Department of Reproductive Health and Research including UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction Annual Technical Report 2003 World Health Organization.
Contents Executive summary. 3 Section 1 – Promoting family planning. 21 Users’ perspectives in the context of reproductive health . 22 Development of improved and new methods of fertility regulation. 31 Safety and effectiveness of existing methods of fertility regulation. 58 Norms and guidelines for use of methods of fertility regulation. 71 Section 2 – Making pregnancy safer. 77 Generating new evidence for maternal and perinatal health. 78 Implementation of evidence-based programmes. 89 Section 3 – Controlling sexually transmitted and reproductive tract infections. 101 Section 4 – Preventing unsafe abortion. 127 Section 5 – Promoting sexual and reproductive health of adolescents. 143 Section 6 – Gender and reproductive rights in reproductive health. 159 Section 7 – Promoting sexual health. 167 Section 8 – Technical cooperation with countries. 173 Overview of activities—interregional activities and collaboration with regional offices. 174 The WHO Regions of Africa and the Eastern Mediterranean. 178 The WHO Region of the Americas. 193 The WHO Regions of South-East Asia and the Western Pacific. 200 Central and Eastern Europe, including the Newly Independent States and Central Asian Republics. 209 Policy and programmatic issues. 213 Implementing best practices. 223 Section 9 – Monitoring and evaluating reproductive health . 237 A n n Section 10 – Communication, advocacy and information. 245 u a l T Section 11 – Clinical trials and informatics support. 249 ec h n Appendix 1 – Staff of the Department, December 2003. 254 ica l R e p o r t 2 0 0 3 1.
Annual Technical Report 2003 Executive summary Executive summary THE DEPARTMENT programme of work. Broad strategic advice on the Pro- gramme’s work is provided by the Scientific and Technical The Department of Reproductive Health and Research Advisory Group (STAG) (Annex 1). In 1999, STAG assumed (RHR—referred to in this document as “the Department”) has the responsibility for reviewing, and advising on, the work of set itself the mission of helping people to lead healthy sexual the whole Department. The Scientific and Ethical Review and reproductive lives. In pursuit of this mission the Depart- Group (SERG) Panel (Annex 2) reviews all projects involving ment endeavours to strengthen the capacity of countries to human subjects and research in animals and contributes to enable people to promote and protect their own health and ethical debate on matters relating to reproductive health. The that of their partners as it relates to sexuality and reproduc- Toxicology Panel (Annex 3) is a complementary review body tion, and to have access to and receive quality reproductive to the SERG Panel. It provides expertise in the evaluation of health services when needed. pharmacokinetic, metabolic, endocrinological, toxicological, teratogenicity, carcinogenicity and mutagenicity studies of The Department of Reproductive Health and Research was drugs or devices developed or studied by the Programme or established in November 1998 by bringing together the referred to it for advice. In addition, the Programme has sev- UNDP/UNFPA/WHO/World Bank Special Programme of eral strategic review committees and specialist panels that Research, Development and Research Training in Human advise on detailed research strategies.
Annual Technical Report 2003 Executive summary • Kenya, South Africa, Uganda, United Republic of Tanzania, In 2003, three new research projects on quality of care Zambia, and Zimbabwe. Findings from this multicountry were launched.
Annual Technical Report 2003 Executive summary Selected highlights: levonorgestrel butanoate as a three-monthly injectable • contraceptive for women. The third edition of Medical eligibility criteria for contra- ceptive use—a guide for policy-makers, family planning • Studies to determine the mechanism of action of levo- programme managers and the scientific community— norgestrel in emergency contraception indicate that the was prepared. Whereas its counterpart, Selected prac- pregnancy-prevention effect is mainly due to inhibition of tice recommendations for contraceptive use, addresses ovulation. how to use contraceptive methods and offers guidance on common clinical issues, the Medical eligibility criteria • The collaborative initiative between the Programme and for contraceptive use addresses who can safely and the Rockefeller Foundation for basic research in implan- effectively use contraceptive methods.
