Implementing a rights-based approach to maternal healthcare

1. Implementing a rights-based approach to maternal healthcare By Professor Hamid Rushwan Chief Executive, International Federation of Gynecology and Obstetrics (FIGO) Geneva, 10 September 2014

2. FIGO Mission Statement • The International Federation of Gynecology and Obstetrics (FIGO) is a professional organisation that brings together obstetrical and gynecological associations from all over the world • FIGO 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 • The organisation pursues its mission through advocacy, programmatic activities, capacity strengthening of member associations and education and training

3. FIGO Commitment to reproductive rights • Since 1954 and in collaboration with its 125 Member Societies, • FIGO has strived to create a world in which … • Women can make informed decisions about whether and when to have children and are free from gender-based violence and coercion • Women benefit from advances in reproductive medicine, and disparitiesin healthcare available to women and newborns are reduced • Obstetricians and gynecologists are equipped with the skills and facilities to uphold women’s reproductive rights

4. From commitment to action • A dedicated Committee for the Ethical Aspects of Human Reproduction and Women’s Health (1985) • A dedicated Committee for Women’s Sexual and Reproductive Rights (2001) • A World Report on Women’s Health every three years to address major issues in women’s sexual and reproductive rights • Development of a number of evidence-based Resolutionsrelating to women’s rights • Support to member associations to build the capacity of healthcare professionals to be actively involved in promoting sexual and reproductive health rights

5. Making maternal healthcare services available, accessible, acceptable and of high quality is at the heart of all FIGO actions, resulting in meaningful contributions being made to the implementation of the 2012 Technical Guidance

6. FIGO- Eliminating discrimination, coercion and harmful practices • FIGO believes that physicians and professional societies are uniquely placed to assist in creating wider awareness of these issues • 1994: Montreal resolution condemning FGM • 2006: FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health published a statement opposing FGM • - Medicalisation of female genital cutting underestimates the overall physical and psychological implications of FGM, creating implied approval

7. FIGO - Eliminating discrimination, coercion and harmful practices • 2009: Guidelines for the Management of Sexual Violence • - Recommendations for better management of survivors of sexual violence, better psychological recovery, and prevention of STIs, post-rape pregnancy and HIV • 2010: ‘The Cutting Tradition: insights into female genital mutilation’ • - A DVD in collaboration with SafeHands for Mothers, with actress Meryl Streep as narrator; the film aims to educate health professionals worldwide on the issues surrounding this highly controversial subject

8. FIGO - Serving vulnerable and marginalised groups • Establishing a dedicated FIGO Committee for Fistula to change the lives of marginalised women from one of shame to one of dignity • Training surgeons on fistula and developing fistula treatment centres • - Development of a standardised Global Competency-Based Fistula Training Manual • Addressing adolescent sexual and reproductive health in low-resource countries

9. FIGO - Serving vulnerable and marginalised groups • Disseminating latest research on the use of misoprostol for the management of post-partum haemorrhage in underserved/low- resource settings • FIGO member associations actively support HIV prevention and treatment programmes • FIGO is a member of the Inter-Agency Task Team (IATT) on the prevention of HIV infection among pregnant women, mothers and their children to help support global work in this area

10. FIGO - Ensuring women participate in decisions that affect their lives • 2007 Guidelines regarding informed consent • 2008 Recommendations on Adolescent and Youth Reproductive Health Care and Confidentiality • High priority placed on training healthcare professionals to provide supportive counselling services • - Initiative on post-partum IUD services invests in training the entire ante-natal team on supportive counselling

11. FIGO - Increasing access to comprehensive sexual and reproductive health services • Curriculum on Women’s Rights for health professionals and medical students • Checklist for quality of care explaining how the rights can be upheld in a service delivery setting • Workshops for obstetricians and gynecologists to increase their understanding of and commitment to the issue of women’s rights in their practice and training programmes www.glowm.com

12. FIGO - Advocating and providing rights-based maternal health services • Ethics Committee recommendations – • Safe Motherhood 2012 • 1 • Obstetric professional societies should publicise the tragedy of maternal mortality as a violation of women’s rights, and not just as a health problem. • 2 • Since the main reason for maternal death is an avoidable delay in implementing proper emergency care during complicated labour, efforts should be made to provide all pregnant women with skilled birth attendants during delivery.

13. Ethics Committee recommendations 3 Where abortion is not against the law, every woman should have the right, after appropriate counselling, to have access to medication or surgical abortion … Proper medical and humane treatment should be made available to women who have undergone an unsafe abortion. 4 Family planning services and information should be made available for the timing and spacing of births. 5 The review of cases of maternal deaths should probe deeply into the underlying causes, beyond the clinical diagnosis.

14. Ethics Committee recommendations 6 Reduction of maternal mortality also depends on non-medical policies such as development of suitable transportation means and roads accessible by vehicle, and financial needs for underprivileged women, particularly within rural communities and in remote areas. 7 Obstetricians should lead the way in demonstrating how emergency obstetric care can be provided in a cost effective way in low-resource settings. North to South and South to South collaborative efforts are needed to advance cost-effective strategies.

15. FIGO General Assembly Resolutions … • Female Genital Mutilation (Montreal 1994) • Violence Against Women (Copenhagen 1997) • Women's Rights Related To Reproductive And Sexual Health (Washington DC 2000) • Women’s Sexual And Reproductive Rights - A Social Responsibility For Obstetricians-Gynecologists (Santiago 2003) • FIGO Professional And Ethical Responsibilities Concerning Sexual And Reproductive Rights (Santiago 2003)

16. FIGO General Assembly Resolutions • Sex Selection For Non-Medical Purposes (Kuala Lumpur 2006) • Conscientious Objection (Kuala Lumpur 2006) • Access To Care (Kuala Lumpur 2006) • Registration Of Maternal Deaths (Kuala Lumpur 2006) • Delegated Use Of Uterotonics For Prevention And Treatment Of Post-Partum Haemorrhage (Cape Town 2009) • Unmet Need For Voluntary Contraception • (Rome 2012)

17. The challenges to implementing a rights-based approach • Rights, autonomy and sexuality remain controversial issues • Lack of political commitment to invest in women’s health services • Limited access to education and employment; high illiteracy rates • Increasing poverty, war, economic instability and HIV/AIDS have reversed the gains of recent decades

18. The challenges to implementing a rights-based approach • Lack of healthcare professionals able and willing to provide rights-based reproductive healthcare services • Basic reproductive healthcare services and commodities (eg contraceptives and emergency obstetric services) remain unavailable to millions • Harmful traditional practices (early marriage, FGM) are widespread

19. The way forward • In line with new science, put maternal health at the core of a nation’s health and future prosperity • Support healthcare professionals to use rights-based quality of care indicators to measure and improve their performance • Ensure that at each maternal health encounter the following 10 rights are upheld • Life • Confidentiality • Right to decide on number and spacing of children • Health • Autonomy in decision making • Freedom from inhumane and degrading treatment • Privacy • Benefit from scientific progress • Information • Non-discrimination

20. The way forward • Adopt gender-equitable approaches to health to enable women’s full participation in the planning/delivery of health services • Move women's sexual and reproductive rights’ discussions from a marginal position to more mainstream thinking • Prioritise sexual and reproductive health and rights within the sustainable development and post 2015 agenda

21. In charting a way forward FIGO and its Member Associations will seek to remain a powerful and credible voice in support of women-centred, rights-based maternal healthcare

22. www.figo2015.org Thank you for your attention www.figo.org