Artificial insemination

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Artificial_insemination

 

Artificial insemination
Schematic illustration of artificial insemination
ICD-9-CM	69.92
MeSH	D007315

Artificial insemination (AI) is the deliberate introduction of sperm into a female's cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse. It is a fertility treatment for humans, and is common practice in animal breeding, including dairy cattle and pigs.

Artificial insemination may employ assisted reproductive technology, sperm donation and animal husbandry techniques. Artificial insemination techniques available include intracervical insemination and intrauterine insemination. The beneficiaries of artificial insemination are women who desire to give birth to their own child who may be single, women who are in a lesbian relationship or women who are in a heterosexual relationship but with a male partner who is infertile or who has a physical impairment which prevents full intercourse from taking place. Intracervical insemination (ICI) is the easiest and most common insemination technique and can be used in the home for self-insemination without medical practitioner assistance. Compared with natural insemination (i.e., insemination by sexual intercourse), artificial insemination can be more expensive and more invasive, and may require professional assistance.

Some countries have laws which restrict and regulate who can donate sperm and who is able to receive artificial insemination, and the consequences of such insemination. Some women who live in a jurisdiction which does not permit artificial insemination in the circumstance in which she finds herself may travel to another jurisdiction which permits it.

In humans

History

The first recorded case of artificial insemination was John Hunter in 1790, who helped impregnate a linen draper's wife. The first reported case of artificial insemination by donor occurred in 1884: Dr. William H. Pancoast, a professor in Philadelphia, took sperm from his "best looking" student to inseminate an anesthetized woman. The case was reported 25 years later in a medical journal. The sperm bank was developed in Iowa starting in the 1920s in research conducted by University of Iowa medical school researchers Jerome Sherman and Raymond Bunge.

In the United Kingdom, the British obstetrician Mary Barton founded one of the first fertility clinics to offer donor insemination in the 1930s, with her husband Bertold Wiesner fathering up to 1000 offspring. 

In the 1980s, direct intraperitoneal insemination (DIPI) was occasionally used, where doctors injected sperm into the lower abdomen through a surgical hole or incision, with the intention of letting them find the oocyte at the ovary or after entering the genital tract through the ostium of the fallopian tube.

General

The sperm used in artificial insemination may be provided by either the woman's husband or partner (partner sperm) or by a known or anonymous sperm donor.

If the procedure is successful, the woman will conceive and carry a baby to term in the normal manner. A pregnancy resulting from artificial insemination is no different from a pregnancy achieved by sexual intercourse. In all cases of artificial insemination, the recipient woman will be the biological mother of any child produced, and the male whose sperm is used will be the biological father. 

There are multiple methods used to obtain the semen necessary for artificial insemination. Some methods require only men, while others require a combination of a male and female. Those that require only men to obtain semen are masturbation or the aspiration of sperm by means of a puncture of the testicle and epididymus. Methods of collecting semen that involve a combination of a male and female include interrupted intercourse, intercourse with a 'collection condom', or the post-coital aspiration of the semen from the vagina.

There are a number of reasons why a woman with a male partner would use artificial insemination to achieve pregnancy. For example, a woman's immune system may be rejecting her partner's sperm as invading molecules. Women who have issues with the cervix – such as cervical scarring, cervical blockage from endometriosis, or thick cervical mucus – may also benefit from artificial insemination, since the sperm must pass through the cervix to result in fertilization.

In the case of heterosexual couples who are finding it difficult to conceive, before artificial insemination is turned to as the solution, doctors will require an examination of both the male and female involved in order to remove any and all physical hindrances that are preventing them from naturally achieving a pregnancy. The couple is also given a fertility test to determine the motility, number, and viability of the male's sperm and the success of the female's ovulation. From these tests, the doctor may or may not recommend a form of artificial insemination.

Preparations

Timing is critical, as the window and opportunity for fertilization is little more than twelve hours from the release of the ovum. To increase the chance of success, the woman's menstrual cycle is closely observed, often using ovulation kits, ultrasounds or blood tests, such as basal body temperature tests over, noting the color and texture of the vaginal mucus, and the softness of the nose of her cervix. To improve the success rate of AI, drugs to create a stimulated cycle may be used, but the use of such drugs also results in an increased chance of a multiple birth.

Sperm can be provided fresh or washed. The washing of sperm increases the chances of fertilization. Pre- and post-concentration of motile sperm is counted. Sperm from a sperm bank will be frozen and quarantined for a period, and the donor will be tested before and after production of the sample to ensure that he does not carry a transmissible disease. For fresh shipping, a semen extender is used.

If sperm is provided by a private donor, either directly or through a sperm agency, it is usually supplied fresh, not frozen, and it will not be quarantined. Donor sperm provided in this way may be given directly to the recipient woman or her partner, or it may be transported in specially insulated containers. Some donors have their own freezing apparatus to freeze and store their sperm.

Techniques

The human female reproductive system. The cervix is part of the uterus. The cervical canal connects the interiors of the uterus and vagina.

 

Semen used is used either fresh, raw, or frozen. Where donor sperm is supplied by a sperm bank, it will always be quarantined and frozen, and will need to be thawed before use. The sperm is ideally donated after 2-3 days of abstinence, without lubrication as the lubricant can inhibit the sperm motility. When an ovum is released, semen is introduced into the woman's vagina, uterus or cervix, depending on the method being used.

Sperm is occasionally inserted twice within a 'treatment cycle'.

Intracervical insemination

Intracervical insemination (ICI) simulates an ejaculation of semen by the penis into the vagina during intercourse. It is painless and is the simplest, easiest and most common method of artificial insemination. ICI involves the introduction of unwashed or raw semen into the vagina at the entrance to the cervix, usually by means of a needleless syringe.

ICI is commonly used in the home, by self-insemination and practitioner insemination. Raw semen from a private donor may be used for ICI. Semen supplied by a sperm bank prepared for ICI or IUI use is suitable for ICI. It is a popular method amongst single and lesbian women purchasing donor sperm on-line, and was previously used in many fertility centers as a method of insemination, although its popularity in this context has waned as other, more reliable methods of insemination have become available.

During ICI, air is expelled from a needleless syringe which is then filled with semen which has been allowed to liquify. A specially-designed syringe, wider and with a more rounded end, may be used for this purpose. Any further enclosed air is removed by gently pressing the plunger forward. The woman lies on her back and the syringe is inserted into the vagina. Care is optimal when inserting the syringe, so that the tip is as close to the entrance to the cervix as possible. A vaginal speculum may be used for this purpose. The plunger is then slowly pushed forward and the semen in the syringe is gently emptied deep into the vagina. It is important that the syringe is emptied slowly for best results. The syringe may be left in place for several minutes before removal. The woman can bring herself to orgasm so that the cervix 'dips down' into the pool of semen, again replicating closely vaginal intercourse, and this may improve the success rate. The woman is advised to lie still for about half-an-hour to improve the success rate.

One insemination during a cycle is usually sufficient. Additional inseminations may not improve the chances of a pregnancy.

Ordinary sexual lubricants should not be used in the process, but special fertility or 'sperm-friendly' lubricants can be used for increased ease and comfort.

