The role of FIGO in women's health and reducing reproductive morbidity and mortality

The International Federation of Gynecology and Obstetrics (FIGO), established in Geneva on July 26, 1954, by Hubert de Watteville, is the only international professional body that brings together obstetric and gynecological associations from around the world—today totaling 124 member associations. FIGO's vision is that women of the world achieve the highest possible standards of physical, mental, reproductive, and sexual health and well-being throughout their lives. Its mission is dedicated to the improvement of women's health and rights and to the reduction of disparities in health care available to women and newborns, and to advance the science and practice of obstetrics and gynecology. The values of the organization are those of innovative leadership, integrity, transparency, professionalism, respect for cultural diversity, and high ethical standards. FIGO's overall goals are improvement of the health and well-being of women and newborn children worldwide; to raise the status of women to enable their active participation to achieve their reproductive and sexual rights and access to efficient education and services throughout their life cycle; and to upgrade the practice of obstetrics and gynecology through education, training, and research to maintain high standards of professionalism and ethical adherence. FIGO pursues its mission and commitments through partnerships, advocacy, and programmatic activities conducted by its committees and working groups, capacity strengthening of member associations, and education and training. It is now more than 60 years since the fundamental human right to health was first codified in the Universal Declaration of Human Rights of the United Nations General Assembly [1]. Article 25 states that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services… Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection” [1]. The Constitution of the World Health Organization declares that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, or economic or social condition [2]. It also declares that health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. The FIGO World Report on Women's Health is an advocacy document that has been published every 3 years since 1994. The 2009 World Report addressed reproductive and sexual health rights 15 years after the International Conference on Population and Development, held in Cairo in 1994. Despite progress made in achieving reproductive and sexual health rights in some countries, the advance is far from what had been anticipated by the international community over the past few years, particularly considering that the time horizon to Millennium Development Goal (MDG) 5 is only 3 years away [3], [4]. It is appropriate then that the 2012 World Report addresses various initiatives to reduce maternal mortality and morbidity. Professional organizations, including FIGO, have a major role to play in achieving the health-related MDGs. FIGO's aim is every pregnancy wanted, every birth safe, every newborn healthy, every wanted pregnancy achieved, and every young woman HIV/AIDS free and treated with respect and dignity. In line with the overall vision and mission of FIGO, as outlined in its constitution, the organization has implemented change over recent years, change to improve the quality of women's and newborns’ health care through education, training, and capacity building of member societies. FIGO has strengthened its ties with member societies and regional federations; coordinated strengthening of ties between its member societies; encouraged member societies and their members to implement ethical guidelines in health care and research on women and newborns; and encouraged advocacy for the rights of women and newborns concerning the highest attainable standards of health and well-being. In implementing its work plan, FIGO—as a global Federation—is well aware of and recognizes the sovereign right of each country, consistent with national laws and development priorities, with full respect for the various religious and ethical values and cultural backgrounds of its people, and in conformity with universally recognized international human rights [5]. FIGO pursues its mission and commitments via various channels, including partnerships, advocacy, programmatic activities conducted by its committees and working groups, capacity strengthening of member associations, and education and training. FIGO participates in the Alliance for Women's Health (formerly the FIGO/WHO Alliance for Women's Health), on which it sits with other agencies to define the most effective role for FIGO in dedicated areas, and to define areas of collaboration. The Alliance members include WHO, UNFPA, The World Bank, International Planned Parenthood Federation (IPPF), the International Confederation of Midwives (ICM), and the International Pediatric Association (IPA). FIGO has Category 1 consultative status with the United Nations, and is in official relations with 21 nongovernmental organizations dedicated to women's health care. The main objectives of the Committee include studying the contemporary ethical issues emanating from research and practice in obstetrics, gynecology, and reproductive medicine, and recommending guidelines on ethical problems in training, education, science, and the practice of obstetrics and gynecology. Current activities include the development of a Bioethics Curriculum in reproductive and sexual health for low-resource countries. The main objectives of the Committee include acting as a focal point for all FIGO activities related to safe motherhood and newborn health; overseeing FIGO's Saving Mothers and Newborns Initiative; providing technical support to the FIGO LOGIC team (see below); and monitoring/participating in international initiatives aimed at improving maternal and newborn health, such as the Prevention of Postpartum Hemorrhage Initiative (POPPHI), the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), and the Maternal and Child Health Integrated Program (MCHIP). The main objectives of the Committee include publishing a triennial global FIGO Cancer Report, classifications and good practice guidelines, and guidelines on combating cervical cancer. The Committee has conducted several meetings and workshops on gynecological oncology in various parts of the world in collaboration with national, regional, and international societies. There are plans to develop a Working Group on Breast Cancer. The main objectives