And its determination to experiment with alternative forms of ownership and community participation include valuable lessons for any progressive movement. Yet an obvious question emerges. The global establishment, in spite of some initial nervousness, has come to understand that this movement for a social economy, when it does not aim higher, is not a threat. It is not just that the elites view this trend as being safe, but that they also see it as being functional to globalization.
With privatization and the erosion of social services, the attempt to provide decentralized alternatives may—inadvertently—legitimate, or at least act to limit opposition to, the regressive changes. Again, I want to be careful not to ignore differences within this movement. It is one thing, as in Porto Alegre, where the movement includes many activists tied to a larger, politicized, anticapitalist project. But where this is not the case, the social economy movement ironically suffers from the same limits it sees in the social democratic parties it has so much contempt for.
Not oriented to mobilizing against corporate power, it becomes either peripheral to change or is incorporated into the system. But is there any basis for believing that globalization, that is to say modern capitalism, can be challenged? There are those who believe that capitalism will collapse from its internal contradictions; I consider this to be one of the weakest aspects of the Marxist legacy. There are, I believe, particular developments within capitalism that leave openings for its legitimacy to be challenged, and the authority of its elites questioned.
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But capitalism will only end when there is a movement with the vision, confidence, and capacity to replace it. In the first world, the opening lies in the question of whether what has been achieved is in fact the best humans can strive for. Global inequality has been rising relentlessly. The World Bank—a prominent player in articulating globalization as both good and necessary, and keenly aware of the political implications of this historical record of growing global inequality—has acknowledged that globalization has left billions of people behind.
This sham argument ignores, first, that where growth has come, it has come not with a general improvement in social justice but with costs in terms of internal democracy, human rights, and equality. The most prominent example, South Korea, did not achieve what it did because its policies were so clever—though they were relevant—but because of its special importance to the United States during the Cold War. This meant that, like Europe before and unlike the third world more generally it received a form of Marshall Aid military spending during the Korean and Vietnam wars and was also given free access to the U.
Third, as long as the successful development model is focused on poor countries competing to export to the West, universal development is a contradiction in terms. The third world can only move towards overall development if there is a focus on mobilizing and developing their human and natural resources to address internal needs.
They do not have to cut themselves off from trade and investment, though they must insist on tightly regulating them to strengthen their internal development. A look at the history of U. The substitution of foreign for domestic manufacturing is a transfer to foreign nations of the advantages occurring from the employment of machinery. Sometime later, James Madison, a principal author of the U. Constitution and later president of the United States, asserted:. The power [to regulate trade] has been understood and used by all commercial and manufacturing nations, as embracing the object of encouraging manufactures.
It is believed that not a single exception could be found. I do not know much about the tariff, but I do know this much, when we buy manufactured goods abroad, we get the goods and the foreigners get the money. When we buy the manufactured goods at home we get both the goods and the money. And at the beginning of the twentieth century another U. We lead all nations in agriculture; we lead all nations in mining; we lead in manufacturing. These are the trophies we bring after [several decades] of a protective tariff.
There have of course been movements within the third world—some inspired by their reading of the history of the West, some inspired by Marxism—that have clearly understood that another path to development was crucial. This implied that domestic conflict was necessary to change internal social structures and relationships—the problem has never simply been that of external domination.
But where this threatened corporate and particularly U. The movements of any country—whether communist, socialist, or nationalist—that aimed to break out of the rules established by the West were ruthlessly crushed, condemning those countries to continuing misery, issuing a warning to others contemplating a similar path, and—by destroying the secular opposition—opening the door to the alternative of religious mobilization and extremism.
As the events of September 11 showed, and common sense should have forewarned, the costs of decisions made by elites in the first world could ultimately not be confined to the third world. Globalization did create one world—however unequal—not three, and aside from moral and human responsibilities, we are now implicated and affected by what happens everywhere. In the developed West, the internal issue is not so much whether capitalism can deliver on economic growth as it is the nature of that growth. Reproductive tourism by attracting international clients from Western countries because treatment can be offered at lower prices is a real danger and is already reported in India Vayena, We also have to realize that even if universal access to infertility care will be available, barriers will always remain considerable.
Not only in many Islamic countries Serour, but also in Latin America the use of ART is severely restricted because of religious doctrines Inhorn, In India a conflict with the normative value of Hindu because of the involvement of a third party which compromises the process of conception has been described Bharadwaj, Consequently, traditional healers will play an important role and have to be educated about the new developments in infertility practice.
