Read- Introduction Recently, Yomiuri Shimbun (2017), the largest media agency i

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Introduction
Recently, Yomiuri Shimbun (2017), the largest media agency i

Read-
Introduction
Recently, Yomiuri Shimbun (2017), the largest media agency in Japan reported a sharp increase in Japanese couples travelling to Taiwan for In-Vitro Fertilization (IVF) treatments. According to their telephone survey with 72 fertility clinics in Taiwan, it was found that between 2014 and 2016, 177 couples travelled to Taiwan for IVF and 110 babies were successfully conceived and born. In 2014, only 17 couples visited Taiwan to obtain care, but within three years, the number has increased to 88, indicating a fivefold increment in outbound reproductive tourism. The report also specified that the availability of donor eggs and lower costs were the key motivations to travel out of Japan. This finding resonates with Hibino and colleagues’ previous assertion that more Japanese couples would travel for fertility care for donor eggs and cost saving (Hibino, Shimazono, Kambayashi, Hitomi, & Nakamura, 2013; Hibino & Shimazono, 2014). This observed trend is certainly not novel, as has been previously discussed more infertile Japanese couples are found to be engaging in fertility care abroad (Hibino & Shimazono, 2014; Ikemoto, 2009; Ito, 2015; Shimazono & Hibino, 2013). Such act of travelling to another country for fertility or reproductive treatments is generally referred to as ‘reproductive tourism’ in existing literature. At present, the Japan Society of Obstetrics and Gynecology (JSOG) prohibits the use of donor eggs and embryos and surrogacy in fertility treatments. Thus, despite having the highest number of fertility clinics and the highest number of IVF cycles performed in the world (Collins, 2002), scholars (e.g. Ikemoto, 2009, 2018; Martin, 2015; Utsunomiya, 2015) noted that Japan would continue to be a prominent source of reproductive tourists, specifically those who seek egg and embryo donation and surrogacy.
Hibino and Shimazono (2014) examined the attitude towards reproductive tourism amongst infertile Japanese couples and found that as high as 76% of the respondents would consider reproductive tourism, while 22% of them have already received treatment abroad. This study asserted that couples who have engaged in reproductive tourism were motivated to circumvent Japan’s stringent restriction on egg and sperm donation (Hibino & Shimazono, 2014). It is found in a government study that between 2009 and 2012, the clinics that participated in the survey had handled 117 donor egg births (Takeshita et al., 2003; as cited in Utsunomiya, 2015, p. 128). Given that the usage of donated eggs is prohibited under JSOG’s guideline, it is reasonable to construe that the 117 cases were in collaboration with fertility centres located outside Japan. In a recent interview, Professor Hibino avows that the understanding of Japanese outbound reproductive tourism remains an under-researched topic, with most of the understanding reported in the media (Brasor, 2017). Furthermore, there is, at present, no reliable statistics on the number of Japanese who have travelled abroad. The phenomenon of outbound Japanese reproductive tourism remains empirically uninvestigated. More important, in Speier’s (2016) book – Fertility Holidays: IVF Tourism and the Reproduction of Whiteness, the phenomenon is conceptualized as a ‘reproduction of whiteness’ to describe the popularity of reproductive tourism in North America and Europe (p. 8). Hudson and colleagues (Hudson & Culley, 2015; Hudson et al., 2011) observed that much of existing empirical works on reproductive tourism focus predominantly on the European, Middle Eastern and North American contexts. There is a dearth of attention paid to Asia, a region where reproductive tourism is an emerging phenomenon, thus presenting a critical literature gap to be addressed in this paper.
Furthermore, while a nascent body of work has briefly illustrated that the prohibition of third-party material such as donor egg and embryo as well as the high costs have propelled outbound travel, understanding why reproductive tourists travel based on national context remains nebulous. This paper puts forth the notion that the law-evasion/reproductive tourism nexus is too reductionist in nature. There is a need to examine the institutional forces that shape fertility practices in Japan to obtain a more concise understanding of why Japanese citizens choose to travel abroad to seek treatment. For these couples, breaking away from the accepted norm in Japan to seek overseas treatment that is deemed immoral and unacceptable in Japan may entail ponderations that are beyond just restrictions and costs. Anchoring on these apparent literature gaps, this paper seeks to explore the driving institutional forces that precipitate the growth of outbound Japanese reproductive tourism. Drawing on institution theory, this paper’s primary aim is to understand why, despite being one of the global leaders in reproductive medicine (Irizawa & Gotoh, 2016), Japanese citizens resort to reproductive tourism. The paper is structured as such – introduction, literature review, institutional theory, discussion and conclusion.
Literature review
Reproductive tourism
Reproductive tourism essentially refers to the act of travelling to another country to receive assisted reproductive treatments. Connell (2011) avers that reproductive tourism involves access to reproductive technology in a foreign destination and sometimes enables cheaper, more efficient and comprehensive services for couples to evade restrictive regulations, long waiting lists and high costs. As a part of the wider trend of medical tourism (Ikemoto, 2009), the phenomenon has amassed substantial scholarly attention in recent decades, presumably due to the global rise in infertility and emergence of medical tourism. With globalization and the rapid advancement of information technology, medical tourism as a form of travel has burgeoned in recent decades. Several commentaries have illustrated that individuals engage in medical tourism to seek different medical procedures, based on a wide range of motivations. However, even though the current findings of travel motivations for medical tourism appears to be similar across various contexts, Gerrits (2018) exposited