Sexual and reproductive health

Message from Director RHR/HRP

July / August 2019

Photo portrait of Ian Askew
Ian Askew,WHO Director, Department of Reproductive Health and Research

It’s been a busy and productive July for all of us, thanks to the dedication of colleagues and partners in promoting and protecting people’s sexual and reproductive health and rights (SRHR). Whether it was in Geneva, Kabul, Lusaka, Male, Mexico City or Vancouver, SRHR was on everyone’s mind, and we think that should always be the case.

This month, Maldives was officially certified for having successfully eliminated mother-to-child transmission of HIV and syphilis. Maldives joins Thailand in WHO’s South-East Asia region as the second country to have achieved this public health milestone. This achievement is due to the country’s proactive, persistent and long-term public health measures which began even before the first case of HIV infection was detected in the country in 1991—proof that strong political will, and robust health systems spell a huge difference in public health. We congratulate the Ministry of Health of Maldives and acknowledge our colleagues Melanie Taylor and Maura Laverty who worked tirelessly for this significant accomplishment.

Access to life-saving medicines is critical for achieving sexual and reproductive health. During this month we learned that mifepristone-misoprostol, heat-stable carbetocin and tranexamic acid are now included in the core list of the updated WHO Essential Medicines List. This is a great development as these medicines can now be made more widely available to people everywhere, especially those who need them the most.

A journal supplement was published featuring seven papers that shed light on various aspects of Nigeria’s maternity care and health system, particularly between 2012 and 2013; Femi Oladapo and former colleague João Paulo Souza led this work. Nigeria has a high maternal mortality ratio and a large population and so the evidence presented in this supplement provides important information to better understand the reasons for the high number of intra-hospital deaths associated with pregnancy-related complications.

WHO has developed stringent processes for its guidelines but is constantly reviewing country’s needs for normative guidance and how to improve these processes to provide the best evidence possible to inform decision-makers. RHR staff have worked with colleagues from across WHO and with experts from around the world to strengthen processes for public health guidelines for the delivery of services in health systems. Whether the guideline is for a complex, multi-component service delivery intervention or a service delivery approach being implemented in a complex context, processes for developing guidelines that appropriately address “complexity” have been lacking. A series of papers published this month provides important insights to the many issues to be address as WHO strengthens its processes and methods for developing guidelines on complex health interventions and interventions delivered in complex systems.

Although you may not be aware of it, it is highly likely that, at some point in your life, you have benefited from a guideline developed by the World Health Organization (WHO). That’s because when countries, external partners or other stakeholders need guidance on clinical or public health problems or policies, they turn to WHO for guidance. An observation sometimes made about these guidelines, however, is that guideline users and those affected by their recommendations are not consulted during the guideline development phase. In a drive to include perspectives from end users and health care providers, WHO recently developed three manuscripts to look at how to incorporate qualitative data into guideline development methods. Qualitative research explores people’s needs, values, perceptions and their experiences of the world around them. This includes their health or illness, healthcare services, and more broadly, social systems and their policies and processes

It’s always heartening to read stories about people who go the extra mile in public health. One such story involves Nasrin Hussaini, a midwife in Afghanistan who helps raise awareness about gender-based violence, and provides reproductive health services to women. Nasrin enthusiastically does these each day, despite her 60-kilometer commute. She counsels women and girls on gender-based violence and trains male members of families, informing all men that women can and must visit clinics, especially for antenatal care, delivery and postnatal care. You can read more about Nasrin’s amazing story and how she’s touched people’s lives in the link below. This story illustrates the impact of the work of our colleagues Claudia Garcia-Moreno, Avni Amin and Elisabeth Roesch through their close collaboration with the WHO Country office in Afghanistan.

As our way of concluding Self Care Month on 24 July, Manjulaa Narasimhan created this presentation to help promote self-care interventions for health. Please feel free to use this presentation to support discussions about self care and its importance in bridging the gaps to essential health services, particularly those that involve sexual and reproductive health and rights. There will be more activities in the pipeline for self care so stay tuned by making sure you follow us on Twitter (@HRPResearch) if you haven’t already done so.

Looking ahead, we are getting ready for two major global events that have important implications for SRHR—the United Nations High-Level Meeting on Universal Health Coverage (UHC) on 23 September 2019 and the Nairobi Summit to commemorate the 25th Anniversary of the International Conference on Population and Development (ICPD) from 12–14 November 2019.

The UHC meeting brings together heads of state, political and health leaders, policy-makers and UHC champions to advocate for health for all. It is hoped that through the meeting, financial and political commitments and health investments will be garnered and sustained. A political declaration on UHC negotiated by Member States and endorsed by Heads of State will be the result of this meeting.

Before 2019 draws to a close, the SRHR community will gather in Nairobi to muster the political will and financial commitments that are necessary to achieve a better world where everyone has rights and choices over their sexual and reproductive health.

Co-convened by the governments of Denmark, Kenya and by UNFPA, the meeting seeks to commit stakeholders to finally and fully implement the ICPD Programme of Action. These commitments involve: achieving zero unmet need for family planning information and services; zero preventable maternal deaths; and zero sexual and gender-based violence and harmful practices against women and girls.