WHO - Sexual and reproductive health highlights of 2015
Publication date: 2016
Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Highlights of 2015 2015 For more information, please contact: Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland Fax: +41 22 791 4171 E-mail: email@example.com www.who.int/reproductivehealth WHO/RHR/HRP/16.06 UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP). Highlights of 2015 © World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: firstname.lastname@example.org). 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Editing and layout: Green Ink (www.greenink.co.uk) Cover photo: Harsha KR licensed under CC BY 2.0 Printed by the WHO Document Production Services, Geneva, Switzerland Contents Photo: © 2014 Chinmoy Biswas, Courtesy of Photoshare 1 High-level advocacy and input to global initiatives for sexual and reproductive health 3 Family planning and contraception 5 Adolescent sexual and reproductive health 7 Maternal and perinatal health 8 Preventing unsafe abortion 9 Sexually transmitted infections and reproductive tract infections; SRH–HIV linkages and multipurpose prevention technologies 10 Cervical cancer 11 Violence against women and harmful practices, including female genital mutilation and early marriage 12 Infertility 12 Sexual health 13 Human rights and gender equality 15 Innovations 15 Biostatistics and data management 16 Advocacy and communications 18 Research capacity strengthening, including the HRP Alliance Highlights2015_Proof8.indd 3 19/05/2016 10:06 Our vision Photo: © 2014 Marcello Perino, Courtesy of Photoshare “We envision a world where all people can attain the highest possible level of sexual and reproductive health, and where everyone, including adolescents and those who are underserved or marginalized, have access to sexual and reproductive health information and services. We strive to promote and protect all people’s rights to enjoy sexual and reproductive health. Our work is premised on the need to achieve access to and ensure the quality of sexual and reproductive health, in order to meet the needs of diverse populations, particularly the most vulnerable.” Ian Askew, Director WHO Department of Reproductive Health and Research including HRP Highlights2015_Proof8.indd 4 19/05/2016 10:06 1Highlights 2015 Highlights of 2015 The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, also known as the Human Reproduction Programme (HRP), is the main instrument and leading research agency within the United Nations system concerned with sexual and reproductive health and rights. The World Health Organization (WHO) serves as the executing agency for HRP, which is housed within, and forms part of, WHO’s Department of Reproductive Health and Research (RHR Department). Established in 1972, HRP supports and coordinates research on a global scale; synthesizes research through systematic reviews of literature; strengthens research capacity in low-income countries; and develops novel dissemination approaches to make efficient use of an ever-increasing body of research and information. By virtue of its unique co-sponsorship arrangement, the work of HRP is coordinated with, and contributes to, the work of its co-sponsors and partners including the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), WHO, the World Bank, the Joint United Nations Programme on HIV and AIDS (UNAIDS) and the International Planned Parenthood Federation (IPPF). High-level advocacy and input to global initiatives for sexual and reproductive health • The Global Strategy for Women’s, Children’s and Adolescents’ Health was launched at the United Nations (UN) General Assembly, 26 September 2015, in New York. • A draft was developed of the Global plan of action to strengthen the role of the health system within a national multisectoral response to address interpersonal violence, in particular against women and girls, and against children. • The draft Global Health Sector Strategy on sexually transmitted infections, 2016–2021, was completed. • A special supplement to The BMJ was issued, entitled “Towards a new Global Strategy for Women’s, Children’s and Adolescents’ Health”. • A report of a study on child, early and forced marriage legislation in the Asia-Pacific region was developed in collaboration with the Inter-Parliamentary Union. Photo: © 2014 Marcello Perino, Courtesy of Photoshare Highlights2015_Proof8.indd 1 19/05/2016 10:06 “We envision a world where, using a rights-based approach, individuals and couples are enabled to meet their contraception needs, where the burden of sexually transmitted infections is reduced, and where all people can realize their desired family size.” James N. Kiarie, Coordinator, Human Reproduction team Contraception and family planning Our priorities Photo: © 2014 by Jonathan Torgovnik/Reportage by Getty Images Highlights2015_Proof8.indd 2 19/05/2016 10:06 3Highlights 2015 Family planning and contraception • In 2015, the Department published 25 