When performed at home without the presence of a professional, aiming the sperm in the vagina at the neck of the cervix may be more difficult to achieve and the effect may be to 'flood' the vagina with semen, rather than to target it specifically at the entrance to the cervix. This procedure is therefore sometimes referred to as intravaginal insemination (IVI). Sperm supplied by a sperm bank will be frozen and must be allowed to thaw before insemination. The sealed end of the straw itself must be cut off and the open end of the straw is usually fixed straight on to the tip of the syringe, allowing the contents to be drawn into the syringe. Sperm from more than one straw can generally be used in the same syringe. Where fresh semen is used, this must be allowed to liquefy before inserting it into the syringe, or alternatively, the syringe may be back-loaded. 

A conception cap, which is a form of conception device, may be inserted into the vagina following insemination and may be left in place for several hours. Using this method, a woman may go about her usual activities while the cervical cap holds the semen in the vagina close to the entrance to the cervix. Advocates of this method claim that it increases the chances of conception. One advantage with the conception device is that fresh, non-liquefied semen may be used. The male may ejaculate straight into the cap so that his fresh semen can be inserted immediately into the vagina without waiting for it to liquefy, although a collection cup may also be used. Other methods may be used to insert semen into the vagina notably involving different uses of a conception cap. This may, for example, be inserted filled with sperm which does not have to be liquefied. Alternatively, a specially designed conception cap with a tube attached may be inserted empty into the vagina after which liquefied semen is poured into the tube. These methods are designed to ensure that semen is inseminated as close as possible to the cervix and that it is kept in place there to increase the chances of conception.

Intrauterine insemination

Intrauterine insemination (IUI) involves injection of washed sperm into the uterus with a catheter. If unwashed semen is used, it may elicit uterine cramping, expelling the semen and causing pain, due to content of prostaglandins. (Prostaglandins are also the compounds responsible for causing the myometrium to contract and expel the menses from the uterus, during menstruation.) Resting on the table for fifteen minutes after an IUI is optimal for the woman to increase the pregnancy rate.

The indications to perform an intrauterine insemination are usually a moderate male factor, the incapability to ejaculate in vagina and an idiopathic infertility. 

Unlike ICI, intrauterine insemination normally requires a medical practitioner to perform the procedure. One of the requirements is to have at least one permeable tube, proved by hysterosalpingography. The infertility duration is also important. A female under 30 years of age has optimal chances with IUI; for the man, a TMS of more than 5 million per ml is optimal. In practice, donor sperm will satisfy these criteria. A promising cycle is one that offers two follicles measuring more than 16 mm, and estrogen of more than 500 pg/mL on the day of hCG administration. A short period of ejaculatory abstinence before intrauterine insemination is associated with higher pregnancy rates. However, GnRH agonist administration at the time of implantation does not improve pregnancy outcome in intrauterine insemination cycles according to a randomized controlled trial.

IUI is a more efficient method of artificial insemination than ICI and, because of its generally higher success rate, is usually the insemination procedure of choice for single women and lesbians using donor semen in a fertility centre and who are less likely to have fertility issues of their own. Enabling the sperm to be inserted directly into the womb will produce a better chance of conceiving.

It is also a method used by couples using donor sperm in a fertility centre. 

The steps to follow in order to perform an intrauterine insemination are:

• Mild Controlled Ovarian Stimulation (COS): there is no control f how many oocytes are at the same time when stimulating ovulation. For that reason, it is necessary to check the amount being ovulated via ultrasound (checking the amount of follicles developing at the same time) and administering the desired amount of hormones.
• Ovulation Induction: using substances known as ovulation inductors.
• Semen capacitation: wash and centrifugation, swim-up, or gradient. The insemination shouldn't be performed later than an hour after capacitation.
• Luteal Phase support: progesterone lack of the endometrium could rick the pregnancy. To avoid that 200 mg/day of micronized progesterone are administered via vagina. If there is pregnancy, this hormone is kept administering until the tenth week of pregnancy.

IUI can be used in conjunction with controlled ovarian hyperstimulation (COH). Clomiphene Citrate is the first line, Letrozole is second line, in order to stimulate ovaries before moving on to IVF. Still, advanced maternal age causes decreased success rates; women aged 38–39 years appear to have reasonable success during the first two cycles of ovarian hyperstimulation and IUI. However, for women aged over 40 years, there appears to be no benefit after a single cycle of COH/IUI.^[17] Medical experts therefore recommend considering in vitro fertilization after one failed COH/IUI cycle for women aged over 40 years.

A double intrauterine insemination theoretically increases pregnancy rates by decreasing the risk of missing the fertile window during ovulation. However, a randomized trial of insemination after ovarian hyperstimulation found no difference in live birth rate between single and double intrauterine insemination.

Due to the lack of reliable evidence from controlled clinical trials, it is not certain which semen preparation techniques are more effective (wash and centrifugation; swim-up; or gradient) in terms of pregnancy and live birth rates.

Intrauterine tuboperitoneal insemination

Intrauterine tuboperitoneal insemination (IUTPI) involves injection of washed sperm into both the uterus and fallopian tubes. The cervix is then clamped to prevent leakage to the vagina, best achieved with a specially designed double nut bivalve (DNB) speculum. The sperm is mixed to create a volume of 10 ml, sufficient to fill the uterine cavity, pass through the interstitial part of the tubes and the ampulla, finally reaching the peritoneal cavity and the Pouch of Douglas where it would be mixed with the peritoneal and follicular fluid. IUTPI can be useful in unexplained infertility, mild or moderate male infertility, and mild or moderate endometriosis. In non-tubal sub fertility, fallopian tube sperm perfusion may be the preferred technique over intrauterine insemination.

Intratubal insemination

Intratubal insemination (ITI) involves injection of washed sperm into the fallopian tube, although this procedure is no longer generally regarded as having any beneficial effect compared with IUI. ITI however, should not be confused with gamete intrafallopian transfer, where both eggs and sperm are mixed outside the woman's body and then immediately inserted into the fallopian tube where fertilization takes place.

Pregnancy rate

Approximate pregnancy rate as a function of total sperm count (may be twice as large as total motile sperm count). Values are for intrauterine insemination. (Old data, rates are likely higher today)

 

The rate of successful pregnancy for artificial insemination are 10-15% per menstrual cycle using ICI, and 15–20% per cycle for IUI. In IUI, about 60 to 70% have achieved pregnancy after 6 cycles.

However, these pregnancy rates may be very misleading, since many factors have to be included to give a meaningful answer, e.g. definition of success and calculation of the total population. These rates can be influenced by age, overall reproductive health, and if the patient had an orgasm during the insemination. The literature is conflicting on immobilization after insemination has increasing the chances of pregnancy. Previous data suggests that it is statistically significant for the patient to remain immobile for 15 minutes after insemination, while other review article claims that it is not.  A point of consideration, is that it does cost the patient or healthcare system to remain immobile for 15 minutes if it does increase the chances. For couples with unexplained infertility, unstimulated IUI is no more effective than natural means of conception.

The pregnancy rate also depends on the total sperm count, or, more specifically, the total motile sperm count (TMSC), used in a cycle. The success rate increases with increasing TMSC, but only up to a certain count, when other factors become limiting to success. The summed pregnancy rate of two cycles using a TMSC of 5 million (may be a TSC of ~10 million on graph) in each cycle is substantially higher than one single cycle using a TMSC of 10 million. However, although more cost-efficient, using a lower TMSC also increases the average time taken to achieve pregnancy. Women whose age is becoming a major factor in fertility may not want to spend that extra time.

