The Unfinished Agenda of Women’s Reproductive Health

THE UNFINISHED AGENDA OF WOMEN’S REPRODUCTIVE HEALTH

International Journal of GYNECOLOGY & OBSTETRICS Volume 131, Supplement 1 (2015)

Supplement to International Journal of Gynecology & Obstetrics Volume 131, Supplement 1 World Report on Women’s Health 2015

Direct Link to Full 85-Page 2015 Publication: http://www.ijgo.org/pb/assets/raw/Health%20Advance/journals/ijg/World%20Report%20on%20Women%E2%80%99s%20Health%202015.pdf

Guest Editors: Chittaranjan Narahari Purandare, Richard Adanu

EDITORIAL

The Unfinished Agenda of Women’s Reproductive Health

The 2015 FIGO World Report on Women’s Health is published at a special time in the history of health interventions. This year marks the end of the Millennium Development Goal (MDG) era and ushers us into the sphere of Universal Health Coverage (UHC). As we talk about UHC it is vital that the emphasis that has been placed on women’s reproductive health over the years does not diminish. The emphasis that WHO is placing on Sustainable Development Goals (SDGs) post 2015 also emphasizes the need to preserve our achievements, while taking on new challenges. In the light of these global developments, the 2015 World Report focuses on the unfinished agenda of women’s reproductive health. The MDG era achieved many successes and women’s health was central to a number of the goals. With the move to build on these successes by targeting UHC, it is important to remember that successes in women’s health over the years are not equivalent to the elimination of women’s reproductive health problems.

The 2015 World Report articles provide new perspectives on issues that are all too familiar. The Report is divided into three sections: maternal health, reproductive health, and leadership and management.

Maternal morbidity and mortality continue to be major issues in many countries. Even though maternal mortality has reduced globally, there are still many places where women face unacceptable risks of death whenever they go through pregnancy, labor, and delivery. The papers in the first chapter stress the need for all health services to ensure that the results of maternal death reviews are acted upon using the new maternal death surveillance and response (MDSR) approach. The controversial issue of task sharing or task shifting to ensure adequate coverage of obstetric services is also addressed. Mobile health (mHealth) is a subject receiving much attention and one article looks at the use of mHealth in providing personalized care to pregnant women. Medical conditions in pregnancy, such as gestational diabetes, have always been an area of concern in maternal health. With the current emphasis on the prevention of noncommunicable diseases (NCDs), it is important to understand how the presence of medical conditions in pregnancy could lead to the increase in incidence of NCDs in women. The prevention of type 2 diabetes in women who have suffered from gestational diabetes is considered in one paper.

Women’s reproductive health is a broad topic that looks at clinical and social problems that affect women. Over the past decade there have been a number of advances in cervical cancer prevention; however, the world continues to see equal numbers of deaths due to cervical cancer and maternal deaths every year. Many of these advances in the management of cervical cancer are not available to many women in the world and we need to look at cost-effective ways of delivering the interventions. The papers in the reproductive health section also highlight the new challenges that are emerging as we make progress in the areas of breast cancer and adolescent health. Despite the numerous gains made in these two areas, the problems of financial access to services and sociocultural barriers to services remain major obstacles to achieving UHC.

The complications of unsafe abortion and restriction of access to safe abortion services still need to be addressed through advocacy, policy change, and service provision. Family planning services have been clearly recognized as the link between women’s reproductive health and maternal health. It is now accepted that family planning services that have unrestricted access and that provide the full range of modern contraceptive methods are crucial in the campaign against maternal mortality. FIGO continues to show its commitment to family planning and is currently involved in the postpartum intrauterine contraceptive device project, which will contribute to increasing the prevalence rate of modern contraceptive methods. The global contraceptive prevalence rate is still low even though there has been some improvement over the years. It has been shown that the health of women as well as newborns is improved by a three-year interval between pregnancies. The reproductive health section examines current advances in preventing newborn deaths and also discusses the use of long-acting reversible contraception. Disrespect and abuse of women in labor are at the intersection of maternal health and women’s reproductive health. As the clinical indicators of maternal health improve, we begin to focus more on quality of care and this has raised the gender-related issue of disrespect and abuse that women in labor tend to suffer at the hands of both male and female care givers. As we aim for UHC, we must be ready to tackle the way in which these lifesaving services are delivered.

The rights of women and children must always be of concern in our health services. Obstetric fistulas lead to the exclusion of many women from society and are also located at the intersection of maternal health and women’s reproductive health. Collaboration between FIGO and other global agencies is improving the capacity for surgical treatment of obstetric fistula. This “old” problem still lives with us and needs to be emphasized as the health community moves beyond 2015.

The last section of the Report comprises two papers that highlight the importance of the role of professional societies and international agencies in ensuring that health targets are met. The need for effective local management in ensuring the success of interventions designed at a global level is also emphasized.

The primary message of the 2015 World Report on Women’s Health is that while we celebrate the successes of the MDG era, we must remember that there are some challenges that we could not overcome. We need to strategize to find new approaches or to persist with the proven interventions that we have been implementing.

Chittaranjan Narahari Purandare Indian College of Obstetrics and Gynaecology and Purandare Hospital, Mumbai, Richard M.K. Adanu School of Public Health, University of Ghana, Legon, Ghana