Professor Hamid Rushwan, Chief Executive, International

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
FIGO Mission
 The International Federation of Gynecology and Obstetrics
(FIGO) is a professional organisation that brings together
obstetrical and gynecological associations from all over the
 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
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
• Women benefit from advances in reproductive medicine, and
disparities in healthcare available to women and newborns are
• Obstetricians and gynecologists are equipped with the skills and
facilities to uphold women’s reproductive rights
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
• Development of a number of evidence-based Resolutions
relating 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
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
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
FIGO - Eliminating discrimination,
coercion and harmful practices
 2009: Guidelines for the Management of Sexual
- 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
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
FIGO - Serving vulnerable and
marginalised groups
 Disseminating latest research on the use of
misoprostol for the management of postpartum haemorrhage in underserved/lowresource 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
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
- Initiative on post-partum IUD services
invests in training the entire ante-natal team
on supportive counselling
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
FIGO - Advocating and providing
rights-based maternal health services
Ethics Committee recommendations –
Safe Motherhood 2012
Obstetric professional societies should
publicise the tragedy of maternal mortality
as a violation of women’s rights, and not
just as a health problem.
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.
Ethics Committee recommendations
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.
Family planning services and information should be made
available for the timing and spacing of births.
The review of cases of maternal deaths should probe deeply into
the underlying causes, beyond the clinical diagnosis.
Ethics Committee recommendations
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.
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.
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)
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)
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
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
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
Right to decide on number and spacing of children
Autonomy in decision making
Freedom from inhumane and degrading treatment
Benefit from scientific progress
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
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
Thank you for
your attention

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