and the timing of motherhood more flexible, manageable and controllable, this chapter explores the effects of anticipation on women's experiences and negotiations of age-related infertility and ARTs. It sheds light on an anticipatory regime which can be called ‘motherhood as right timing’. It shows how, in this regime, the temporality of the lifecourse is brought back to a biological temporality and how expectations and injunctions towards managing and controlling time contain the possibility of their failure, as they are associated with a multiplication of uncertain, complex and resisting biologies. At the core of the practices and politics of anticipating fertility decline, there is a tension between acting upon and being acted upon time, which are embedded in a moral economy of responsibility and volition in which women are blamed, or blame themselves, for not anticipating what is by definition beyond individual control and anticipation.