FIGO delivering innovative projects
International Federation of Gynecology and Obstetrics delivering innovative projects to save women’s lives around the world
Vancouver, BC, Wednesday, October 7, 2015 - The International Federation of Gynecology and Obstetrics (FIGO) - representing 125 national societies of obstetricians and gynecologists worldwide - announced today at the XXI World Congress of Gynecology and Obstetrics new opportunities in lowresource countries to reduce global maternal mortality. These innovative “on the ground projects” are helping to achieve the recently adopted UN Sustainable Development Goal (SDG) 3.1 aimed at reducing the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. FIGO’s global maternal mortality projects include:
- Post-Partum IUD (PPIUD) Initiative: Maternal mortality is reduced when women space their pregnancies more than two years apart. IUDs (intra-uterine devices - “coils”) inserted immediately after childbirth are safe, effective and reversible. The Initiative involves training health care professionals to counsel and insert IUDs. It is being implemented in six countries worldwide.
- Prevention of Unsafe Abortion Initiative: Unsafe abortion remains one of the main causes of maternal mortality and morbidity in countries with restrictive abortion laws. Obstetricians and gynecologists play a fundamental role in implementing the interventions this FIGO Initiative is promoting, intending to reduce unsafe abortion rates and the maternal mortality and morbidity associated with unsafe abortion.
- Helping Mothers Survive: Postpartum hemorrhage (PPH) remains the leading cause of maternal morbidity and mortality in sub Saharan Africa. This initiative aims to ensure that health providers in rural areas are equipped to manage PPH through regular, frequent training and support.
- Misoprostol for Postpartum Hemorrhage in Low-Resource Settings Initiative: The initiative advocates for the use of misoprostol for post-partum haemorrhage (PPH) prevention and treatment by acting as a ‘guiding’ organisation for advocacy among the medical community and health professionals. It involves disseminating strong evidence-based results relating to the effectiveness and greater use of misoprostol, including guidelines and protocols, for professional groups on the use of misoprostol for PPH.
Dr. De Caestecker adds
Prevention and timely treatment of postpartum hemorrhage, reducing unsafe abortion and ensuring access to effective contraception are key interventions to reduce maternal mortality and severe morbidity,” says Dr. Linda De Caestecker, FIGO PPIUID Deputy Project Director. “These FIGO projects involve obstetricians and gynecologists, in partnership with midwives and other professionals, in the task of ensuring that more women worldwide have easy access to these interventions, addressed to protect mothers and newborns from preventable death and illness,
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About The International Federation of Gynecology and Obstetrics (FIGO)
The International Federation of Gynecology and Obstetrics (FIGO) is a non-profit organization that brings together obstetrical and gynecological associations from 125 countries/territories worldwide. It is dedicated to the improvement of women’s health and rights and to the reduction of disparities in healthcare available to women and newborns, as well as to advancing the science and practice of obstetrics and gynecology. Based in London, the organization hosts a triennial World Congress that draws more than 7,000 women’s health scientists, clinicians, and other allied health professionals to present the latest science and best clinical practice in obstetrics and gynecology.
FIGO Global Maternal Mortality Initiatives
Post-Partum IUD (PPIUD) Services and Increasing Access to Information and Education on Contraception Initiative:
- The goal of the Institutionalizing Post-Partum IUD (PPIUD) Services and Increasing Access to Information and Education on Contraception initiative is to institutionalize the practice of offering immediate post-partum intra-uterine device (IUD) services in teaching hospitals.
- Long-acting reversible contraceptive methods such as the IUD enable a woman to plan her family, space her pregnancies, increase her productivity, and improve the health of both her and her baby. IUDs have the lowest rates of discontinuation; are cost effective; and can be provided by mid-level providers’ long–term after suitable training.
- The initiative is being implemented in six countries: Sri Lanka, India, Kenya, Tanzania, Bangladesh and Nepal. Training is being undertaken for health professionals on counselling women on this method of contraception and on insertion immediately after delivery. FIGO will monitor and learn from the uptake of the initiative which could lead to a long term, sustainable programme to enable more women worldwide to have choice on the timing of their next pregnancy and to reduce maternal and child mortality.