that specific characteristics of the tourist’s country may also influence travel motivation, for example, in Sunni Islam countries such as the UAE, all forms of third-party assisted ART are prohibited, prompting infertile couples to travel to other Islamic countries such as Iran, where the dominant Shi’a Islam policy has more liberal policies towards ART (Moghimehfar & Nasr-Esfahani, 2011). However, while reproductive tourism may seem to be a mere component of medical tourism, as Ikemoto (2009, 2018) notes, there are important distinctions between reproductive tourism and other forms of medical tourism. For instance, cosmetic tourism, which refers to the act of travelling to another country to obtain cosmetic enhancements on one’s body, is a prevalent form of medical tourism due to its low-risk and elective nature. According to Viladrich and Baron-Faust (2014), the medical tourist’s body is the only medium and endpoint of cosmetic tourism. Conversely, reproductive tourism involves the reproduction of human life, which raises different yet important bioethical questions as to the child’s status and future welfare. Furthermore, this form of medical tourism involves not just the infertile couples but also other stakeholders such as third-party gamete donors or surrogates (Ikemoto, 2018). As such, reproductive tourism is a complicated variation of medical tourism. More importantly, the act of travelling to another country to receive fertility care, such as IVF has been discussed and empirically examined across various disciplines, with a preponderant of works on the travel motivation of reproductive tourists. The existing body of literature has highlighted a multitude of travel motivations of reproductive tourists, encapsulating, inter alia, circumvention of legal restrictions and cost saving.
Circumvention of legal restrictions
Pennings (2002) defines reproductive tourism as ‘the travelling by candidate service recipients from one institution, jurisdiction or country where treatment is not available to another institution, jurisdiction or country where they can obtain the kind of medically assisted reproduction they desire’ (p. 337). A plethora of commentaries has collectively insinuated that the key impetus of reproductive tourism is law (Inhorn, Shrivastav, & Patrizio, 2012; Storrow, 2011). Accordingly, Whittaker (2010) notes, reproductive tourism is largely characterized by travelling to countries where regulations allow fertility treatments that are not available in the patient’s home country. The varying legal perspectives toward ART across nations has facilitated the growth of reproductive tourism, as some countries with a rigorous legal framework of ART became departure nations and others with minimal or no legislation of ART became reproductive tourism destinations.
Most of the legal bans on ART revolve around the use of third-party gamete (egg or sperm). In countries such as Italy, Turkey and the Middle East where religious doctrines play an influential role in public policy, third-party involved reproductive assistance such as sperm and egg donation, embryo donation and surrogacy are prohibited (Zanini, 2011). To exemplify, the legal framework of ART in Italy has been described to be ‘one of the strictest’ in the world. Reproductive medicine is stringently regulated under the Law 40 which was implemented in 2004 due to Catholic lobbying. This overarching law forbids a wide continuum of ART procedures, such as limiting ART to heterosexual married couples; prohibiting the use of donor eggs, sperm, uteri and surrogacy as well PGD. What is noteworthy is that prior to the arrival of Law 40, Italy was known to be a destination country in Europe with the highest number of IVF pregnancies amongst postmenopausal women due to the negligible legislations, however, as the law became legally-binding in 2004, Italy’s previous position as a destination country is now reversed (Bartolucci, 2008; Ikemoto, 2009; Pennings, 2002). Zanini (2011) propounds that the enactment of Law 40 precipitated a quadruplet increase in outbound reproductive tourism, with 70% of the Italian couples in her study citing law evasion as the main travel motivation. The Italian respondents in her study appear to feel betrayed and abandoned by their government and the church, as they felt forced to leave their country to seek for fertility treatment elsewhere.
On the other hand, some commentators note that even in countries where ART is fully or partially covered under national healthcare plans, citizens are sometimes still denied access to ART procedures due to certain demographic restrictions. Factors such as sexual orientation, marital status and age are some of the common reasons that precipitate reproductive tourism abroad
Guidelines-
Must be 750 words
Analyzing Article Guidelines
1. Clearly Define Research Questions/Issues – Introduction section:
• Begin your report by clearly stating the research questions or issues that the article aims to address.
• Provide a brief rationale for why these questions are both interesting and essential in the context of travel and tourism.
2. Summarize Previous Studies in the article – Literature Review section
• Study Findings
a) Provide a concise summary of relevant literature, highlighting key findings from previous studies in the article;
b) Discuss how these findings contribute to the existing knowledge in the field.
• Identify Business Problems/Issues/Challenges
a) Clearly outline the business problems or issues addressed in the reviewed literature;
b) Emphasize the gaps or limitations in previous research that the article seeks to address.
3. Describe the Results and Conclusion – Results and Conclusion Sections
• Clearly articulate the key outcomes and insights obtained from the study.
• Clearly communicate the implications of the results and conclusion, avoiding unnecessary technical details.
4. Study Implications
• Analyze Strategic Implications for Travel and Tourism
a) Discuss practical applications of the study’s results for the development of the travel and tourism sector;
b) Consider how industry stakeholders can leverage these findings for decision-making;
c) Analyze the broader strategic implications of the research on the travel and tourism industry;
d) Explore potential challenges and opportunities that may arise based on the study.

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