scientific papers on family planning and contraception. • The update of the Medical eligibility criteria for contraceptive use (MEC) and its accompanying job aid for providers of family planning services, the MEC Wheel, were published. Through a rigorous review of the latest science addressing contraceptive safety, 14 topics (encompassing more than 575 recommendations) were reviewed as part of the revision process to develop the fifth edition of the MEC. • The Compendium of WHO recommendations for postpartum family planning guidance was launched. The tool uses a new user-friendly digital platform to enable easy access to its recommendations. It is aimed at health-care providers who counsel postpartum women on contraceptive options to help them quickly and easily access WHO recommendations on contraceptive options. • The Department provided technical support to 10 countries in the WHO African Region to develop postpartum family planning. Photo: © 2014 by Jonathan Torgovnik/Reportage by Getty Images Highlights2015_Proof8.indd 3 19/05/2016 10:06 Our priorities Adolescent sexual and reproductive health Photo: Léo Parpais licensed under CC BY 2.0 “We envision a world where all adolescents and young people have universal access to appropriate sexual and reproductive health information and services, allowing them to obtain and maintain the highest possible level of sexual and reproductive well-being.” Lale Say, Coordinator, Adolescents and at-Risk Populations team Highlights2015_Proof8.indd 4 19/05/2016 10:06 5Highlights 2015 Adolescent sexual and reproductive health • The Department’s three flagship adolescent research studies – ARMADILLO (providing ASRH messages through mobile phones), AHEAD (preventing rapid repeat pregnancy) and GEAS (understanding factors in early adolescence, including gender norms which are precursors to ASRH behaviours) – have completed their formative phases in multiple countries. – ARMADILLO: Activities for message development have been completed, and the messages are now being pilot-tested in Kenya. Formative activities for message development are under way in Peru. – AHEAD: Formative data collection has been completed to inform an intervention strategy in Ghana, and formative activities are under way in Malawi. – GEAS: Formative research has been completed at all 15 study sites and the toolkit face-validity and pilot-testing process has begun. • Country case studies of the policy and programmatic environment have been prepared in 10 countries and six of these were published as peer-reviewed journal articles. Photo: Léo Parpais licensed under CC BY 2.0 Photo: Anil Gulati/Photoshare Highlights2015_Proof8.indd 5 19/05/2016 10:06 “We envision a world where every woman and newborn receives good quality care throughout pregnancy, childbirth and the postnatal period, and where we can end preventable mortality and morbidity.” A. Metin Gülmezoglu, Coordinator, Maternal and Perinatal Health and Preventing Unsafe Abortion team Improving maternal and perinatal health and preventing unsafe abortion Our priorities Photo: Jonathan Torgovnik/Reportage by Getty Images Highlights2015_Proof8.indd 6 19/05/2016 10:06 7Highlights 2015 Maternal and perinatal health • The WHO framework on quality of care for pregnant women and newborns around the time of childbirth was published in BJOG. The quality statements and indicators for the eight domains focusing on both provision and experience of care were finalized. • The WHO statement on caesarean section rates was published, including information on optimal rates and monitoring of caesarean sections at facilities. The new Statement emphasizes that while there seem to be mortality benefits up to national population level rates of 10%, much of the association can be explained by development status of the country. WHO recommends the 10-group Robson classification to monitor caesarean section rates. • An analysis of changes in caesarean section usage in 21 countries was published in Lancet Global Health. • WHO recommendations on interventions to improve preterm birth outcomes were published. This provided much-needed guidance following the publication of the large multicountry trial, which cast doubt on the safety and efficacy of antenatal corticosteroids for women at risk of preterm birth in low- and middle-income countries. In addition, the Department secured a grant from the Bill & Melinda Gates Foundation to conduct a randomized clinical trial in sub-Saharan Africa and South Asia to address an important research gap on this topic. • WHO recommendations for prevention and treatment of maternal peripartum infections were launched. • The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review was published. The review, which was based on data from 34 countries, suggested that mistreatment of women during childbirth is widespread globally. • Estimates of maternal mortality for the period 1990–2015 were published. It is estimated that 303 000 maternal deaths occurred