Samples per child

The number of samples (ejaculates) required to give rise to a child varies substantially from person to person, as well as from clinic to clinic. However, the following equations generalize the main factors involved: 

For intracervical insemination:

${\displaystyle N={\frac {V_{s}\times c\times r_{s}}{n_{r}}}}$

• N is how many children a single sample can give rise to.
• V_s is the volume of a sample (ejaculate), usually between 1.0 mL and 6.5 mL
• c is the concentration of motile sperm in a sample after freezing and thawing, approximately 5–20 million per ml but varies substantially
• r_s is the pregnancy rate per cycle, between 10% to 35%
• n_r is the total motile sperm count recommended for vaginal insemination (VI) or intra-cervical insemination (ICI), approximately 20 million pr. ml.

The pregnancy rate increases with increasing number of motile sperm used, but only up to a certain degree, when other factors become limiting instead.

Derivation of the equation (click at right to view)

 

Approximate live birth rate (r_s) among infertile couples as a function of total motile sperm count (n_r). Values are for intrauterine insemination.

 

With these numbers, one sample would on average help giving rise to 0.1–0.6 children, that is, it actually takes on average 2–5 samples to make a child.

For intrauterine insemination, a centrifugation fraction (f_c) may be added to the equation:

f_c is the fraction of the volume that remains after centrifugation of the sample, which may be about half (0.5) to a third (0.33).

${\displaystyle N={\frac {V_{s}\times f_{c}\times c\times r_{s}}{n_{r}}}}$

On the other hand, only 5 million motile sperm may be needed per cycle with IUI (n_r=5 million).

Thus, only 1–3 samples may be needed for a child if used for IUI.

Social implications

One of the key issues arising from the rise of dependency on assisted reproductive technology (ARTs) is the pressure placed on couples to conceive; 'where children are highly desired, parenthood is culturally mandatory, and childlessness socially unacceptable'.

The medicalization of infertility creates a framework in which individuals are encouraged to think of infertility quite negatively. In many cultures donor insemination is religiously and culturally prohibited, often meaning that less accessible "high tech" and expensive ARTs, like IVF, are the only solution. 

An over-reliance on reproductive technologies in dealing with infertility prevents many – especially, for example, in the "infertility belt" of central and southern Africa – from dealing with many of the key causes of infertility treatable by artificial insemination techniques; namely preventable infections, dietary and lifestyle influences.

If good records are not kept, the offspring when grown up risk accidental incest.

Legal restrictions

Some countries restrict artificial insemination in a variety of ways. For example, some countries do not permit AI for single women, and some Muslim countries do not permit the use of donor sperm. As of May 2013, the following European countries permit medically assisted AI for single women:

• Armenia
• Belarus
• Belgium
• Bulgaria
• Cyprus
• Denmark
• Estonia
• Finland
• Germany
• Greece
• Hungary
• Iceland
• Ireland
• Latvia
• Macedonia
• Moldova
• Montenegro
• Netherlands
• Romania
• Russia
• Spain
• Ukraine
• United Kingdom

In animals

A man performing artificial insemination of a cow.

 

A breeding mount with built-in artificial vagina used in semen collection from horses for use in artificial insemination

 

AI is used for pets, livestock, endangered species, and animals in zoos or marine parks difficult to transport.

Reasons and techniques

It may be used for many reasons, including to allow a male to inseminate a much larger number of females, to allow use of genetic material from males separated by distance or time, to overcome physical breeding difficulties, to control the paternity of offspring, to synchronise births, to avoid injury incurred during natural mating, and to avoid the need to keep a male at all (such as for small numbers of females or in species whose fertile males may be difficult to manage).

Semen is collected, extended, then cooled or frozen. It can be used on site or shipped to the female's location. If frozen, the small plastic tube holding the semen is referred to as a straw. To allow the sperm to remain viable during the time before and after it is frozen, the semen is mixed with a solution containing glycerol or other cryoprotectants. An extender is a solution that allows the semen from a donor to impregnate more females by making insemination possible with fewer sperm. Antibiotics, such as streptomycin, are sometimes added to the sperm to control some bacterial venereal diseases. Before the actual insemination, estrus may be induced through the use of progestogen and another hormone (usually PMSG or Prostaglandin F2α).

History

IA tools brought from the USSR by Luis Thomasset in 1935 to work at Cambridge Laboratories and South America.

 

The first viviparous animal to be artificially fertilized was a dog. The experiment was conducted with success by the Italian Lazzaro Spallanzani in 1780. Another pioneer was the Russian Ilya Ivanov in 1899. In 1935, diluted semen from Suffolk sheep was flown from Cambridge in Britain to Kraków, Poland, as part of an international research project. The participants included Prawochenki (Poland), Milovanoff (USSR), Hammond and Walton (UK), and Thomasset (Uruguay). 

Modern artificial insemination was pioneered by John O. Almquist of Pennsylvania State University. He improved breeding efficiency by the use of antibiotics (first proven with penicillin in 1946) to control bacterial growth, decreasing embryonic mortality, and increase fertility. This, and various new techniques for processing, freezing, and thawing of frozen semen significantly enhanced the practical utilization of AI in the livestock industry, and earned him the 1981 Wolf Foundation Prize in Agriculture. Many techniques developed by him have since been applied to other species, including humans.

Species

Artificial insemination is used in many non-human animals, including sheep, horses, cattle, pigs, dogs, pedigree animals generally, zoo animals, turkeys and creatures as tiny as honeybees and as massive as orcas (killer whales).

Artificial insemination of farm animals is common in the developed world, especially for breeding dairy cattle (75% of all inseminations). Swine are also bred using this method (up to 85% of all inseminations). It is an economical means for a livestock breeder to improve their herds utilizing males having desirable traits. This procedure is condemned by animal rights campaigners such as People for the Ethical Treatment of Animals and Joey Carbstrong, who identify the practice as a form of rape due to its sexual, involuntary and perceived painful nature.

Although common with cattle and swine, AI is not as widely practised in the breeding of horses. A small number of equine associations in North America accept only horses that have been conceived by "natural cover" or "natural service" – the actual physical mating of a mare to a stallion – the Jockey Club being the most notable of these, as no AI is allowed in Thoroughbred breeding. Other registries such as the AQHA and warmblood registries allow registration of foals created through AI, and the process is widely used allowing the breeding of mares to stallions not resident at the same facility – or even in the same country – through the use of transported frozen or cooled semen.

In modern species conservation, semen collection and artificial insemination is used also in birds. In 2013 scientist of the Justus-Liebig-University of Giessen, Germany, from the working group of Michael Lierz, Clinic for birds, reptiles, amphibians and fish, developed a novel technique for semen collection and artificial insemination in parrots producing the world's first macaw by assisted reproduction.

Scientists working with captive orcas were able to pioneer the technique in the early 2000s, resulting in "the first successful conceptions, resulting in live offspring, using artificial insemination in any cetacean species". John Hargrove, a SeaWorld trainer, describes Kasatka as being the first orca to receive AI.

Amish

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Amish

 

Amish

An Amish family riding in a traditional Amish buggy in Lancaster County, Pennsylvania
Total population
342,000 (2019, Old Order Amish)
Founder
Jakob Ammann
Regions with significant populations
United States (notably Pennsylvania, Ohio, Indiana, Wisconsin, and New York) Canada (Ontario, and Prince Edward Island)
Religions
Anabaptist
Scriptures
The Bible
Languages
Pennsylvania German, Bernese German, Low Alemannic Alsatian German, Amish High German, English

The Amish (/ˈɑːmɪʃ/; Pennsylvania German: Amisch; German: Amische) are a group of traditionalist Christian church fellowships with Swiss German Anabaptist origins. They are closely related to, but distinct from, Mennonite churches. The Amish are known for simple living, plain dress, and reluctance to adopt many conveniences of modern technology.

