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Undue inducement, or unfair exclusion: considering a case study of pregnancy in an HIV prevention trial
  1. Bridget G Haire1,
  2. Morenike Oluwatoyin Folayan2
  1. 1 Kirby Institute, University of NSW Australia, Sydney, New South Wales, Australia
  2. 2 Pediatric Dentistry, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
  1. Correspondence to Dr Bridget G Haire, Kirby Institute, Level 6 Wallace Wurth Building, UNSW Sydney, Kensington NSW Australia 2052; b.haire{at}unsw.edu.au

Abstract

In their recent paper‘Undue inducement: a case study in CAPRISA 008’, Mngadi et al conclude that a participant in an HIV prevention study who deliberately concealed her pregnancy was not ‘unduly induced’ to participate by the offer of an experimental product. This paper argues that while the authors’ conclusion is sound, the framing of this case study is consistent with the preoccupation in research ethics with the concept of undue inducement, coupled with a highly risk-averse attitude to pregnancy (regardless of whether those risks may be willingly assumed by pregnant women themselves). We suggest that the critical research ethics question raised by Mngadi et al’s case study is not ‘undue inducement’, but the exclusion of pregnant women from research studies where the risks are acceptable to the potential participant, and benefits likely. We also suggest that current regulatory paradigms regarding pregnancy are both overly paternalistic and value the fetus over the mother. In order to ensure timely provision of new HIV prevention agents, we argue that there is a need for expeditious testing of proven effective agents in pregnancy, with due consideration given to situations where preliminary efficacy data exist but fall short of licensure standards. This requires a paradigm shift from researchers, funders, regulators and ethical review bodies towards practices that critically examine the legitimacy of the exclusion of pregnant women on a study-by-study basis.

  • Hiv Infection And Aids
  • Research Ethics
  • Reproductive Medicine
  • Paternalism
  • Coercion
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Footnotes

  • Contributors BGH conceived and drafted the article. MOF reviewed and revised the article for content and style, and made substantial contributions.

  • Competing interests BGH was the ethicist on the CAPRISA 008 Data Safety Monitoring Board.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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