during 2015 and that there has been a 44% decline in the maternal mortality ratio (MMR) since 1990, falling short of the Millennium Development Goal to reduce it by three quarters. These estimates will serve as the baseline for Sustainable Development Goal target 3.1: to reduce the global MMR to less than 70 per 100 000 live births by 2030. Photo: Jonathan Torgovnik/Reportage by Getty Images Highlights2015_Proof8.indd 7 19/05/2016 10:06 Photo: © 2016 Tushar Sharma, Courtesy of Photoshare 8 Highlights 2015 Preventing unsafe abortion • The guideline on Health worker roles in providing safe abortion care and post-abortion contraception was launched. • The Clinical practice handbook on safe abortion (published in 2014) was awarded first prize in the obstetrics and gynaecology category of the British Medical Association’s 2015 Medical Book Awards. • The evaluation of the comprehensive abortion care scale-up project in Moldova showed that 72% of all induced abortions are now done using WHO-approved methods. • Preliminary results from the feasibility study on midwife provision of medical abortion in rural Kyrgyzstan show that this approach is safe, effective and feasible. • As part of the Global Abortion Policies Project, preliminary data collection on abortion- related laws and policies was completed for over 190 countries. • A fully interactive website was launched to facilitate access to the recommendations of the WHO guideline entitled Health worker roles in providing safe abortion care and post-abortion contraception. The website allows for recommendations to be filtered by cadre and tasks, and provides access to the clinical, technical and policy guidelines on abortion: http://srhr.org/safeabortion/ Highlights2015_Proof8.indd 8 19/05/2016 10:06 Photo: © 2016 Tushar Sharma, Courtesy of Photoshare 9Highlights 2015 Sexually transmitted infections and reproductive tract infections; SRH–HIV linkages and multipurpose prevention technologies • A comprehensive package of studies to evaluate dual HIV/syphilis rapid diagnostic tests in China, Colombia and Zambia was completed. • Core protocols were developed for an independent laboratory-based and field (clinic-based) validation of point-of-care tests to detect Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and syphilis. • A pilot study investigating the persistence of Ebola virus in body fluids in a cohort of Ebola virus disease survivors showed that Ebola virus may be present in semen well beyond six months post-Ebola virus disease onset. • Updated treatment recommendations were developed for Neisseria gonorrhoeae, Chlamydia trachomatis, herpes simplex virus and Treponema pallidum. • Cuba became the first country validated by the Global Validation Advisory Committee for elimination of mother-to-child transmission of HIV and syphilis. • Several articles related to the sexual and reproductive health and rights of women living with HIV, including outcomes of a global community survey, were published in a special supplement to the Journal of the International AIDS Society and launched on World AIDS Day 2015. • Two research proposals relating to microbicides and multipurpose prevention technologies development and introduction were initiated: (i) biomedical measurement of user adherence; and (ii) preclinical development of simple and inexpensive depot injectable formulations for combination contraception and HIV prevention. • To address the need for better sexually transmitted infection (STI) data, in 2015 the Department published three new global STI estimates on (i) HSV-2 infection, (ii) HSV-1 infection and (iii) curable STIs. • The draft Global Health Sector Strategy on sexually transmitted infections, 2016–2021, was developed. Highlights2015_Proof8.indd 9 19/05/2016 10:06 10 Highlights 2015 Cervical cancer • To date, 8500 women have been enrolled in ESTAMPA, “Multicentric study of cervical cancer screening and triage with HPV testing”, at five study sites: Colombia, Honduras, Paraguay and Uruguay. Over 90% of human papillomavirus-positive women have undergone colposcopy procedures. • In a study in Swaziland, 655 women aged 15–49 years were screened with visual inspection with acetic acid (VIA); 14.8% were positive for signs of cervical pre-cancer and all underwent treatment. • Recruitment of study participants in AISHA, “An implementation study on rapid HPV testing in Tanzania”, was carried out between May and August 2015. • WHO, UNFPA, The World Bank, UN Women, UNAIDS, UNICEF, the International Atomic Energy Agency, the International Agency for Research on Cancer and the United Nations Office on Drugs and Crime are collaborating with the objectives of reducing morbidity and mortality from cervical cancer, strengthening health-care delivery systems, and detecting, treating and palliating cervical cancer. The primary expected result of the project is to establish a coordinated approach for planning and implementing cervical cancer prevention and control