ReproductiveReproductive healthhealth researchresearch atat WHOWHO

TheThe successsuccess storystory ofof thethe SpecialSpecial ProgrammeProgramme ofof Research,Research, DevelopmentDevelopment andand ResearchResearch TrainingTraining inin HumanHuman ReproductionReproduction (HRP)(HRP) Paul F.A. Van Look, MD PhD FRCOG

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/1 Department of reproductive health and research health of reproductive Department “Health isastate ofcomplete “Health isastate ofcomplete well-being and notmerely physical, mental andsocial infirmity.” the absence ofdisease or well-being and notmerely physical, mental andsocial infirmity.” the absence ofdisease or éatmn at trcecegénésiques santé et recherche Département 7 April 1948 7 April 1948

PVL_RHCourse_MAR03/2 FunctionsFunctions ““InIn orderorder toto achieveachieve itsits objective,objective, thethe functionsfunctions ofof thethe OrganizationOrganization shallshall be:be:

(a)(a) toto actact asas thethe directingdirecting andand coco--ordinatingordinating authorityauthority onon internationalinternational healthhealth work;work; ...... (n)(n) toto promotepromote andand conductconduct researchresearch inin thethe fieldfield ofof health;health; ...”...” (WHO(WHO Constitution,Constitution, ArticleArticle 2)2)

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/3 Department of reproductive health and research health of reproductive Department Growth oftotal worldpopulation Growth oftotal worldpopulation Billions Growth oftotal worldpopulation 0 1 2 3 4 5 6 7 1600 1700 1800 Years Years 1804 1900 éatmn at trcecegénésiques santé et recherche Département 1927 1960 2000 1974 1987 1999 2100

PVL_RHCourse_MAR03/4 TheThe Programme’sProgramme’s historyhistory

““REQUESTSREQUESTS thethe DirectorDirector--GeneralGeneral toto developdevelop furtherfurther thethe programmeprogramme proposed:proposed:

(a)(a) inin thethe fieldsfields ofof referencereference services,services, studiesstudies onon medicalmedical aspectsaspects ofof sterilitysterility andand fertilityfertility controlcontrol methodsmethods andand healthhealth aspectsaspects ofof populationpopulation dynamics;dynamics; …”…” (WHA(WHA ResolutionResolution 18.49;18.49; 1965)1965)

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/5 TheThe Programme’sProgramme’s historyhistory

1965: WHA18.49 Human Reproduction Unit within existing Division of Family Health

1971: Feasibility study Expanded (Special) Programme of Research, Development and Research Training in Human Reproduction (HRP)

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/6 TheThe Programme’sProgramme’s historyhistory

197219721972-1988:--1988:1988: WHOWHOWHO SpecialSpecialSpecial ProgrammeProgrammeProgramme

198819881988-present:--present:present: UNDP/UNFPA/WHO/WorldUNDP/UNFPA/WHO/World BankBankBank cosponsoredcosponsored SpecialSpecial ProgrammeProgramme (WHA(WHA ResolutionResolution 41.9;41.9; 1988)1988)

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/7 ““ToTo coordinate,coordinate, promote,promote, conductconduct andand evaluateevaluate internationalinternational researchresearch inin humanhuman reproduction.”reproduction.”

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/8 0 1 2 3 4 5 6 7 rate fertility Total Department of reproductive health and research health of reproductive Department fertility Initial Factors contributing tofertilitydecline Factors contributing tofertilitydecline Factors contributing tofertilitydecline fertility Final Reduction in fertilit y r ate Percentage ofreductionbycontributing factor 100 -4 -2 80 20 40 60 0 0 0 at m Highe a rr r ag i a éatmn at trcecegénésiques santé et recherche Département g e e br e R a e stfe d u ced ed ing

c Mo o (Source: World Bank,1984) (Sourc n t r racep e useo e: WorldBa t i on f

More indu abo r tion n c k e , 198 d 4 All other fa ) ctor s PVL_RHCourse_MAR03/9 Department of reproductive health and research health of reproductive Department PerPer centcent usersusers 40 60 80 20 0 Trends inuseof contraception Trends inuseof contraception Developing countries Developing countries 1960-1965 éatmn at trcecegénésiques santé et recherche Département Developed countries Developed countries (Source: U ( S our ce: Un n ited Nati it ed Nat i ons, 1991 and1999) on s , 1 9 9 1 an d 199 9)

