Sexual and reproductive health

Message from Director RHR/HRP

February 2017

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

This month I was honoured to participate in the launch of the Network to Improve Quality of Care for Mothers and Newborns, which took place in Lilongwe, Malawi. This important initiative, led by nine countries with technical support from WHO, UNFPA and UNICEF, commits countries to a common vision in which every pregnant woman and newborn infant receives good quality care and their right to respect and dignity are protected throughout pregnancy, childbirth and the postnatal period. The initiative strives to halve maternal and newborn mortality and stillbirths in health facilities within five years, thereby working towards the overall national targets of ending preventable maternal and newborn deaths and stillbirths.

WHO estimates that 5.6 million women and infants died in 2015 due to complications in pregnancy, childbirth and in the first month of life. Most of these deaths occur on the day of birth, mainly from preventable causes. While significant progress has been made over the past two decades to reduce maternal mortality, high quality healthcare during pregnancy and childbirth (as highlighted in the recently launched WHO Antenatal care guidelines) can prevent many negative health outcomes, as well as improve women and adolescent girls’ experience of pregnancy and childbirth.

High quality healthcare is also that which safeguards human rights, upholds dignity and ensures equity. Unfortunately however, human rights are often undermined. Recently published evidence – generated through the HRP Alliance research capacity strengthening programme – suggests that many women worldwide experience mistreatment and abuse during childbirth by health-care providers.

Such mistreatment constitutes a violation of the right to the highest attainable standard of health, which includes the right to dignified, respectful healthcare throughout pregnancy and childbirth, as well as the right to be free from violence and discrimination. It is also a barrier towards reducing maternal mortality and morbidity in countries worldwide. It is my hope that the new Quality of Care Network will work towards ending such mistreatment by health-care providers and to ensuring that health-care facilities are places of security, dignity and well-being.

In order to ensure high quality healthcare, providers need to be empowered with crucial skills and knowledge, and supported by their communities and countries in their work. A special supplement to the International Journal of Gynecology and Obstetrics, entitled Management of health outcomes of female genital mutilation, which was published on the occasion of the International Day of Zero Tolerance for Female Genital Mutilation, highlights the importance of investing in the training of health-care providers to both prevent female genital mutilation (FGM) and to treat its complications.

The co-authors of the supplement – which informed the WHO guidelines on the management of health complications from female genital mutilation – note there is an urgent need to reach and support women and girls who have experienced FGM with high quality healthcare.

The High Level Working Group on the Health and Human Rights of Women, Children and Adolescents met in Geneva earlier this month, to reaffirm the urgency of safeguarding human rights to improve the health and well-being of women, children and adolescents worldwide. The meeting brought together champions, leaders and experts in the fields of health and human rights, and placed particular emphasis on leaving no one behind, including the poorest and those living in conflict zones. Jointly convened by the Director-General of WHO and the UN High Commissioner for Human Rights, the Department’s staff are the secretariat for the Working Group.

To support the 2030 Agenda for Sustainable Development’s principle of leaving no one behind, the department organized a technical meeting to shape a global research agenda to generate evidence for ensuring universal access to sexual and reproductive health in humanitarian settings for the estimated 26 million women and girls of reproductive age living in such settings.

More than 50 experts came together to identify evidence gaps; to share challenges in data collection and research in such settings; to discuss ways to adapt and implement WHO guidelines on sexual and reproductive health to humanitarian settings; and to launch a ‘research to action’ consortium dedicated to improving the generation and use of rigorous evidence to strengthen sexual and reproductive health and rights in humanitarian settings.

HRP’s two advisory bodies, the gender and rights advisory panel (GAP) and the scientific and technical advisory group (STAG), met in Geneva last week, and the Department continues to benefit enormously from the guidance and advice that these global leaders in SRHR provide. Their insights ensure that not only is our research of the highest quality, but also that human rights and gender equality are explicitly addressed in both our research and the normative guidelines we develop.

As an example of the Department’s commitment to a human rights approach and ensuring that our guidelines are person-centred, the WHO Consolidated guideline on sexual and reproductive health and rights of women living with HIV was launched this week. This ground-breaking guideline underwent a unique development process, which included meaningful engagement with communities of women living with HIV. Taking a woman-centred approach, the guideline highlights how human rights must be safeguarded, and gender inequalities must be addressed, if sexual and reproductive health interventions are to effectively meet the needs of women living with HIV.

At a three-day consultation in Windhoek, Namibia, hosted by the Ministry of Health, and convened by HRP, WHO, UNAIDS, USAID and PEPFAR, I joined with representatives from around eastern and southern Africa, as well as Namibia’s First Lady, to discuss how to accelerate efforts to improve prevention of HIV for adolescent girls and young women. I highlighted the fact that HIV prevalence in adolescent girls and young women is largely driven by gender inequality, socioeconomic conditions and pervasive violence. Governments need to ensure that effective interventions to address these issues are implemented at scale to make a lasting and sustainable difference.