<![CDATA[Background. Reproductive rights are central to ethical midwifery policy, yet contemporary commitments to autonomy continue to coexist with historical patterns of medical authority, maternal obligation, and unequal access to reproductive and maternity services. These tensions raise questions about whether formally recognized rights can be meaningfully exercised across different institutional and social contexts. Purpose. This study aimed to examine historical continuities and philosophical tensions in reproductive-rights policy across five jurisdictions, with particular attention to autonomy, clinical responsibility, fetal interests, equitable access, and the regulatory position of midwifery. Method. A qualitative historical-comparative design integrated normative bioethical inquiry with analysis of 214 historical and contemporary documents and semistructured interviews with 44 policymakers, midwifery leaders, bioethicists, advocates, regulators, legal experts, and service-user representatives. Genealogical analysis, thematic policy analysis, cross-case comparison, and wide reflective equilibrium were used to interpret the data and evaluate normative tensions across jurisdictions. Results. The analysis generated five themes: institutionally conditioned autonomy, continuity through maternal-responsibility discourse, fetal interests as an ethical amplifier, formal rights without equitable access, and midwifery as both mediator and regulated agent. Contemporary policies strengthened consent, dignity, and bodily autonomy; however, institutional definitions of risk and responsible choice continued to shape available reproductive options. Conclusion. Ethical midwifery policy should integrate bodily autonomy, relational support, clinical responsibility, historical awareness, and distributive justice. Reproductive safeguards should be evidence-based, proportionate, transparent, and non-discriminatory while ensuring continuity of care following informed refusal.]]>
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