Because they speak the language of the local people and appeal to local cultural belief, their support and cooperation will be crucial. Infertility care has to be an essential part of a more comprehensive reproductive health care program including infertility and HIV prevention, family-planning and safe mother-care, a go-together of prevention and treatment programs Sharma et al.
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Global access to infertility care is the key message but can only be implemented and sustained if they are supported by local policy makers as well as the international community. The implementation of new reproductive technologies will require well-organised education and training programmes. Regular audits and systems of accreditation and registration should be implemented in order to maintain appropriate standards of care in all centres involved. The need for funding is crucial and is likely to require input and collaboration from various role players. Funding is needed for the fixed costs of new fertility centres building, equipment, I hope that the medical and pharmaceutical industry will also make relevant contributions such as providing cheap medication, manufacturing of basic ultrasound and laboratory equipment at low price etc.
Foundations have to be convinced about the value of this project, taking into account the growing demand from the developing countries itself and the case of equity and social justice. All these organization can contribute actively in the realisation of this project.
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Table II summarizes the urgent needs for the Arusha Project. The great majority of infertile and childless couples are residents of developing countries. Bilateral tubal occlusion due to sexually transmitted diseases STDs and pregnancy-related infections is the most common cause of infertility in developing countries. Consequently most cases of infertility are only treatable by using assisted reproductive technologies ART which are either unavailable or very costly and only within reach of the happy few who can afford it. Prevention remains the number one priority, not only the prevention of STDs but also the prevention of infertility due to unsafe abortions and deliveries.
We urgently need a better public education on reproductive health and raising awareness of health care providers and politicians on the importance of childlessness. Most striking is the total lack of interest of the international society including foundations and non-governmental organizations working in the field of reproductive health.
Time has come to change policies and to realize that access to infertility care is one of the largest emerging fields in global medicine. The immense problem of childlessness in developing countries requires greater attention at national and international levels for reasons of social justice and equity. Keystones in the successful implementation of infertility care in low-resource settings include simplification of ART procedures in order to establish accessible good quality infertility services at low cost.
To conclude, I believe that global access to infertility care in developing countries can only be achieved when good quality but affordable infertility care is linked to more effective family planning and safe motherhood programmes. If couples are urged to postpone or widely space pregnancies, it is imperative that they should be helped to achieve pregnancy when they so decide, in the more limited time they will have available.
Mother or nothing — the agony of infertility - M. Fathalla, WHO Bulletin, I would like to thank Dr Nathalie Dhont for the critical revision of this article. We gratefully acknowledge Ingrid Jossa for the technical support in preparing this manuscript. National Center for Biotechnology Information , U. Facts Views Vis Obgyn.
Find articles by W. Author information Copyright and License information Disclaimer. Correspondence at: eb. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.
Abstract According to WHO data more than million couples in developing countries suffer from primary or secondary infertility. Keywords: Developing countries, equity, government, human rights, infertility treatment, involuntary childlessness, low cost ART, social justice. Introduction As the power of medical technology advances, more and more difficult questions are raised about what sorts of rights to such technologies people might have, especially in resource-poor countries. The Facts The large majority of childless couples are residents of developing countries.
Open in a separate window. Total fertility trajectories for the world and the major development groups, World Population Prospects: The Revision, page 6. Life expectancy at birth for the world and the major development groups, World Population Prospects: The Revision, page Some of the most important foundations, NGOs and international societies linked to reproductive health. Table I. Global access to infertility care in developing countries: facts, views and vision.
Views The level of reproductive health care education is very low in most developing countries although it is the most cost-effective strategy in the prevention of unwanted pregnancies and sexually transmitted diseases Lutz and Goujon, Population and Development Review ; Vision Infertility care has to be an essential part of a more comprehensive reproductive health care program including infertility and HIV prevention, family-planning and safe mother-care, a go-together of prevention and treatment programs Sharma et al.
Table II. Important challenges for the Arusha Project C Janisch, , personal communication. Conclusion The great majority of infertile and childless couples are residents of developing countries. Acknowledgments I would like to thank Dr Nathalie Dhont for the critical revision of this article. Contributor Information W. References Aboulghar MA. The importance of fertility treatment in the developing world. Affordable ART: a different perspective.