- In addition, the Initiative includes a partnership with the Harvard T.H. Chan School of Public Health in Sri Lanka aimed at evaluating the initiative including longer term follow up of the outcomes and women’s views about the counselling and the method of contraception. The evaluation will also 3 investigate whether the practice spreads more widely as trained professionals move to different hospitals and clinics. This work involves the development of tailored data collection tools that will facilitate tablet-based data collection to streamline the monitoring processes and provide country teams with the information and tools they need to ensure quality of services and advocate for continued expansion of PPIUD services.
Prevention of Unsafe Abortion Initiative:
- The goal of the Prevention of Unsafe Abortion Initiative is to reduce unsafe abortion rates and the maternal mortality and morbidity associated with it. By adopting the initiative and working directly with Member Societies, FIGO wants to ensure that gynaecologists and obstetricians in participating countries pay attention to the problem of unsafe abortion and contribute to its prevention.
- Each society has named a focal point, who prepares an action plan in collaboration with the national Ministry of Health. The action plans include any up to all the four levels of prevention proposed by FIGO:
- primary, to reduce unintended pregnancies and abortions
- secondary, to make unavoidable abortion safer
- tertiary, for timely and correct treatment of abortion complications
- quaternary, to reduce its repetition.
- The Initiative involves 46 countries from seven regions. Representatives from all the societies from the same regions meet once a year in Regional workshops, where progress in the plans of action are presented and the plans are updated, and concentrates on 16 priority countries with high unsafe abortion and maternal mortality rates.
- The countries involved had made great progress, particularly in improving the treatment of incomplete abortion, following the FIGO recommendation of replacing sharp curettage for vacuum aspiration or misoprostol, which facilitate a prompt treatment because these methods do not require a surgical theatre. Another FIGO recommendation of providing Family Planning counselling and an effective contraceptive method after abortion is already included in all the plans of action of participating countries, helping to reduce repeated abortion which are almost half of all induced abortions.
- Many of the plans of action are now including the provision of safe pregnancy termination within the full intent of the law, following the Cairo ICPD recommendation which had been ignored until now. As one element to move toward that end, the article: ‘Evidences supporting greater access to safe legal abortion’ is included in the 2015 ‘World Report on Women’s Health’.
Misoprostol for Post-Partum Haemorrhage in Low-Resource Settings Initiative:
- PPH is the most significant direct cause of maternal mortality in low-resource countries. It accounts for approximately 30 per cent of maternal deaths worldwide and is highly preventable.
- Misoprostol is used for a variety of reproductive health indications – it is particularly useful in lowresource settings as it does not require refrigeration, is stable at room temperature and is easy to administer
- There is a growing body of literature on its efficacy and safety for PPH prevention and treatment
- Misoprostol for PPH management is recommended as part of many international guidelines for PPH Management (WHO, FIGO, RCOG) and is included on the WHO Model List of Essential Medicines for PPH treatment and prevention
- FIGO works to disseminate through all available means the latest international guidelines on the prevention and treatment of PPH with misoprostol and advocate for the incorporation of these recommendations on misoprostol for PPH care into national clinical guidelines
- FIGO’s guidelines and dosage charts assist healthcare providers to use misoprostol correctly.
- It is part of a global project that is looking at ways to translate scientific and operational research on misoprostol for PPH into effective policies, programmes and practice.
- This is a joint project between FIGO and Gynuity Health Projects.
Project Profile: Helping Mothers Survive - (in collaboration with the International Confederation of Midwives)
- FIGO is working in Uganda and Tanzania to prevent mothers dying of postpartum haemorrhage.
- Ensuring that health providers are able to deal with life-threatening situations is a key step due to reducing in-facility deaths.
- Low-dose, high-frequency trainings are an important option in low resource-settings to support health providers in rural areas to prevent and treat post-partum haemorrhage.
- The 1-day training utilizes simulation models called Mama Natalies. Clinical mentors from each facility will support weekly practice sessions for 6-8 weeks. Results will be available in 2016/2017.
- Training focuses on key knowledge and skills including: consistent application of Active management of the third stage of labor (AMTSL), improved monitoring of blood loss, investigations to determine the cause of the bleeding, and bimanual compression of the uterus for atonic haemorrhage.
- The project is funded by the Laerdal Foundation.