programmes. Highlights2015_Proof8.indd 10 19/05/2016 10:06 11Highlights 2015 Violence against women and harmful practices, including female genital mutilation and early marriage • The survey methodology of the WHO multicountry study on women’s health and domestic violence against women was used to conduct Cambodia’s national population-based prevalence survey on violence against women. The survey results were published in November 2015. • The Department led the development of a draft Global plan of action to strengthen the role of the health system within a national multisectoral response to address interpersonal violence, in particular against women and girls, and against children. • A set of job aids developed by WHO in collaboration with the United Nations Office on Drugs and Crime and supported by UN Action, entitled Strengthening the medico-legal response to sexual violence, was published. • The Department contributed to the establishment of the Working Group on Violence against Women of the International Federation of Gynecology and Obstetrics (FIGO). • The Guideline Development Group meeting for the WHO guidelines on the management of health complications from female genital mutilation (FGM) was held in September 2015, during which current, evidence-based recommendations were formulated to improve health care of women and girls living with FGM. Photo: modenadude licensed under CC BY-NC-ND 2.0 Highlights2015_Proof8.indd 11 19/05/2016 10:06 12 Highlights 2015 Infertility • A workshop on the fertility intentions of HIV-affected individuals and couples was held with support from the Brocher Foundation. • The Department initiated development of guidance on diagnosis, management and treatment of infertility/subfertility and interventions that provide fertility care. Sexual health • A new chapter in the 11th revision of one of WHO’s hallmark publications, The International Classification of Diseases (ICD) is dedicated to “Conditions related to sexual health”. To accompany this, a publication on the importance and rationale of the new ICD-11 “Sexual health” chapter was published in Reproductive Health Matters in November 2015. • An interagency statement on ending violence and discrimination against lesbian, gay, bisexual, transgender and intersex (LGBTI) people was released with the support of 12 UN agencies on 29 September 2015. • The Department committed to carrying out a sexual health research prioritization exercise, using the Child Health and Nutrition Research Initiative approach. • The guideline Brief sexuality-related communication: recommendations for a public health approach was published and widely disseminated in 2015. Highlights2015_Proof8.indd 12 19/05/2016 10:06 13Highlights 2015 Human rights and gender equality • The Department led the process for development of the Women and health report for the World Health Assembly, focusing on the unfinished agenda and emerging priorities related to women’s health. • The Department published a landmark report on Sexual health, human rights and the law. • The Department continued to support treaty monitoring bodies in their work on sexual and reproductive health. This included ongoing support to the Committee on Economic, Social and Cultural Rights in the development of their draft General Comment on the right to sexual and reproductive health, and to the UN Human Rights Committee in the development of their General Comment on the right to life. • A special series was published in The BMJ on women’s, children’s and adolescents’ health, with a specific focus on sexual and reproductive health and human rights. • The Department led advocacy efforts for inclusion of sexual and reproductive health and rights in the post-2015 sustainable development agenda. Photo: © 2014 ZaqatalaartPhoto, Courtesy of Photoshare Highlights2015_Proof8.indd 13 19/05/2016 10:06 Photo: HRP/Mark Leong Highlights2015_Proof8.indd 14 19/05/2016 10:06 15Highlights 2015 Innovations • The Department conducted research across three sites of the Technologies for Health Registers, Information, and Vital Events Consortium to inform functional and data requirements for multiple reproductive, maternal, newborn and child health frontline workforce cadres. This effort also led to the creation of a common reproductive, maternal, newborn and child health community-health information system data dictionary. • The MAPS toolkit: mHealth assessment and planning for scale was launched. This resource is intended to assist implementers to systematically assess their scale-up efforts, and to plan for corrective actions and next steps. • The Department released the WHO practical guide to engaging with mobile network operators for reproductive, maternal, newborn, child and adolescent health, a tool to address the common challenges faced among mHealth implementers in securing partnerships with telecommunications companies. • Development began of a WHO technical guidance document related to assessment and prioritization of digital