PVL_RHCourse_MAR03/10 Department of reproductive health and research health of reproductive Department Mesigyna Cyclofem Mesigyna Cyclofem Once Once - - a a ® ® ® ® - - month month the Programme the Programme : : : : injectables injectables 25 mg 50 mg + 5mg acetate + 5mg 25 mg 50 mg + 5mg acetate + 5mg medroxyprogesterone norethisterone medroxyprogesterone norethisterone estradiol estradiol estradiol estradiol éatmn at trcecegénésiques santé et recherche Département developed by developed by cypionate valerate cypionate valerate enantate enantate

PVL_RHCourse_MAR03/11 100

20 40 % users60 80 0 Department of reproductive health and research health of reproductive Department R egul ar Depo Depo pat Bleeding patterns experiencedby Bleeding patterns experiencedby injectable injectable ter n I r - r - egul provera provera ar pat t e r n A m enor users at1yearof use users at1yearof use r hoea 100 20 40 60 80

0 % users éatmn at trcecegénésiques santé et recherche Département Re g u l a r p a t t e r Cyclofem Cyclofem n I rre g u l a r pa t t e r n A m e n orrh oe

PVL_RHCourse_MAR03/12 a Department of reproductive health and research health of reproductive Department Once Once Mesigyna Mesigyna - - a a - - month month injectables injectables • • • • éatmn at trcecegénésiques santé et recherche Département (low publicsectorprice (low publicsectorprice licensed to currently registeredin licensed to currently registeredin – – – – – – – – – – Tanzania Kenya Egypt America (44 countries) Caribbean and Latin Turkey Tanzania Kenya Egypt America (44 countries) Caribbean and Latin Turkey for women for women Schering Schering ) )

PVL_RHCourse_MAR03/13 Department of reproductive health and research health of reproductive Department 25 mg 25 mg medroxyprogesterone medroxyprogesterone CYCLOFEM CYCLOFEM Registered Registered acetate +5mg acetate +5mg M M a a Re Re nufacture nufacture gi gi éatmn at trcecegénésiques santé et recherche Département st st rat rat i i on pendi on pendi estradiol estradiol ng ng cypionate cypionate

PVL_RHCourse_MAR03/14 Department of reproductive health and research health of reproductive Department intercourse toPREVENTpregnancy Methods whichwomen canuseAFTER intercourse toPREVENTpregnancy Methods whichwomen canuseAFTER What isemergency contraception? What isemergency contraception? (Consensus Statement,Bellagio, 1995) (Consensus Statement,Bellagio, 1995) éatmn at trcecegénésiques santé et recherche Département

PVL_RHCourse_MAR03/15 Department of reproductive health and research health of reproductive Department Methods ofemergency contraceptionin Methods ofemergency contraceptionin • • • • Copper ( Ethinylestradiol/levonorgestrel (1970s (1970s Copper ( Ethinylestradiol/levonorgestrel – – – – – Yuzpe – – – – – Yuzpe efficacy ofgreaterthan 90% painful atinsertion,risk of often unsuitable, requirestrainedproviders efficacy approx. 75% nausea 50%,vomiting20% efficacy ofgreaterthan 90% painful atinsertion,risk of often unsuitable, requirestrainedproviders efficacy approx. 75% nausea 50%,vomiting20% ) ) - - regimen) regimen) T intrauterine device T intrauterine device early 1990s early 1990s (1974) (1974) éatmn at trcecegénésiques santé et recherche Département PID PID

PVL_RHCourse_MAR03/16 Department of reproductive health and research health of reproductive Department Emergency contraception isindicatedto Emergency contraception isindicatedto • • • • • • prevent pregnancy afterintercourse In cases ofsexual assault misuse, including: When thereisacontraceptive failureor When nocontraceptive wasused prevent pregnancy afterintercourse In cases ofsexual assault misuse, including: When thereisacontraceptive failureor When nocontraceptive wasused – – – – – – – – failed coitus late forcontraceptive injection pills 2 ormoreconsecutive missedoral contraceptive condom breakage, slippageormisuse failed coitus late forcontraceptive injection pills 2 ormoreconsecutive missedoral contraceptive condom breakage, slippageormisuse interruptus interruptus , etc. , etc. éatmn at trcecegénésiques santé et recherche Département