Hum Reprod. Why adoption is not an option in India: the visibility of infertility, the secrecy of donor insemination, and other cultural complexities. Soc Sci Med. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Worldwide patterns of infertility: is Africa different? Geneva, Switzerland: World Health Organization; Infertility and social suffering: the case of ART in developing countries; pp. HIV infection and sexual behaviour in primary and secondary infertile relationships: a case — control study in Kigali, Rwanda.
Sex Transm Infect. Clinical, epidemiological and socio-cultural aspects of infertility in resource-poor settings PhD Summary www. Pharmaceuticals Policy and Law 9. International treatment differences: Policy, politics, partnership and ART; pp. Psychological distress among women suffering from couple infertility in South Africa: a quantitative assessment. Patterns and predictors of infertility among African women: a cross-national survey of twenty-seven nations.
Sexual and reproductive health for all: a call for action. We love to trace our philosophical thoughts to Greece and Rome, but we ignore that both civilizations believed in a government run by the well educated and property class—nothing more, if I may add, than an oligarchy—and what later would be called the European nobility. The expectation remained in Europe, and the rest of the world except America , that the masses were destined to live at the brink of starvation, famine and disease.
This was the way it had been since the dawn of civilization. The human condition was characterized first by chaos and then misery—as the strong plundered the weak. Economic life was a struggle, pure and simple. Life was brutal and short, void of human rights or justice. The idea of a social contract between government and the people or that people had natural rights and could live a descent life, with opportunities for improving their condition, was considered illogical and contrary to the norms of society. It violated the customs and traditions of the relations that bounded the Church and the faithful, Prince and subject people, property owner and peasant, master and servant.
Equally disturbing was that in the normal course of events ordinary people did not expect anything but misfortune and privation, nor did they expect significant improvement in their social status or standard of living. From the beginning of recorded history, the workers and weaker members of society expected to be pressed down and exploited. The majority opinion was that the passions of men did not conform to the ideas of reason, fairness or justice; hence, there was the uncritical acceptance of the selfish nature of man—and that the strong would prey over the weak.
A slightly more optimistic current took hold in America, spearheaded by political leaders who were influenced by the humanitarian ideas of the Age of Enlightenment. Still, the concepts of slavery and indentured servants existed and were woven into the social order during the colonial and post-colonial era. In Europe Locke, Voltaire, and Rousseau were considered extremely radical among their contemporaries, promoting ideas based on a false and untenable conception of human nature. In some ways they were the mouse that roared.
Few people of power and property took them seriously, but eventually their writings began to seep into discussions at the taverns and coffee shops of Geneva, London and Paris. During the Industrial Revolution which started in merry-old England around the time of the American Revolution, special skills and special abilities of people resulted in slightly higher wages than the norm.
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But the fixed economic system and social traditions of prior societies directed toward the past remained intact, rather than toward a future which men themselves might shape. The amount of people who rose from pittance to what might be called middle class was miniscule in numbers compared to the masses who remained poor and destitute. Actually, the Industrial Revolution increased inequality between the mercantile and manufacturing class with the labor and working class because the vast portion of wealth attributed to economic growth went to the economic elite, not the masses.
We are not all in the same boat, as Jack found out the hard way in the movie Titanic. No doubt the new industries allowed a tiny number of entrepreneurial people to accumulate capital and equipment. Thus a few people endowed by nature, that is by strength and cunning, were able to take advantage of the fruits of their power and abilities. This idea was modified in the New World, whereby common people could successfully compete and fit well into the American landscape, largely because of the frontier experience, the abundance of free land and natural resources, the constant flow of immigrants, and the long-favored notion of progress and change.
Moreover, there was no history of warlords, family lineage or bloodlines; the land had not been carved up by centuries of war and strife, by warlords who later became known as Dukes, Earls, and Barons. The point is that in the U. In both centuries, however, the capitalist system evolved from the brutal conditions of the ancient world: The strong survived and the weak barely existed or perished.
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Life was a struggle, a part of nature—where every group, every animal or human was always in a ceaseless struggle with its environment and its species. There is little concern for the working person—as well as for the weak, the old, the disabled, etc. Immigrants fleeing from oppressive governments or economic hardship can start a new life and have multiple chances to succeed.
Keep in mind our history: The ideas of the Enlightenment, when transported across the ocean, prevailed over authoritarianism and theocracy. Thank the heavens that a group of middle-aged rebels were willing to put their lives on the line, and thank Thomas Jefferson who wrote the Declaration of Independence and said the right words at the right time and provided the framework that gave us the natural right to establish the rights of people and separate the church and state.