The history of the Amish church began with a schism in Switzerland within a group of Swiss and Alsatian Anabaptists in 1693 led by Jakob Ammann. Those who followed Ammann became known as Amish. In the second half of the 19th century, the Amish divided into Old Order Amish and Amish Mennonites. The latter do not eschew motor cars, whereas the Old Order Amish retained much of their traditional culture. When people refer to the Amish today, they normally refer to the Old Order Amish.

In the early 18th century, many Amish and Mennonites immigrated to Pennsylvania for a variety of reasons. Today, the Old Order Amish, the New Order Amish, and the Old Beachy Amish continue to speak Pennsylvania German, also known as "Pennsylvania Dutch", although two different Alemannic dialects are used by Old Order Amish in Adams and Allen counties in Indiana.

As of 2000, over 165,000 Old Order Amish lived in the United States and about 1,500 lived in Canada. A 2008 study suggested their numbers had increased to 227,000, and in 2010, a study suggested their population had grown by 10 percent in the past two years to 249,000, with increasing movement to the West. Most of the Amish continue to have six or seven children, while benefiting from the major decrease in infant and maternal mortality in the 20th century. Between 1992 and 2017, the Amish population increased by 149 percent, while the U.S. population increased by 23 percent.

Amish church membership begins with baptism, usually between the ages of 16 and 23. It is a requirement for marriage within the Amish church. Once a person is baptized within the church, he or she may marry only within the faith. Church districts have between 20 and 40 families and worship services are held every other Sunday in a member's home. The district is led by a bishop and several ministers and deacons. The rules of the church, the Ordnung, must be observed by every member and cover many aspects of day-to-day living, including prohibitions or limitations on the use of power-line electricity, telephones, and automobiles, as well as regulations on clothing. Most Amish do not buy commercial insurance or participate in Social Security. As present-day Anabaptists, Amish church members practice nonresistance and will not perform any type of military service. The Amish value rural life, manual labor, and humility, all under the auspices of living what they interpret to be God's word.

Members who do not conform to these community expectations and who cannot be convinced to repent are excommunicated. In addition to excommunication, members may be shunned, a practice that limits social contacts to shame the wayward member into returning to the church. Almost 90 percent of Amish teenagers choose to be baptized and join the church. During an adolescent period of rumspringa ("running around") in some communities, nonconforming behavior that would result in the shunning of an adult who had made the permanent commitment of baptism, may be met with a degree of forbearance. Amish church groups seek to maintain a degree of separation from the non-Amish world, i.e. American and Canadian society. Non-Amish people are generally referred to as "English". Generally, a heavy emphasis is placed on church and family relationships. The Amish typically operate their own one-room schools and discontinue formal education after grade eight, at age 13 or 14. Until the children turn 16, they have vocational training under the tutelage of their parents, community, and the school teacher. Higher education is generally discouraged, as it can lead to social segregation and the unraveling of the community. However, some Amish women have used higher education to obtain a nursing certificate so that they may provide midwifery services to the community.

History

Anabaptist beginnings

Cover of The Amish and the Mennonites, 1938

 

An old Amish cemetery in Lancaster County, Pennsylvania, 1941

The Anabaptist movement, from which the Amish later emerged, started in circles around Huldrych Zwingli (1484–1531) who led the early Reformation in Switzerland. In Zürich on January 21, 1525, Conrad Grebel and George Blaurock practiced adult baptism to each other and then to others. This Swiss movement, part of the Radical Reformation, later became known as Swiss Brethren.

Emergence of the Amish

The term Amish was first used as a Schandename (a term of disgrace) in 1710 by opponents of Jakob Amman. The first informal division between Swiss Brethren was recorded in the 17th century between Oberländers (those living in the hills) and Emmentaler (those living in the Emmental valley). The Oberländers were a more extreme congregation; their zeal pushed them into more remote areas and their solitude made them more zealous.

Swiss Anabaptism developed, from this point, in two parallel streams, most clearly marked by disagreement over the preferred treatment of "fallen" believers. The Emmentalers (sometimes referred to as Reistians, after bishop Hans Reist, a leader among the Emmentalers) argued that fallen believers should only be withheld from communion, and not regular meals. The Amish argued that those who had been banned should be avoided even in common meals. The Reistian side eventually formed the basis of the Swiss Mennonite Conference. Because of this common heritage, Amish and Mennonites from southern Germany and Switzerland retain many similarities. Those who leave the Amish fold tend to join various congregations of Conservative Mennonites.

Migration to North America

Amish began migrating to Pennsylvania, then known for its religious toleration, in 1727 as part of a larger migration from the Palatinate and neighboring areas. This migration was a reaction to religious wars, poverty, and religious persecution in Europe. The first Amish immigrants went to the region that became Berks County, Pennsylvania, but later moved, motivated by land issues and by security concerns tied to the French and Indian War. Many eventually settled in Lancaster County. Other groups later settled elsewhere in North America.

1850–1878 Division into Old Orders and Amish Mennonites

Most Amish communities that were established in North America did not ultimately retain their Amish identity. The major division that resulted in the loss of identity of many Amish congregations occurred in the third quarter of the 19th century. The forming of factions worked its way out at different times at different places. The process was rather a "sorting out" than a split. Amish people are free to join another Amish congregation at another place that fits them best.

In the years after 1850, tensions rose within individual Amish congregations and between different Amish congregations. Between 1862 and 1878, yearly Dienerversammlungen (ministerial conferences) were held at different places, concerning how the Amish should deal with the tensions caused by the pressures of modern society. The meetings themselves were a progressive idea; for bishops to assemble to discuss uniformity was an unprecedented notion in the Amish church. By the first several meetings, the more traditionally minded bishops agreed to boycott the conferences.

The more progressive members, comprising roughly two-thirds of the group, became known by the name Amish Mennonite, and eventually united with the Mennonite Church, and other Mennonite denominations, mostly in the early 20th century. The more traditionally minded groups became known as the Old Order Amish. The Egli Amish had already started to withdraw from the Amish church in 1858. They soon drifted away from the old ways and changed their name to "Defenseless Mennonite" in 1908. Congregations who took no side in the division after 1862 formed the Conservative Amish Mennonite Conference in 1910, but dropped the word "Amish" from their name in 1957.

Because no division occurred in Europe, the Amish congregations remaining there took the same way as the change-minded Amish Mennonites in North America and slowly merged with the Mennonites. The last Amish congregation in Germany to merge was the Ixheim Amish congregation, which merged with the neighboring Mennonite Church in 1937. Some Mennonite congregations, including most in Alsace, are descended directly from former Amish congregations.

20th century

Though splits happened among the Old Order in the 19th century in Mifflin County, Pennsylvania, a major split among the Old Orders took until World War I. At that time, two very conservative affiliations emerged – the Swartzentruber Amish in Holmes County, Ohio, and the Buchanan Amish in Iowa. The Buchanan Amish soon were joined by like-minded congregations all over the country.

With World War I came the massive suppression of the German language in the US that eventually led to language shift of most Pennsylvania German speakers, leaving the Amish and other Old Orders as almost the only speakers by the end of the 20th century. This created a language barrier around the Amish that did not exist before in that form.