PVL_RHCourse_MAR03/17 * Department of reproductive health and research health of reproductive Department LNG Yuzpe Group LNG Yuzpe Group The difference inpregnancyratewas statisticallysignificant. The difference inpregnancyratewas statisticallysignificant. Lower pregnancy rateafter Lower pregnancy rateafter Number of Number of women women 976 979 976 979 levonorgestrel levonorgestrel pregnancies rate(95% CI) pregnancies rate(95% CI) Observed Observed 11 31 11 31 éatmn at trcecegénésiques santé et recherche Département (Source: W (Source: W 1.1% 3.2% Pregnancy 1.1% 3.2% Pregnancy (0.6, 2.0) (2.2, 4.5) (0.6, 2.0) (2.2, 4.5) H H O, O, Lancet,1998) Lancet,1998)

PVL_RHCourse_MAR03/18 Side Nausea Vomit Headache Dizziness Fatigue Nausea Vomit Headache Dizziness Fatigue Side Department of reproductive health and research health of reproductive Department - - i i effect effect ng ng Less side Less side No. (%)ofcases No. (%)ofcases - - 494 184 198 163 279 effects after 494 184 198 163 279 effects after Yuzpe Yuzpe (50.5) (18.8) (20.2) (16.7) (28.5) (50.5) (18.8) (20.2) (16.7) (28.5) éatmn at trcecegénésiques santé et recherche Département levonorgestrel levonorgestrel No. (%)ofcases No. (%)ofcases 226 (23.1) 164 (16.8) 109 (11.2) 165 (16.9) 226 (23.1) 164 (16.8) 109 (11.2) 165 (16.9) (Source: W (Source: W 55 (5.6) 55 (5.6) LNG LNG H H O, O, Lancet, 1998) Lancet, 1998) <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 p p 0.06 0.06 - - value value

PVL_RHCourse_MAR03/19 Department of reproductive health and research health of reproductive Department Pregnancy rate (%) 0 1 2 3 4 5 Emergency contraception ismoreeffective Emergency contraception ismoreeffective (n=386) (n=522)(n=326) (n=379) (n=191) (n=146) 0-12 0.5 13-24 the sooneritisstarted the sooneritisstarted 1.5 25-36 Delay (hours) 1.8 37-48 éatmn at trcecegénésiques santé et recherche Département 2.6 49-60 (Source: W (Source: W 3.1 H H 61-72 O, O, Lancet, 1998) Lancet, 1998) 4.1

PVL_RHCourse_MAR03/20 Department of reproductive health and research health of reproductive Department éatmn at trcecegénésiques santé et recherche Département

PVL_RHCourse_MAR03/21 Department of reproductive health and research health of reproductive Department emergency contraception (asofNovember2002) emergency contraception (asofNovember2002) Availability of Availability of Postinor Postinor Norlevo Norlevo levonorgestrel levonorgestrel - - 2 2 Others Both preparations Others Both preparations éatmn at trcecegénésiques santé et recherche Département preparations for preparations for

PVL_RHCourse_MAR03/22 Department of reproductive health and research health of reproductive Department Group Group LNG 0.75mg x2 LNG 1.5mg x1 Mifepristone All LNG LNG 0.75mg x2 LNG 1.5mg x1 Mifepristone All LNG Levonorgestrel Levonorgestrel do notdifferin efficacy do notdifferin efficacy 10 mg 10 mg pregnancies pregnancies and Observed Observed and 24/1356 20/1356 21/1359 44/2712 24/1356 20/1356 21/1359 44/2712 /total /total éatmn at trcecegénésiques santé et recherche Département mifepristone mifepristone (Source: W (Source: W H H O, O, Lancet,2002) Lancet,2002) 1.77% 1.62% 1.47% 1.55% 1.77% 1.62% 1.47% 1.55% Rate Rate

PVL_RHCourse_MAR03/23 Department of reproductive health and research health of reproductive Department ------Mifepristone Mifepristone and secondtrime pregnancy termination(first cervical ripening menses induction ovulation blocking luteal emergency contraception and secondtrime pregnancy termination(first cervical ripening menses induction ovulation blocking luteal emergency contraception éatmn at trcecegénésiques santé et recherche Département contraception contraception s s research research ter) ter)

