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Message from the President
My sincere gratitude for electing me as President of this prestigious organisation for the period 2012-2015.
On behalf of FIGO, I would like to thank the world of obstetricians and gynecologists, national governments and our professional partners and donors (which include ICM, ICN, IPA, Bill & Melinda Gates, The Fistula Foundation, USAID, UNFPA, WHO, Jhpiego, IPAS etc among others) for an incredible job well done in terms of Millennium Development Goal 5. I would also like to put on record the excellent work done by the FIGO Officers, Executive Board and staff over the last three years under the esteemed leadership of Professor Gamal Serour. We can now take over from what we have achieved, knowing that we have much more work to do.
The aim of MDG5 is to reduce the 1990 figures of 540,000 maternal deaths by 75 per cent by the year 2015. In the year 2010 we reduced it to 287,000 per year: a 47 per cent reduction. However, this falls short of the expected percentage change, so for the next three years, before the MDGs come to an end in 2015, we should accelerate the pace and reduce these figures even further.
Success has been evidenced in low- and middle-income countries. This was based on analysis of data from low-resource countries, by the Institute of Global Health at Imperial College and McKinsey’s, in addition to interviewing a number of academic and health service implementers who have been involved in work related to these countries.
The five principles that underpin success are:
1) Commitment by governments to make maternal health as a priority. This commitment has to be with partners ie non-governmental organisations, donors and national professional organisations of obstetricians and gynecologists, midwives, paediatricians, public and private organisations and donors.
2) Selecting and tackling a few areas of concern. Based on the cause of maternal deaths, effective contraception can reduce maternal deaths by 30 per cent; provision of safe abortion care can reduce mortality by 13 per cent; and emergency obstetric care can reduce a further significant amount. Depending on the situational and need analysis in countries, governments and professionals should plan the priority areas of work.
3) Engagement with the community and women. The ownership of programmes should involve people at the grass-roots level so that they feel that they have something to contribute to this equation. They have to be motivated to attend antenatal clinics, delivery facilities and avail of contraceptive services.
4) Innovation for effective health care delivery. There are a number of countries that have produced very innovative ideas eg Mozambique trained midwives to be surgeons to perform caesarean sections because it is a country of 20 million people with about 62 obstetricians. Obstetricians are not available in many centres to do caesarean sections, and the surgical assistants take their place - the clinical outcome is good.
5) Accountability ie measurement to show that what we do is effective. We cannot improve on the current status unless we continually measure the maternal and perinatal outcome. An audit of structure, process and outcomes is essential to improve safety and quality of care. Countries that do well have introduced audits and confidential enquiries.
FIGO will adapt these principles in many areas of work over the next few years. I urge FIGO’s National Societies to consider these principles. While we keep our watch and work on maternal mortality, we will forge ahead with other issues in women’s health. Benign gynecological disorders - like fibroids and menstrual disorders - affect 80 million women who are not having children. New definitions and appropriate management of menstrual problems were proposed by the FIGO Working Group on Menstrual Disorders and accepted by FIGO. The Committee for Reproductive Medicine has developed The FIGO Fertility Tool Box ™, encompassing aspects of prevention to treatment and is applicable to low- and high-resource countries. The use of this Tool Box would be disseminated by workshops and by applying it to certain countries. Cancer in women is a global problem: cancer of the cervix causes 275,000 deaths every year, mainly in less resourced countries. We will promote immunisation with the HPV vaccine in all countries. In the developing world we shall review simpler forms of screening and treatment. The Committee for Gynecologic Oncology will also look at the minimal requirements for pathology services to aid in diagnosis, and it is also reviving the oncology triennial report which will give us the essential data to advance classification and management options.
We will work towards improving women's health by contributing to the efforts of our partners. We will work closely with the International Confederation of Midwives (ICM) and the International Paediatric Association (IPA) in order to implement well-known interventions.
As a prelude to the FIGO conference in Rome, we held a Pre-Congress Workshop with our partners over two days where we discussed the priority areas for our organisation that need to be tackled over the next three years. It was very clear from the discussion that family planning is a key issue. Based on maternal deaths, we can identify that 30 per cent can be avoided by proper contraception. By avoiding pregnancy, these women are not exposed to the complications of pregnancy and childbirth. Also, there will not be a need for an abortion. By providing good contraception, we should be able to reduce maternal morbidity and mortality, indirectly help to reduce poverty, and improve child health and education. FIGO will concentrate on post-partum long-acting reversible contraception, and the availability of emergency contraception.
Safe abortion care is an important issue in countries where it is legally permitted ie we should be able to provide good and friendly services and remove the stigma associated with such services. Programmes on training and provision of emergency obstetric care need to be escalated, and we would like to work with partners who are directly involved in such programmes, such as Jhpiego, the Liverpool School of Tropical Medicine, the Laerdal Foundation, Rotary and many others.
HIV/AIDS in women is a major problem, more so in some poor countries. Rather than having vertical programmes to tackle this, we would like to integrate these services with contraceptive and other women’s health services by working with UNAIDS.
The recommendations on these areas of work were made at the Pre-Congress Workshop, and we will work with FIGO National Societies to carry this forward in the next three years.
I would be grateful if FIGO members can take action based on the FIGO 2012 World Report on Women’s Health, which is produced as a supplement of the International Journal of Gynecology & Obstetrics (IJGO). The World Report has two sections: one on safe motherhood and the other on women’s health issues that tackle benign and malignant gynecological disorders. The articles provide best practices from the world which can be applied in high- and low-income countries. Sir Liam Donaldson, former Chief Medical Officer of England, visited many health centres and said: ‘There are islands of excellence or good practice in a sea of mediocrity’. The World Report provides information about the islands of excellence and best practice, taking country programmes and disease management algorithms as examples. I would urge you to make use of the knowledge provided in this invaluable Supplement.
There are a number of other issues that need to be tackled. We need to help reduce three million still births and three million neonatal deaths and the burden of prematurity. We have major women’s rights issues starting from before birth, affecting the girl child, adolescents and women in both the reproductive, and older, age groups. These manifest in various forms: sex selective abortions, female genital mutilation (FGM), inadequate sex education, non-availability of contraception, no treatment of sexually transmitted infections, domestic violence, fistula, to name but a few. The various FIGO Committees try and help as much as possible by advocacy and work at the grass-roots level to tackle these problems. However, all these issues cannot be tackled by one single organisation like FIGO. We need help from a number of partners eg national associations of obstetrics and gynecology, midwives, paediatricians, donors and government support and co-operation.
The five principles expressed earlier should help us to move forwards and FIGO will ‘work together’ to improve women’s rights and health.
I join the Officers, staff and the Executive Board in wishing you the very best throughout 2014.
With kind regards
Professor Sir Sabaratnam Arulkumaran