In the late 1920s, the more change minded faction of the Old Order Amish, that wanted to adopt the car, broke away from the mainstream and organized under the name Beachy Amish.

During the Second World War, the old question of military service for the Amish came up again. Because Amish young men in general refused military service, they ended up in the Civilian Public Service (CPS), where they worked mainly in forestry and hospitals. The fact that many young men worked in hospitals, where they had a lot of contact with more progressive Mennonites and the outside world, had the result that many of these men never joined the Amish church.

In the 1950s, the Beachy Amish transformed into an evangelical church. The ones who wanted to preserve the old way of the Beachy became the Old Beachy Amish.

Until about 1950, almost all Amish children attended small, local, non-Amish schools, but then school consolidation and mandatory schooling beyond eighth grade caused Amish opposition. Amish communities opened their own Amish schools. In 1972, the United States Supreme Court exempted Amish pupils from compulsory education past eighth grade. By the end of the 20th century, almost all Amish children attended Amish schools.

In the last quarter of the 20th century, a growing number of Amish men left farm work and started small businesses because of increasing pressure on small-scale farming. Though a wide variety of small businesses exists among the Amish, construction work and woodworking are quite widespread. In many Amish settlements, especially the larger ones, farmers are now a minority. Approximately 12,000 of the 40,000 dairy farms in the United States are Amish-owned as of 2018.

Until the early 20th century, Old Order Amish identity was not linked to the use of technologies, as the Old Order Amish and their rural neighbors used the same farm and household technologies. Questions about the use of technologies also did not play a role in the Old Order division of the second half of the 19th century. Telephones were the first important technology that was rejected, soon followed by the rejection of cars, tractors, radios, and many other technological inventions of the 20th century.

Religious practices

A scan of the historical document Diß Lied haben die sieben Brüder im Gefängnüß zu Gmünd gemacht

Two key concepts for understanding Amish practices are their rejection of Hochmut (pride, arrogance, haughtiness) and the high value they place on Demut (humility) and Gelassenheit (calmness, composure, placidity), often translated as "submission" or "letting-be". Gelassenheit is perhaps better understood as a reluctance to be forward, to be self-promoting, or to assert oneself. The Amish's willingness to submit to the "Will of Jesus", expressed through group norms, is at odds with the individualism so central to the wider American culture. The Amish anti-individualist orientation is the motive for rejecting labor-saving technologies that might make one less dependent on the community. Modern innovations such as electricity might spark a competition for status goods, or photographs might cultivate personal vanity. Electric power lines would be going against the Bible, which says that you shall not be "conformed to the world" (Romans 12:2).

Way of life

Amish couple in horse-driven buggy in rural Holmes County, Ohio, September 2004

Amish lifestyle is regulated by the Ordnung ('order'), which differs slightly from community to community, and within a community, from district to district. What is acceptable in one community may not be acceptable in another. The Ordnung is agreed upon – or changed – within the whole community of baptized members prior to Communion which takes place two times a year. The meeting where the Ordnung is discussed is called Ordnungsgemeine in Standard German and Ordningsgmee in Pennsylvania Dutch. The Ordnung include matters such as dress, permissible uses of technology, religious duties, and rules regarding interaction with outsiders. In these meetings, women also vote in questions concerning the Ordnung.

Bearing children, raising them, and socializing with neighbors and relatives are the greatest functions of the Amish family. Amish typically believe that large families are a blessing from God. Farm families tend to have larger families, because sons are needed to perform farm labor. Community is central to the Amish way of life.

Working hard is considered godly, and some technological advancements have been considered undesirable because they reduce the need for hard work. Machines such as automatic floor cleaners in barns have historically been rejected as this provides young farmhands with too much free time.

Clothing

The Amish are known for their plain attire. Men wear solid colored shirts, broad-brimmed hats, and suits that signify similarity amongst one another. Amish men grow beards to symbolize manhood and marital status, as well as to promote humility. They are forbidden to grow mustaches because mustaches are seen by the Amish as being affiliated with the military, which they are strongly opposed to, due to their pacifist beliefs. Women have similar guidelines on how to dress, which are also expressed in the Ordnung, the Amish version of legislation. They are to wear calf-length dresses, muted colors along with bonnets and aprons. Prayer caps or bonnets are worn by the women because they are a visual representation of their religious beliefs and promote unity through the tradition of every women wearing one. The color of the bonnet signifies whether a woman is single or married. Single women wear black bonnets and married women wear white. The color coding of bonnets is important because women are not allowed to wear jewelry, such as wedding rings, as it is seen as drawing attention to the body which can induce pride in the individual. All clothing is sewn by hand, but the way to fasten the garment widely depends on whether the Amish person is a part of the New Order or Old Order Amish. The Old Order Amish seldom, if ever, use buttons because they are seen as too flashy; instead, they use the hook and eye approach to fashion clothing or metal snaps. The New Order Amish are slightly more progressive and allow the usage of buttons to help attire clothing.

Cuisine

Amish cuisine is noted for its simplicity and traditional qualities. Food plays an important part in Amish social life and is served at potlucks, weddings, fundraisers, farewells, and other events. Many Amish foods are sold at markets including pies, preserves, bread mixes, pickled produce, desserts, and canned goods. Many Amish communities have also established restaurants for visitors. Amish meat consumption is similar to the American average though they tend to eat more preserved meat.

Subgroups of Amish

Over the years, the Amish churches have divided many times mostly over questions concerning the Ordnung, but also over doctrinal disputes, mainly about shunning. The largest group, the "Old Order" Amish, a conservative faction that separated from other Amish in the 1860s, are those who have most emphasized traditional practices and beliefs. The New Order Amish are a group of Amish whom some scholars see best described as a subgroup of Old Order Amish, despite the name.

Affiliations

About 40 different Old Order Amish affiliations are known; the eight major affiliations are below, with Lancaster as the largest one in number of districts and population:

Affiliation	Date established	Origin	States	Settlements	Church districts
Lancaster	1760	Pennsylvania	8	37	291
Elkhart-LaGrange	1841	Indiana	3	9	176
Holmes Old Order	1808	Ohio	1	2	147
Buchanan/Medford	1914	Indiana	19	67	140
Geauga I	1886	Ohio	6	11	113
Swartzentruber	1913	Ohio	15	43	119
Geauga II	1962	Ohio	4	27	99
Swiss (Adams)	1850	Indiana	5	15	86

Use of technology by different Amish affiliations

The table below indicates the use of certain technologies by different Amish affiliations. The use of cars is not allowed by any Old and New Order Amish, nor are radio, television, or in most cases the use of the Internet. The three affiliations: "Lancaster", "Holmes Old Order", and "Elkhart-LaGrange" are not only the three largest affiliations, but they also represent the mainstream among the Old Order Amish. The most conservative affiliations are above, the most modern ones below. Technologies used by very few are on the left; the ones used by most are on the right. The percentage of all Amish who use a technology is also indicated approximately. The Old Order Amish culture involves lower greenhouse gas emissions in all sectors and activities with the exception of diet, and their per-person emissions has been estimated to be less than one quarter that of the wider society.

Language

Most Old Order Amish speak Pennsylvania Dutch, and refer to non-Amish people as "English", regardless of ethnicity. Some Amish who migrated to the United States in the 1850s speak a form of Bernese German or a Low Alemannic Alsatian dialect.