PVL_RHCourse_MAR03/24 Department of reproductive health and research health of reproductive Department éatmn at trcecegénésiques santé et recherche Département

PVL_RHCourse_MAR03/25 Department of reproductive health and research health of reproductive Department • • • • • • • • • • • • • • safety safety Long Third Safety and efficacy of DMPA and breastcancer Oral contraceptivesand breastcancer Oral contraceptivesand cardiovasculardisease Oral contraceptivesand cancer(benefitsandrisks) thromboembolism DMPA and breastcancer Oral contraceptivesand breastcancer Oral contraceptivesand cardiovasculardisease Oral contraceptivesand cancer(benefitsandrisks) Long Third Safety and efficacy of thromboembolism - - - - / / term safety andefficacy ofNorplant term safety andefficacy ofNorplant generation oral contraceptivesand venous Important new generation oral contraceptivesand venous Important new efficacy efficacy of hormonal of hormonal methods methods mifepristone mifepristone knowledge knowledge éatmn at trcecegénésiques santé et recherche Département fertility fertility about about - - regulating regulating ® ®

PVL_RHCourse_MAR03/26 Department of reproductive health and research health of reproductive Department Countries (numberof clinics)participatingin Countries (numberof clinics)participatingin C C o o lo lo 3 3 Post mb mb Post Chil Chil 2 ia 2 ia

e e - - marketing surveillance ofNorplant marketing surveillance ofNorplant Eg Eg 5 5 yp yp t t

éatmn at trcecegénésiques santé et recherche Département Sr Sr Bang Bang i Lanka i Lanka 1 1 ladesh 2 ladesh 2 C C h 10 h 10 ina ina T T h h a a 4 4 i i land land Indon Indon 5 5 es es ia ia

® ®

PVL_RHCourse_MAR03/27 PostPost--marketingmarketing surveillancesurveillance ofof NorplantNorplant®

CumulativeCumulative pregnancypregnancy raterate atat fivefive yearsyears

Norplant® Copper Non-Copper Sterilization IUD IUD

Woman-years 32,977 24,289 2619 6905

Events 88 215 77 10

Rate (SE) 1.46 (0.16) 4.19 (0.28) 13.00 (1.39) 0.72 (0.23)

(Source: WHO, 2001)

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/28 ® Post-Marketing Surveillance of Norplant® Selected Side-effects (Rate ratios Norplant/Controls adjusted for clinic and age) Bleeding disturbances - excessive /irregular, Norplant hospitalised IUD 1.14 (0.39, 3.31) 0.82 Sterilization 2.33 (0.28, 19.7) 0.44

- excessive/irregular Norplant IUD 2.72 (2.49, 2.97) P<0.001 Sterilization 11.39 (8.49, 15.3) P<0.001

- amenorrhoea Norplant IUD 4.80 (3.88, 5.95) P<0.001 Sterilization 6.69 (4.07, 11.0) P<0.001 Anaemia Haemoglobin <10g/dl Norplant IUD 0.78 (0.53, 1.13) 0.19 Sterilization 1.10 (0.40, 3.02) 0.85

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/29 Department of reproductive health and research health of reproductive Department Cumulative pregnancy rate (per TCu 100 woman-years) TCu 0 1 2 3 4 5 WHO trials 1978-1982 start of 380A IUD:US FDAAPPROVALS 380A IUD:US FDAAPPROVALS 13579 4 y 1984 NDA r s Years ofuse 4 y 1989 r s-6 y éatmn at trcecegénésiques santé et recherche Département r s 6 y r 1991 s-8 y 8 y r s 1993 r s-9 y r s 9 yr 1994 s 1 -10 1 yr s

PVL_RHCourse_MAR03/30 PID rate years) 1000 (per Department of reproductive health and research health of reproductive Department 10 12 6 8 0 2 4 1 2 Months (firstyear) 3 4 (95% confidenceinterval) - (95% confidenceinterval) PID INCIDENCERATE PID INCIDENCERATE 6 7 Time since insertion - 1 2 2 3 éatmn at trcecegénésiques santé et recherche Département 4567 Year 8 +

PVL_RHCourse_MAR03/31 Department of reproductive health and research health of reproductive Department PerPer centcent usersusers 20 40 60 80 0 Trends inuseof contraception Trends inuseof contraception Developing countries Developing countries 1960- 1 965 1990 éatmn at trcecegénésiques santé et recherche Département Developed countries Developed countries (Source: U ( S our ce: Un n ited Nati it ed 2001 Nat i ons, 1991 and1999) on s , 1 9 9 1 an d 199 9)

