My Year at FIGO What can we learn

My Year at FIGO What can we learn from international public health? Institutionalization of Immediate Post-Partum IUD Services 1

FIGO • FIGO brings together professional societies of obstetricians and gynecologists on a global basis. • FIGO currently has Member Societies in 131 countries/territories; projects implemented through the member societies • FIGO's vision is for women of the world to achieve the highest possible standards of physical, mental, reproductive and sexual health and wellbeing throughout their lives.

FIGO Projects • Post-Partum Family Planning • Improving fistula surgery around the world • Development of Misoprostol Guidelines for management and prevention of PPH • Evaluation of training for Helping Mothers Survive • Improving Preconceptual, Adolescent and Maternal nutrition • Implementation of essential interventions in maternal and child health • Prevention of unsafe abortion • Improving identification and management of hyperglycaemia in pregnancy Common themes • Low-resource settings • Focus on the most vulnerable women • Potential to impact on health and also to promote gender equality • Capacity-building • Sustainability • Linked to SDGs

Lifetime risk of maternal death • Developed countries - 1 in 7300 • Sweden - 1 in 17, 400 • Asia - 1 in 94 • Sub-Saharan Africa - 1 in 22 • Chad - 1 in 8 “ Women are not dying because medical science does not know how to save them but because societies do not think these women’s lives are worth saving” Mahmoud Fathalla (FIGO president 19941997)

Access to contraceptive information is central to achieving gender equality • Empowers women to determine whether and when to have children; • Enables women to complete their education; • Increases women’s autonomy within their households; • Boosts their earning power, improving economic security and well-being of women and their families.

“If all women waited at least 24 months to conceive again, under-five deaths would fall by 13 percent. The effect of waiting 36 months to conceive again would avoid 25 percent of under-five deaths. Institutionalization of Immediate Post-Partum IUD Services From: Kozuki et al. , BMC Public Health, 2013 13(Suppl 3): S 3 Birth interval less than 18 months (Reference 24 -<60 months) was associated with: 6

Institutionalization of Immediate Post-Partum IUD Services as a routine part of antenatal counselling and delivery room services in Sri Lanka, Kenya, India, Tanzania, Nepal and Bangladesh “From misconceptions to delayed conceptions” Institutionalization of Immediate Post-Partum IUD Services 7

The need for PPIUD • PPIUD inserted immediately after delivery of placenta, within 48 hours or at Caesarian Section • PPIUD constitutes a effective choice for women delivering in facilities – It is offered at a time when motivation is high – Circumvents need to return to a facility for a FP method – Safe, painless, effective Institutionalization of Immediate Post-Partum IUD Services 8

FIGO PPIUD initiative ü Being implemented in Sri Lanka, India, Bangladesh, Nepal, Tanzania, Kenya ü Providing women with additional information and contraceptive counselling at antenatal clinics ü Training providers to counsel women on PPIUD ü Training providers through a ‘training the trainer’ model ü Supplying equipment for training ü Research by Harvard School of Public Health in 3 countries 30/11/2020 6 countries will implement the FIGO Institutionalization of Immediate Post-Partum IUD Services initiative Institutionalization of Immediate Post-Partum IUD Services

Family Planning should be approached as a rights issue • Some women are denied PPIUD on the basis of the stand of health care providers, views of family, inadequate access to information or services • This does not promote women’s rights and is a lost opportunity for a potentially life-saving intervention for the woman 30/11/2020 Institutionalization of Immediate Post-Partum IUD Services

Huge influence of Mothers – in-law

121 counselling in antenatal clinic and post natal ward in Mumbai

Queuing up to see the doctor for hours…. . a missed opportunity

Busy postnatal wards in Bangladesh

Progress • Master training in all countries completed and facility training progressing • Baseline data completed in intervention facilities in the research countries • 6, 500 providers trained in counselling and/or inserting • 17, 551 women have had PPIUD inserted since start of initiative • Where good follow-up, low expulsion rates 30/11/2020 Institutionalization of Immediate Post-Partum IUD Services

Learning from international public health • Health care professional organisations are an important route to health improvement especially if working together Institutionalization of Immediate Post-Partum IUD Services 17

Long term commitment “If only poverty could be overcome by writing reports” • “I’m always amazed how overnight successes take a helluva long time. ” Institutionalization of Immediate Post-Partum IUD Services 18

Learning from international public health Pluralism can be made to work Institutionalization of Immediate Post-Partum IUD Services 19

Task sharing Institutionalization of Immediate Post-Partum IUD Services 20

Task sharing not task shifting Institutionalization of Immediate Post-Partum IUD Services 21

All meetings can be Skype meetings Institutionalization of Immediate Post-Partum IUD Services 22

Mobile technology Institutionalization of Immediate Post-Partum IUD Services 23

What did I learn? Institutionalization of Immediate Post-Partum IUD Services 24

We’re lucky… 1. The NHS Institutionalization of Immediate Post-Partum IUD Services 25

2. Gender equality A woman’s place is…. in the audience Institutionalization of Immediate Post-Partum IUD Services 26

Scale –up is not easy but ownership and participation are key Institutionalization of Immediate Post-Partum IUD Services 27

Lord Nigel Crisp, independent crossbench member of the House of Lords “All UK doctors, whether they choose to work in the developing world or in Britain, must have an awareness of global issues. It improves their critical thinking, enables them to empathise more with their patients and develops their knowledge of health systems, not least our own. . ” Institutionalization of Immediate Post-Partum IUD Services 28

Cycling is possible in a UK city Institutionalization of Immediate Post-Partum IUD Services 29