Contrary to popular belief, the word "Dutch" in "Pennsylvania Dutch" is not a mistranslation, but rather a corruption of the Pennsylvania German endonym Deitsch, which means "Pennsylvania Dutch / German" or "German". Ultimately, the terms Deitsch, Dutch, Diets and Deutsch are all cognates of the Proto-Germanic word *þiudiskaz meaning "popular" or "of the people". The continued use of "Pennsylvania Dutch" was strengthened by the Pennsylvania Dutch in the 19th century as a way of distinguishing themselves from later (post 1830) waves of German immigrants to the United States, with the Pennsylvania Dutch referring to themselves as Deitsche and to Germans as Deitschlenner (literally "Germany-ers", compare Deutschland-er) whom they saw as a related but distinct group.

According to one scholar, "today, almost all Amish are functionally bilingual in Pennsylvania Dutch and English; however, domains of usage are sharply separated. Pennsylvania Dutch dominates in most in-group settings, such as the dinner table and preaching in church services. In contrast, English is used for most reading and writing. English is also the medium of instruction in schools and is used in business transactions and often, out of politeness, in situations involving interactions with non-Amish. Finally, the Amish read prayers and sing in Standard German (which, in Pennsylvania Dutch, is called Hochdeitsch) at church services. The distinctive use of three different languages serves as a powerful conveyor of Amish identity. "Although 'the English language is being used in more and more situations,' Pennsylvania Dutch is 'one of a handful of minority languages in the United States that is neither endangered nor supported by continual arrivals of immigrants.'"

Ethnicity

The Amish largely share a German or Swiss-German ancestry. They generally use the term "Amish" only for members of their faith community and not as an ethnic designation. However some Amish descendants recognize their cultural background knowing that their genetic and cultural traits are uniquely different from other ethnicities. Those who choose to affiliate with the church, or young children raised in Amish homes, but too young to yet be church members, are considered to be Amish. Certain Mennonite churches have a high number of people who were formerly from Amish congregations. Although more Amish immigrated to North America in the 19th century than during the 18th century, most of today's Amish descend from 18th-century immigrants. The latter tended to emphasize tradition to a greater extent, and were perhaps more likely to maintain a separate Amish identity. There are a number of Amish Mennonite church groups that had never in their history been associated with the Old Order Amish because they split from the Amish mainstream in the time when the Old Orders formed in the 1860s and 1870s. The former Western Ontario Mennonite Conference (WOMC) was made up almost entirely of former Amish Mennonites who reunited with the Mennonite Church in Canada. Orland Gingerich's book The Amish of Canada devotes the vast majority of its pages not to the Beachy or Old Order Amish, but to congregations in the former WOMC.

Para-Amish groups

Several other groups, called "para-Amish" by G. C. Waldrep and others, share many characteristics with the Amish, such as horse and buggy transportation, plain dress, and the preservation of the German language. The members of these groups are largely of Amish origin, but they are not in fellowship with other Amish groups because they adhere to theological doctrines (e.g., assurance of salvation) or practices (community of goods) that are normally not accepted among mainstream Amish. The Bergholz Community is a different case, it is not seen as Amish anymore because the community has shifted away from many core Amish principles.

Population

Historical population
Year	Pop.	±% p.a.
1920	5,000	—
1928	7,000	+4.30%
1936	9,000	+3.19%
1944	13,000	+4.70%
1952	19,000	+4.86%
1960	28,000	+4.97%
1968	39,000	+4.23%
1976	57,000	+4.86%
1984	84,000	+4.97%
1992	128,150	+5.42%
2000	166,000	+3.29%
2010	249,500	+4.16%
2019	341,900	+3.56%
Source: 1992, 2000, 2010, 2019

Because the Amish are usually baptized no earlier than 18 and children are not counted in local congregation numbers, estimating their numbers is difficult. Rough estimates from various studies placed their numbers at 125,000 in 1992, 166,000 in 2000, and 221,000 in 2008. Thus, from 1992 to 2008, population growth among the Amish in North America was 84 percent (3.6 percent per year). During that time, they established 184 new settlements and moved into six new states. In 2000, about 165,620 Old Order Amish resided in the United States, of whom 73,609 were church members. The Amish are among the fastest-growing populations in the world, with an average of seven children per family in the 1970s and a total fertility rate of 5.3 in the 2010s.

In 2010, a few religious bodies, including the Amish, changed the way their adherents were reported to better match the standards of the Association of Statisticians of American Religious Bodies. When looking at all Amish adherents and not solely Old Order Amish, about 241,000 Amish adherents were in 28 U.S. states in 2010.

Distribution

United States

U.S. state	Amish pop. in 1992	Amish pop. in 2000	Amish pop. in 2010	Amish pop. in 2019
Pennsylvania	32,710	40,100	59,350	79,200
Ohio	34,830	49,750	58,590	76,195
Indiana	23,400	32,650	43,710	57,430
Wisconsin	6,785	10,250	15,360	22,020
New York	4,050	5,000	12,015	20,595
Michigan	5,150	9,300	11,350	16,410
Missouri	3,745	6,100	9,475	13,990
Kentucky	2,625	5,150	7,750	13,345

United States is the home to the overwhelming majority (98.35%) of the Amish people. In 2019, Old Order communities were present in 31 U.S. states. The total Amish population in United States as of June 2019 has stood at 336,235, up 11,335 or 3.5%, compared to the previous year. Pennsylvania has the largest population (79,200), followed by Ohio (76,200) and Indiana (57,400), as of June 2019. The largest Amish settlements are in Lancaster County in southeastern Pennsylvania (39,255), Holmes County and adjacent counties in northeastern Ohio (36,755), and Elkhart and LaGrange counties in northeastern Indiana (25,660), as of June 2019. Nearly 50% of the population in Holmes County is Amish.

The largest concentration of Amish west of the Mississippi River is in Missouri, with other settlements in eastern Iowa and southeast Minnesota. The largest Amish settlements in Iowa are located near Kalona and Bloomfield. The largest settlement in Wisconsin is near Cashton with 13 congregations, i.e. about 2,000 people in 2009.

Because of rapid population growth in Amish communities, new settlements are formed to obtain enough affordable farmland. Other reasons for new settlements include locating in isolated areas that support their lifestyle, moving to areas with cultures conducive to their way of life, maintaining proximity to family or other Amish groups, and sometimes to resolve church or leadership conflicts.

The adjacent table shows the eight states with the largest Amish population in the years 1992, 2000, 2010, and 2019.

Canada

Amish settlements are in four Canadian provinces: Ontario, Prince Edward Island, Manitoba, and New Brunswick. The majority of Old Order settlements is located in the province of Ontario, namely Oxford (Norwich Township) and Norfolk Counties. A small community is also established in Bruce County (Huron-Kinloss Township) near Lucknow. 

Area outside the U.S.	Amish pop. in 1992	Amish pop. in 2010	Amish pop. in 2019
Canada:	2,295	4,725	5,665
> Ontario	2,295	4,725	5,340
> Prince Edward Island	0	0	205
> Manitoba	0	0	65
> New Brunswick	0	0	55
Bolivia	0	0	150
Argentina	0	0	50

In 2016, several dozen Old Order Amish families founded two new settlements in Kings County in the province of Prince Edward Island. Increasing land prices in Ontario had reportedly limited the ability of members in those communities to purchase new farms. At about the same time a new settlement was founded near Perth-Andover in New Brunswick, only about 12 km from Amish settlements in Maine. In 2017, an Amish settlement was founded in Manitoba near Stuartburn.