innovations to strengthen health systems, including health information systems. Biostatistics and data management • Statistics, data management, research coordination and monitoring support were provided for 23 clinical trials and epidemiological studies during 2015. • The Unit conducted on-site research training on data entry and data management for staff in six collaborating countries participating in projects with the Department: Argentina, Kyrgyzstan, Mozambique (twice), Singapore, South Africa and the United Kingdom. Photo: HRP/Mark Leong Highlights2015_Proof8.indd 15 19/05/2016 10:06 16 Highlights 2015 Advocacy and communications • In 2015, the Department worked to implement the communications strategy that was developed in 2014 with the participation of partners, funders and staff, and with the guidance of a leading global communications firm. This included a new focus on intensive communications work around a number of key publications and events, including a heightened presence on social media. • Thirty-two new WHO publications in English were produced and distributed. • The Department began to distribute its publications on USB sticks at conferences in preference to hard copies. During 2015, over 4000 USB sticks were distributed, containing over 120 publications in multiple languages. • The Department produced and distributed 45 translations of existing Department publications. • Research results and knowledge syntheses were published in the scientific press, in 203 peer- reviewed articles. There was a noticeable increase in the number of times these articles were cited by others, including increased relevance and impact. • There were 2.7 million page views of the Department’s “Reproductive health” webpage, 3.1 million of the WHO Reproductive Health Library (RHL) website, and 18 000 video views on the RHL and HRP YouTube channels. • In 2015, HRP launched a podcast channel, making available professional-quality podcasts recorded in-house. Five podcasts with health experts speaking on technical topics and subjects of public interest were produced in 2015. • The Department’s outputs were widely disseminated, and sexual and reproductive health and rights were advocated for, at many different conferences, symposia and international meetings. • A wide range of international days were marked by the Department. Web features were prepared for these days, which were well supported by the WHO central communications services. • The Department’s work saw an increased number of highlights on the WHO homepage. • HRP’s Twitter account (@HRPresearch) saw a steady increase in followers during 2015, from approximately 315 at the end of 2014 to approximately 1000 at the end of 2015. The account was used to disseminate information about the Department’s work and latest news. • A new format was designed for HRP News, the Department’s electronic newsletter, and during the year 10 issues were sent out. The number of recipients now stands at 4254, an increase of over 1000 during 2015. • A TEDx Chisinau talk from Moldova entitled “Why we shouldn’t shy away from sexual education” was viewed more than 9500 times. • An online tool to search WHO guidelines for recommendations related to SRHR was developed and launched. This tool enables users to search across multiple WHO guidelines to find all recommendations relevant to the search term: http://search.srhr.org/ Highlights2015_Proof8.indd 16 19/05/2016 10:06 Photo: UNAIDS Highlights2015_Proof8.indd 17 19/05/2016 10:06 18 Highlights 2015 Research capacity strengthening, including the HRP Alliance • In 2015, HRP awarded Long-term Institutional Development (LID) grants to 10 institutions and research training grants to 13 individuals. • In the WHO Eastern Mediterranean Region, three new institutions in Morocco, Pakistan and in the West Bank and Gaza Strip were awarded LID grants. • The Institute de Recherché en Science de la Santé in Burkina Faso, in the fifth year of its first cycle, was invited to apply for WHO Collaborating Centre status, reflecting its presence as a growing institution in West Africa. • The Cellule de Recherché en Santé de la Reproduccion en Guinée, a LID grantee institution in the fourth year of its first LID cycle, has been successfully integrated into the multicountry study on mistreatment of women during childbirth. • Two HRP Alliance meetings were held successfully, one for the WHO African and Eastern Mediterranean Regions combined, and one for the Region of the Americas. Photo: Pan American Health Organization PAHO licensed under CC BY 2.0 Highlights2015_Proof8.indd 18 19/05/2016 10:06 Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Highlights of 2015 2015 For more information, please contact: Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland Fax: +41 22 791 4171 E-mail: email@example.com www.who.int/reproductivehealth front front 2 Highlights2015_(Pr8)FINAL_HR(inside pages) back Blank Page
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