Among key achievements
For 40 years, HRP – The UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – has been the main instrument within the United Nations system for research in human reproduction, bringing together policy-makers, scientists, health care providers, clinicians, consumers and community representatives to identify and address priorities for research to improve sexual and reproductive health.
Eliminating congenital syphilis
Congenital syphilis continues to be a major public health problem, causing stillbirths, prematurity, neonatal deaths, and congenital disease. An estimated 2.65 million stillbirths occur yearly, of which 98% occur in low and middle-income countries. Maternal infections such as syphilis are one of the top five major causes of stillbirth. In addition, genital ulcer diseases such as syphilis increase the risk of HIV transmission by three- to five-fold.
Elimination of congenital syphilis as a public health problem is feasible with a relatively simple set of existing interventions focusing on maternal and newborn care. Universal screening for syphilis among antenatal care attendees and treatment of positive women is cost-effective even in low-prevalence settings. Syphilis screening in pregnancy is more effective in preventing stillbirths than any other pregnancy intervention besides comprehensive emergency obstetric care, and costs less per pregnant woman treated than nearly any other intervention. Interventions to improve screening programmes for antenatal syphilis could reduce syphilis-attributable stillbirths and perinatal deaths by 50%.
The building blocks for congential prevention are already in place in many countries: policy guidelines for universal antenatal syphilis screening exist in most countries; levels of antenatal attendance are high; screening tests are low-cost and technically feasible even at the primary health-care level; and treatment with penicillin is inexpensive and is on the essential medicines list of all countries. Despite these numerous facilitating factors, the majority of pregnant women are not screened for syphilis as there is a great under-appreciation of the burden of congenital syphilis and syphilis screening of pregnant women is often not a priority public health intervention.
HRP is leading the Global Elimination of Congenital Syphilis Initiative to highlight the importance of congenital syphilis as a key issue for maternal and newborn health, as well as emphasize how efforts to improve antenatal syphilis screening can be used to strengthen underlying antenatal care systems. In addition, HRP is working with partners to support regions and countries in dual elimination of mother-to-child transmission of HIV and syphilis, and strengthen surveillance, monitoring, and evaluation systems. HRP is finalizing an advocacy tool to outline the rationale for investing in elimination of congenital syphilis efforts: the Investment case for eliminating congenital syphilis: promoting better maternal and child health and stronger health systems.
HRP is collaborating with countries and external partners to identify how to best monitor elimination of congenital syphilis efforts, and to understand better the importance of early treatment for syphilis in pregnancy.