Of course, the English aristocrats and conservatives did not see it the same way. Liberty and freedom are not given to a country, but it is a result of hard-won struggles, a belief in the rights of all people and the protection of minority rights. It is not easy to transcend religion in a deeply religious country as ours, and to allow secular laws to prevail. It is not easy to overcome the power of the rich and allow the people to govern, whereby the rich ultimately have to answer to the people and where the rule of law prevails.
In the U. There would be genuine reform in which people of different classes and occupations would come nearer in speaking the same language and have similar opportunities than anywhere else in the world. The ultimate question comes down to what we should do so all Americans could thrive. The answer was to use government to bring about reform so everyone had the potential to prosper.
The country would have to work for everyone! A government of the people and for the people was the only counter force powerful enough to curtail corporate power and abuse. So we are the lucky ones. Over the course of nearly years, this nation has grown from a small cluster of colonies with a ragtag collection of people and a makeshift army, to a free, mighty, and wealthy nation—the most influential one in the history of humankind and on the present world stage.
How was this possible? Does it boil down to accident, luck, or design? I cannot give you a precise answer—why we are the chosen ones, or the lucky ones. The answer, to some extent, comes from the heart, from the feelings and emotions of plain people, immigrant people, and working people who inhabit our landscape and who know they are free: Free from the yoke of oppression, free from the sword, whip and boot—and therefore strive, innovate, and invent. Despite that we are a nation of many nations, with different customs and folklore, we all speak the same language as free men and women and breathe the same free air.
Here common people can fulfill their dreams. Here justice has a chance to prevail. The human being—confident, self-reliant, tolerant, generous, future oriented—is a vast improvement over the wretched, fatalistic, and intolerant human being that traditional societies have always produced and…produce now. Then there is David Reynolds, a Cambridge historian, who recently wrote a lengthy history of the U. American contradictions are described between our lofty ideals and practice. He sees the nation as an empire pieced together by war and conquest, much like other empires of the past.
But he also sees America as the successful integration of different people from around the world with diverse and innovative thoughts. Faceless and unknown, lacking hereditary privilege and wealth, people come to America seeking a new beginning, a fair chance, and a future that is offered no where else on earth. The pictures at Ellis Island tell a story: A tale of people clamoring to come to America, some weeping for joy as they passed into the New York Harbor and saw the Statue of Liberty beckoning them—the huddled masses yearning to be free.
Indeed, there is no better way to judge this country, or any country, than by the numbers of people trying to get into it, as opposed to other parts of the world where people are desperately trying to get out of their country. The notion of social justice is based on the Christian doctrine of helping less fortunate people—the weak, sickly, and oppressed. To be sure, Jesus cared deeply about people. He went out of his way to help people facing injustices. The Bible is full of passages that advocate helping and caring for people. Instead of being motivated by power, pride, or material wealth, those clergy that follow the scriptures find purpose through acts of justice.
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Since the s, social democratic governments in Western Europe have reinforced the view that all citizens should be treated equally. Society cannot be fair or just if it has different categories or types of citizenship, such as nobility and the rest of the population, whites as first class citizens and blacks as second class, dominant and subordinate or oppressed groups, etc.
Inequality must be reduced or eliminated; opportunities for poor and working people need to be expanded; government is obligated to provide free health and education including college services; the free market system needs to be regulated by government; labor has the right to organize into unions; resources need to be allocated more equally; and the rich have to pay higher taxes. In short, income and wealth should be redistributed so there is greater opportunity and equality among the populace, and therefore more justice.
Bill of Rights. Ideally government would be used to bring about reform so that every American could participate in the American dream; government legislation would right the wrongs of history. Starting in the early s social scientists began to touch on topics of justice without using or identifying the name.
The conversation focused on equality—and issues related to class and caste. Indeed, the s ushered in a period in which the social conscious of Americans burst forth—coinciding with our concern over racial discrimination, poverty, and equal opportunity. In he published Slums and Suburbs. Slum schools were compared to their suburban counterparts; they lacked resources, experienced teachers, and a relevant curriculum that could meet the needs of their students. Slum schools were in grave physical condition— characterized by broken windows, broken toilets, and graffiti on the walls.
In short, he was predicting the social and racial upheaval that would soon grip the American landscape. He discussed social issues that later gave rise to equal opportunity legislation and affirmative action policies.