Latin America

The first attempt by Old Order Amish to settle in Latin America was in Paradise Valley, near Galeana, Nuevo León, Mexico, but the settlement only lasted from 1923 to 1929. An Amish settlement was tried in Honduras from about 1968 to 1978, but this settlement failed too. In 2015, new settlements of New Order Amish were founded east of Catamarca, Argentina, and Colonia Naranjita, Bolivia, about 75 miles (121 km) southwest of Santa Cruz. Most of the members of these new communities come from Old Colony Mennonite background and have been living in the area for several decades.

Europe

In Europe, no split occurred between Old Order Amish and Amish Mennonites; like the Amish Mennonites in North America, the European Amish assimilated into the Mennonite mainstream during the second half of the 19th century through the first decades of the 20th century. Eventually, they dropped the word "Amish" from the names of their congregations and lost their Amish identity and culture. The last European Amish congregation joined the Mennonites in 1937 in Ixheim, today part of Zweibrücken in the Palatinate region.

Seekers and joiners

Only a few outsiders, so-called seekers, have ever joined the Amish. Since 1950, only some 75 people have joined and remained members of the Amish. Since 1990, some twenty people of Russian Mennonite background have joined the Amish in Aylmer, Ontario.

Two whole Christian communities have joined the Amish: The church at Smyrna, Maine, one of the five Christian Communities of Elmo Stoll after Stoll's death and the church at Manton, Michigan, which belonged to a community that was founded by Harry Wanner (1935–2012), a minister of Stauffer Old Order Mennonite background. The "Michigan Churches", with which Smyrna and Manton affiliated, are said to be more open to seekers and converts than other Amish churches. Most of the members of these two para-Amish communities originally came from Plain churches, i.e. Old Order Amish, Old Order Mennonite, or Old German Baptist Brethren. 

More people have tested Amish life for weeks, months, or even years, but in the end decided not to join. Others remain close to the Amish, but never think of joining.

Stephen Scott, himself a convert to the Old Order River Brethren, distinguishes four types of seekers:

• Checklist seekers are looking for a few certain specifications.
• Cultural seekers are more enchanted with the lifestyle of the Amish than with their religion.
• Spiritual utopian seekers are looking for true New Testament Christianity.
• Stability seekers come with emotional issues, often from dysfunctional families.

Health

Amish farm near Morristown, New York

Amish populations have higher incidences of particular conditions, including dwarfism, Angelman syndrome, and various metabolic disorders, as well as an unusual distribution of blood types. The Amish represent a collection of different demes or genetically closed communities. Although the Amish do not have higher rates of genetic disorders than the general population, since almost all Amish descend from about 200 18th-century founders, genetic disorders resulting from inbreeding exist in more isolated districts (an example of the founder effect). Some of these disorders are rare or unique, and are serious enough to increase the mortality rate among Amish children. The Amish are aware of the advantages of exogamy, but for religious reasons, marry only within their communities. The majority of Amish accepts these as Gottes Wille (God's will); they reject the use of preventive genetic tests prior to marriage and genetic testing of unborn children to discover genetic disorders. When a child is born with a disorder, it is accepted into the community and tasked with chores within their ability. However, Amish are willing to participate in studies of genetic diseases. Their extensive family histories are useful to researchers investigating diseases such as Alzheimer's, Parkinson's, and macular degeneration.

While the Amish are at an increased risk for some genetic disorders, researchers have found their tendency for clean living can lead to better health. Overall cancer rates in the Amish are reduced and tobacco-related cancers in Amish adults are 37% and non-tobacco-related cancers are 72% of the rate for Ohio adults. The Amish are protected against many types of cancer both through their lifestyle and through genes that may reduce their susceptibility to cancer. Even skin cancer rates are lower for Amish, even though many Amish make their living working outdoors where they are exposed to sunlight. They are typically covered and dressed by wearing wide-brimmed hats and long sleeves which protect their skin.

Treating genetic problems is the mission of Clinic for Special Children in Strasburg, Pennsylvania, which has developed effective treatments for such problems as maple syrup urine disease, a previously fatal disease. The clinic is embraced by most Amish, ending the need for parents to leave the community to receive proper care for their children, an action that might result in shunning. Another clinic is DDC Clinic for Special Needs Children, located in Middlefield, Ohio, for special-needs children with inherited or metabolic disorders. The DDC Clinic provides treatment, research, and educational services to Amish and non-Amish children and their families. 

People's Helpers is an Amish-organized network of mental health caregivers who help families dealing with mental illness and recommend professional counselors. Suicide rates for the Amish are about half that of the general population.

The Old Order Amish do not typically carry private commercial health insurance. A handful of American hospitals, starting in the mid-1990s, created special outreach programs to assist the Amish. In some Amish communities, the church will collect money from its members to help pay for medical bills of other members.

Although not forbidden, most Amish do not practice any form of birth control. They are against abortion and also find "artificial insemination, genetics, eugenics, and stem cell research" to be "inconsistent with Amish values and beliefs". However, some communities allow access to birth control to women whose health would be compromised by childbirth.

Amish life in the modern world

Traditional, Lancaster style Amish buggy

 

Amish school near Rebersburg, Pennsylvania

 

As time has passed, the Amish have felt pressures from the modern world. Issues such as taxation, education, law and its enforcement, and occasional discrimination and hostility are areas of difficulty.

The Amish way of life in general has increasingly diverged from that of modern society. On occasion, this has resulted in sporadic discrimination and hostility from their neighbors, such as throwing of stones or other objects at Amish horse-drawn carriages on the roads.

The Amish do not usually educate their children past the eighth grade, believing that the basic knowledge offered up to that point is sufficient to prepare one for the Amish lifestyle. Almost no Amish go to high school and college. In many communities, the Amish operate their own schools, which are typically one-room schoolhouses with teachers (usually young, unmarried women) from the Amish community. On May 19, 1972, Jonas Yoder and Wallace Miller of the Old Order Amish, and Adin Yutzy of the Conservative Amish Mennonite Church were each fined $5 for refusing to send their children, aged 14 and 15, to high school. In Wisconsin v. Yoder (1972), the Wisconsin Supreme Court overturned the conviction, and the U.S. Supreme Court affirmed this, finding the benefits of universal education were not sufficient justification to overcome scrutiny under the Free Exercise Clause of the First Amendment.

The Amish are subject to sales and property taxes. As they seldom own motor vehicles, they rarely have occasion to pay motor vehicle registration fees or spend money in the purchase of fuel for vehicles. Under their beliefs and traditions, generally the Amish do not agree with the idea of Social Security benefits and have a religious objection to insurance. On this basis, the United States Internal Revenue Service agreed in 1961 that they did not need to pay Social Security-related taxes. In 1965, this policy was codified into law. Self-employed individuals in certain sects do not pay into or receive benefits from the United States Social Security system. This exemption applies to a religious group that is conscientiously opposed to accepting benefits of any private or public insurance, provides a reasonable level of living for its dependent members, and has existed continuously since December 31, 1950. The U.S. Supreme Court clarified in 1982 that Amish employers are not exempt, but only those Amish individuals who are self-employed.