of the Committee include coordinating FIGO's activities in the field of fistula treatment and prevention, and producing effective proposals for the possible expansion and enhancement of the invaluable work undertaken in the prevention and treatment of fistula. Current activities include dissemination of the FIGO Global Competency-Based Fistula Surgery Training Manual aimed at trainers and individual practitioners in low- and middle-income countries, and the implementation of structured fistula surgical training programs in up to 5 countries in Sub-Saharan Africa using a standardized training curriculum. The main objectives of the Committee include educating and increasing awareness among obstetrics and gynecology professionals about women's sexual and reproductive rights, involving them in an evaluation of their practice to assess whether they are protecting and promoting these rights, and developing a robust curriculum on women's sexual and reproductive rights that can be adopted and adapted for medical schools across the world to help raise awareness of these problems among their students. Current activities include the promotion of the curriculum at various national and regional conferences. The main objectives of the Committee include creating access to quality reproductive medical care for all women of the world and developing evidence-based, culturally sensitive, cost-effective policies and guidelines that are accepted as standards for increasing access to quality reproductive medical care in all countries. Current activities include development of the “FIGO Fertility Tool Box,” which will assist the obstetrics/gynecology community in helping to prevent infertility and apply evidence-based and cost-effective infertility treatment. The main objectives of the Committee include providing leadership in the educational and training activities of FIGO and promoting the educational objectives of FIGO in the field of women's sexual and reproductive health and rights. Current activities include preparation of pre-Congress workshops for the 2012 FIGO World Congress and conducting workshops in collaboration with national societies and regional federations at conferences and meetings across the world (e.g. hands-on training programs on postpartum hemorrhage, fistula, pelvic floor dysfunction, minimally invasive surgery and assisted reproduction in low-resource countries). FIGO has 3 working groups of specialists to review and explore the issues surrounding Menstrual Disorders, Pelvic Floor Medicine and Reconstructive Surgery, and the Prevention of Unsafe Abortion. Detailed information on all committees and working groups can be found at: http://www.figo.org/about/. The goal of the Initiative is to improve maternal and newborn health in low-resource countries through strengthening the role of obstetric and gynecological national associations. Over 5 years, FIGO hopes to enable these member associations to play a catalytic role in making positive changes in policy and practice and improve maternal and newborn health services for underserved populations. The countries involved are Burkina Faso, Cameroon, Ethiopia, India, Mozambique, Nepal, Nigeria, and Uganda. The goal of the Initiative is to advocate for and disseminate evidence-based information on misoprostol for postpartum hemorrhage for providers and clinical policy makers (to influence policy and practice, and to help normalize misoprostol use for postpartum hemorrhage). The goal of the Initiative is to help reduce the number of women dying as a result of unsafe abortion, which accounts for 13% of annual global maternal deaths and hundreds of thousands of women suffering long-term complications. The goal of the Initiative is to disseminate the FIGO Global Competency-Based Fistula Surgery Training Manual aimed at trainers and individual practitioners in low- and middle-income countries, to ensure high-quality clinical training for the care of women with obstetric fistula, and to increase capacity of service sites and staff to provide comprehensive management and treatment of fistula through a program of training of trainers and support to the training centers. The goal of the Initiative is to build and sustain the capacity of the obstetrics and gynecology and midwifery societies in the participating low-resource countries to conduct essential projects relevant to the promotion of safe motherhood and the improvement of maternal health, with the aim of reducing maternal and newborn morbidity and mortality, and contributing to the achievement of MDGs 4 and 5 in 10 countries: Haiti, Peru, Kenya, Uganda, Uruguay, Ukraine, Nigeria, Moldova, Kosovo, and Pakistan. The goal of the Initiative is to strengthen the capacity of FIGO member associations to support adolescent sexual and reproductive interventions at the national level. This aim complements FIGO's wider objective of strengthening its capacity to support national societies and, alongside this, increasing national societies’ capacity to play a major role in advocacy, training, policy development, and reproductive health programs. FIGO's specialist publications include the International Journal of Gynecology and Obstetrics (including special Supplements such as the World Report on Women's Health); the FIGO Newsletter; the triennial FIGO Cancer Report; FIGO Guidelines and Statements; Recommendations on Ethical Issues; Staging Classifications and Good Practice Guidelines; and the Three-Year Report. FIGO's World Congress has been held every 3 years since 1958 and rotates through 5 continents. Its location is chosen by vote at the General Assembly 6 years in advance. Since 1991, the Congress has been held in Singapore, Montreal, Copenhagen, Washington, Santiago de Chile, Kuala Lumpur, and Cape Town. The 2012 FIGO World Congress will take place in Rome, Italy, from 7–12 October (www.figo2012.org). FIGO leadership believes that in our endeavor to bring about change in progress toward achieving the health-related MDGs for women and newborns, we must not be discouraged by the slow progress made in the past; if we choose to be bound by the past, we will never move forward. We have the power and the potential to bring about the changes we seek, but only if we have the courage to make a new beginning, a determined beginning, building upon what has been achieved in the past and working together with all parties concerned [6]. Professor Serour is President of FIGO (2009–2012). The author has no conflicts of interest to declare.

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