Annual Technical Report 2003 Executive summary tive interventions to reduce maternal and newborn morbidity gies in maternal and perinatal nutrition were published. A and mortality (see below Implementation of evidence-based similar document on the future of maternal and perinatal programmes). health research was prepared for the 25th anniversary of the United Kingdom National Perinatal Epidemiology Regions and countries are heavily involved in discussions Unit; all of these position papers are contributing to the on the future work of the global Making Pregnancy Safer global research agenda for the next decade. initiative in order to assure that WHO’s plans, structures, and • commitments are responsive to their identified needs and Considerable efforts were made to disseminate the constraints. Despite severe funding shortages faced by the results of previous research and secondary analyses Department in 2003, much progress was made in achieving of data collected in the context of several trials. In 2003, country objectives by fostering closer collaboration and coor- 21 publications were produced. The primary results of dination with other United Nations agencies and partners. In the trial evaluating a strategy to reduce unnecessary 2003, WHO became host to the Secretariat of the Partner- caesarean sections will be published in 2004, together ship for Safe Motherhood and Newborn Health. with reports on women’s and providers’ perceptions of care and the economic evaluation of interventions tested Generating new evidence for maternal and in the context of the WHO Caesarean Section Trial and perinatal health the WHO Antenatal Care Trial.
Annual Technical Report 2003 Executive summary Pregnancy Safer teams from WHO headquarters, regional with pregnancy, childbirth, postpartum and newborn and country offices at the policy and strategy level, as well as care: a guide for essential practice (field reviews in at the maternal and newborn health programme development Malawi and the Philippines); Beyond the numbers: and implementation level, are under way in 82 countries. reviewing maternal deaths and complications for making pregnancy safer (regional facilitators are being trained in Despite severe funding constraints, much was accomplished South-East Asia and Africa); the revised WHO midwifery in 2003. A significant number of key guidance tools were education modules; the Strengthening midwifery toolkit; finalized, translated and published, and are being used by the Reference guide on HIV-related care and support to countries throughout the world. Other major tools which women and children. address policy, strategy, clinical services, training and advo- • cacy are near completion. Future efforts will continue to shift Major tools in the final stages of development included from development of guidance towards greater support to (provisional titles): Standards for maternal and neonatal countries. Still, work will need to continue to strengthen the care; Antenatal care reference guide; Making pregnancy evidence base to assure that WHO continues to provide the safer education and training strategy; Making pregnancy most up-to-date information and guidance in the field. safer planning guide; Human rights assessment tool for maternal and neonatal health: a multisectoral approach Selected highlights—development of tools and for improving laws, policies and standards of care; and guidelines: on CD-ROM, Making pregnancy safer essential health technology package. • The Integrated Management of Pregnancy and Child- birth is a comprehensive set of tools designed to provide Selected highlights—technical support to countries: guidance to countries for improving maternal and new- • born heath. An overview of the tools is regularly updated In Africa, a major achievement of 2003 was the estab- on the Department’s web site. Managing complications lishment or strengthening of Making Pregnancy Safer/ in pregnancy and childbirth: a guide for midwives and Safe Motherhood national task forces or partner coordi- doctors is being used in several countries to improve nation committees. Task forces are meeting routinely in national standards of emergency obstetric care. Trans- Ethiopia, Mauritania, Mozambique, Nigeria, and Uganda lations into Chinese, Lao, Mongolian, Spanish, and and efforts are being intensified to revitalize similar task Vietnamese were completed in 2003. By 2004, the guide forces in the other countries of the region. will be available in over 10 languages, including French, • Arabic and Portuguese. The companion guide, Manag- During 2003, the WHO Regional Office for the Americas ing newborn problems: a guide for doctors, nurses and provided intensive technical assistance to priority coun- midwives was endorsed by UNFPA, UNICEF, the World tries (Bolivia, Brazil, Dominican Republic, Ecuador, El Bank, FIGO, the International Pediatric Association and Salvador, Guatemala, Guyana, Haiti, Honduras, Nicara- the International Confideration of Midwives. Pregnancy, gua, Paraguay, and Peru) to operationalize the regional childbirth, postpartum and newborn care: a guide for strategy for maternal morbidity and mortality reduction at essential practice was endorsed in 2003 by UNFPA, national and local levels. UNICEF, and the World Bank. Its adaptation is under • way in Africa and the Western Pacific. Validation studies In the WHO Eastern Mediterranean Region, technical were conducted in Brazil in 2003 and similar studies are and financial support has been maintained to strengthen planned for Sudan and Uganda. and expand Making Pregnancy Safer strategies in prior- ity countries such as Afghanistan, Djibouti, Iraq, Paki- • During 2003, the Making Pregnancy Safer team worked stan, Somalia, Sudan, and the Republic of Yemen.