"All couples and individuals have the
basic right to decide freely and responsibly the number and
spacing of their children and to have the information, education
and means to do so." Few would disagree with this statement,
agreed by world leaders at the United Nations' International
Conference on Population and Development in Cairo, a decade
The arrival of a child is a life-changing event one
that we would all like to control, and plan for. Alas, it
often doesn't work out that way. Infertility curses many couples,
whereas lives are turned upside down every day by reproductive
'accidents'. That's especially true in the developing world,
where access to contraception is limited. But even in the
United States about half of all pregnancies are unplanned.
Meeting the UN conference's goal will not be easy. Religious
and moral agendas often complicate the picture, arguing
unrealistically that unwanted pregnancies are best
avoided through sexual abstinence. Economic and social factors
weigh heavily: the trend in many rich countries to delay reproduction
until later in life helps to explain why many couples then
have trouble conceiving. But reproductive empowerment will
require a vigorous research agenda, which provides the backdrop
to this Outlook.
Mention the science of human reproduction, and thoughts turn
to in vitro fertilization and similar technologies. In this
area, science fact often seems to blur into science fiction.
For a glimpse of what might lie ahead, a leading exponent
of that genre has devised a brochure for a reproductive services
company operating 75 years from now.
Other articles look at the nearer term. One of the most exciting
and controversial frontiers of fertility is
the removal of the menopause. Here, the science is moving
fast. So too in other areas, such as how imprinting
the differential expression of genes, depending on whether
they come from the mother or the father controls fetal
But many of the field's frontiers are shrouded in ignorance
and, in some cases, blighted by inaction. Is our biological
fertility declining? If so, is environmental pollution to
blame? And why are millions of people, even in the developed
world, using contraceptive methods that are unreliable and
fail to deploy the latest findings in molecular biology?
Our authors don't claim to have all the answers. But we hope
that this Outlook will frame the questions from which a brighter
reproductive future can emerge.