Publishing

In 1964, Pathway Publishers was founded by two Amish farmers to print more material about the Amish and Anabaptists in general. It is located in Lagrange, Indiana, and Aylmer, Ontario. Pathway has become the major publisher of Amish school textbooks, general-reading books, and periodicals. Also, a number of private enterprises publish everything from general reading to reprints of older literature that has been considered of great value to Amish families. Some Amish read the Pennsylvania German newspaper Hiwwe wie Driwwe, and some of them even contribute dialect texts.

Similar groups

Groups that sprang from the same late 19th century Old Order Movement as the Amish share their Pennsylvania German heritage and often still retain similar features in dress. These Old Order groups include different subgroups of Old Order Mennonites, traditional Schwarzenau Brethren and Old Order River Brethren. The Noah Hoover Old Order Mennonites are so similar in outward aspects to the Old Order Amish (dress, beards, horse and buggy, extreme restrictions on modern technology, Pennsylvania German language), that they are often perceived as Amish and even called Amish.

Conservative "Russian" Mennonites and Hutterites who also dress plain and speak German dialects emigrated from other European regions at a different time with different German dialects, separate cultures, and related but different religious traditions. Particularly, the Hutterites live communally and are generally accepting of modern technology.

The few remaining Plain Quakers are similar in manner and lifestyle, including their attitudes toward war, but are unrelated to the Amish. Early Quakers were influenced, to some degree, by the Anabaptists, and in turn influenced the Amish in colonial Pennsylvania. Almost all modern Quakers have since abandoned their traditional dress.

The Amish and the Native Americans

The Northkill Amish Settlement, established in 1740 in Berks County, Pennsylvania, was the first identifiable Amish community in the new world. During the French and Indian War, the so-called Hochstetler Massacre occurred: Local tribes attacked the Jacob Hochstetler homestead in the Northkill settlement on September 19, 1757. The sons of the family took their weapons but father Jacob did not allow them to shoot. Jacob Sr.'s wife, Anna (Lorentz) Hochstetler, a daughter (name unknown) and Jacob Jr. were killed by the Native Americans. Jacob Sr. and sons Joseph and Christian were taken captive. Jacob escaped after about eight months, but the boys were held for several years.

As early as 1809 Amish were farming side by side with Native American farmers in Pennsylvania. According to Cones Kupwah Snowflower, a Shawnee genealogist, the Amish and Quakers were known to incorporate Native Americans into their families to protect them from ill-treatment, especially after the Removal Act of 1832.

The Amish, as pacifists, did not engage in warfare with Native Americans, nor displace them directly, but were among the European immigrants whose arrival resulted in their displacement.

In 2012, the Lancaster Mennonite Historical Society collaborated with the Native American community to construct a replica Iroquois Longhouse.

Deductible

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Deductible

In an insurance policy, the deductible is the amount paid out of pocket by the policy holder before an insurance provider will pay any expenses. In general usage, the term deductible may be used to describe one of several types of clauses that are used by insurance companies as a threshold for policy payments.

Deductibles are typically used to deter the large number of claims that a consumer can be reasonably expected to bear the cost of. By restricting its coverage to events that are significant enough to incur large costs, the insurance firm expects to pay out slightly smaller amounts much less frequently, incurring much higher savings. As a result, insurance premiums are typically cheaper when they involve higher deductibles. For example, health insurance companies offer plans with high premiums and low deductibles, or plans with low premiums and high deductibles. One plan may have a premium of $1,087 a month with a $6,000 deductible, while a competitive plan may have a premium of $877 a month with a $12,700 deductible. The consumer with the $6,000 deductible will have to pay $6,000 in health care costs before the insurance plan pays anything. The consumer with the $12,700 deductible will have to pay $12,700.

Deductibles are normally provided as clauses in an insurance policy that dictate how much of an insurance-covered expense is borne by the policyholder. They are normally quoted as a fixed quantity and are a part of most policies covering losses to the policy holder. The insurer then becomes liable for claimable expenses that exceed this amount (subject to the maximum sum claimable indicated in the contract). Depending on the policy, the deductible may apply per covered incident, or per year. For policies where incidents are not easy to delimit (health insurance, for example), the deductible is typically applied per year.

Several deductibles can be set by the insurer based on the cause of the claim. For example, a single housing insurance policy may contain multiple deductible amounts for loss or damage arising from theft, fire, natural calamities, evacuation etc.

There are also deductible reimbursement programs that reimburse a deductible in the event of an automobile, home, boat/yacht or health insurance claim.

Vs. franchise

A deductible should not be confused with a franchise. Where a deductible represents a part of the expense for which the insurer is not liable, the franchise is a pure threshold that, when exceeded, transfers liability for the entire expense to the insurer. For example, with a franchise of $20,000, a claim of $19,900 is borne entirely by the policyholder and a claim of $20,500 is borne entirely by the insurer.

Vs. excess

An excess can refer to one of two very different insurance terms.

The first is excess post-hospitalization which refers to the extra costs borne by the insured over and above the maximum coverage that the insurance company pays. This terminology is especially common in areas of insurance sensitive to loss (like liability insurance) and is addressed by the insurance market through excess line insurance companies through mechanisms like excess insurance, gap insurance, and umbrella insurance.

The second is excess pre-hospitalization which refers to an insurance exception that is (often interchangeably but wrongly) referred to also as an excess or a deductible. It is "the first amount of the claim which the insured has to bear. If the insured has an excess of $500 and the total repair costs $3,000, then the insured has to pay $500 while the insurer pays the remaining $2,500."

Automobile and property insurance

In a typical automobile insurance policy, a deductible will apply to claims arising from damage to or loss of the policy holder's own vehicle, whether this damage/loss is caused by accidents for which the holder is responsible, or vandalism and theft. Depending on the policy, the deductible may differ based on the type of expense incurred that triggers the insurance claim.

Third-party liability coverages including auto liability, general liability, garage keepers, inland marine, professional liability and workers compensation are also written with deductibles. These deductibles on commercial liability policies are known as third party deductibles or liability deductibles. Because the insured and claimant are not the same entity, insurers cannot pay the claim minus the deductible. This creates a receivable owed from the insured to the insurer. Due to the complexity of identifying these third party deductible receivables, many are often missed by the insurer causing millions of dollars to go uncollected.

An insured has the option to accept an appearance allowance that can be used towards their deductible. Appearance allowances help manage repair costs by allowing for the insured to choose not to fix expensive parts that have minor damage and using the money towards their deductible.

Health and travel insurance

Most health insurance policies and some travel insurance policies have deductibles as well. The type of health insurance deductibles can also vary, as individual amounts and family amounts.

Given the nature of medical treatment, the insured often faces multiple medical expenses spread over several days for a single illness or injury. Due to this reason, health insurance deductibles often tend to be imposed on a term basis (e.g. annually) as opposed to a per-visit threshold. In spite of this, major medical insurance policies may have a per-visit excess which often does not cover the cost of routine visits to a GP, unless it is certified to be a part of a continuous treatment (and the bills can be collated in a single claim).

Industrial and commercial insurance

In industrial risks it is also common for the deductible to be expressed as a percentage of the loss, often though not always, with a minimum and maximum amount. This is similar to co-insurance, where the company pays a certain percentage of the losses, coupled with minimum and maximum payment thresholds. For example, with a deductible of 10% with a minimum of $1,500 and a maximum of $5,000, a claim of $25,000 would incur a deductible of $2,500 (i.e. 10% of the loss) and the resulting payment would be $22,500. A claim below $15,000 would incur the minimum deductible of $1,500 and a claim above $50,000 would incur the maximum deductible of $5,000.