PVL_RHCourse_MAR03/32 Research anddevelopment Research anddevelopment Department of reproductive health and research health of reproductive Department Emphasis onresearch capability Emphasis onresearch capability US$ 2 US$ 2 strengthening strengthening éatmn at trcecegénésiques santé et recherche Département Research capability Research capability strengthening strengthening US$ 1 US$ 1

PVL_RHCourse_MAR03/33 Department of reproductive health and research health of reproductive Department AFRO Countries collaborating withtheDepartment Countries collaborating withtheDepartment in theyear2001(n =99countries) in theyear2001(n =99countries) AMRO EM RO EURO éatmn at trcecegénésiques santé et recherche Département SEARO W PRO

PVL_RHCourse_MAR03/34 Department of reproductive health and research health of reproductive Department

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PVL_RHCourse_MAR03/35 Department of reproductive health and research health of reproductive Department • • • • • • • • • • based, gender women, female genitalmutilation a concern forneglected issues:violence against men, refugees a placefor neglectedgroups: youngpeople, a newwayofworking: client comprehensive,”horizontal”, integratedway a broaderagendato beaddressedinaholistic, a newlanguage based, gender women, female genitalmutilation a concern forneglected issues:violence against men, refugees a placefor neglectedgroups: youngpeople, a newwayofworking: client comprehensive,”horizontal”, integratedway a broaderagendato beaddressedinaholistic, a newlanguage The ICPDProgramme ofAction The ICPDProgramme ofAction A radicaldeparture A radicaldeparture - - sensitive sensitive éatmn at trcecegénésiques santé et recherche Département - - centred, rights centred, rights - - - -

PVL_RHCourse_MAR03/36 ““AllAll countriescountries shouldshould strivestrive toto makemake accessibleaccessible throughthrough thethe primaryprimary healthhealth--carecare systems,systems, reproductivereproductive healthhealth toto allall individualsindividuals ofof appropriateappropriate agesages asas soonsoon asas possiblepossible andand nono laterlater thanthan thethe yearyear 2015.”2015.”

(ICPD Programme of Action, para. 7.6)

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/37 Department of reproductive health and research health of reproductive Department % of total DALYs 0 1 2 3 4 5 6 7 8 6. Reproductive ill Reproductive ill H 1 I V / A I D 5. S 9 portions ofglobalburden ofdisease portions ofglobalburden ofdisease 1. 1 S T I s 0. 6 4. M 4 a t e r nal - - health accountsforsubstantial health accountsforsubstantial 1. 7 C anc er 0. 2 6. P 4 e r i nat al 7 éatmn at trcecegénésiques santé et recherche Département mal fe (Source: Worl (Sourc m e a s l e s e: Worl 19. 7 d Health Report2002) d He Total alth Rep 13. 7 o rt 2 0 0 0 5 10 15 20 25

2

)

s Y L A D total of %

PVL_RHCourse_MAR03/38 RisksRisks toto sexualsexual andand reproductivereproductive healthhealth

Attributable Attributable Measured adverse Risk factor Rank deaths DALYs outcomes of (% of total) exposure

Unsafe sex 2 2.9 million 91.9 million HIV/AIDS, STIs, (5.2%) (6.3%) cervical cancer

Lack of 19 149,000 8.8 million maternal mortality contraception (0.3%) (0.6%) and morbidity

(Source:WHO,World Health Report 2002)

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/39 ““InvestmentsInvestments inin reproductivereproductive healthhealth,, includingincluding familyfamily planningplanning andand accessaccess toto contraceptives,contraceptives, areare crucialcrucial accompanimentsaccompaniments ofof investmentsinvestments inin diseasedisease controlcontrol.. TheThe combinationcombination ofof diseasedisease controlcontrol andand reproductivereproductive healthhealth isis likelylikely toto translatetranslate intointo reducedreduced fertility,fertility, greatergreater investmentsinvestments inin thethe healthhealth andand educationeducation ofof eacheach child,child, andand reducedreduced populationpopulation growth.”growth.”

(Commission on Macroeconomics and Health, 2001)

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/40 Maternal health intervention research during 1995 -2002 with leading/active participation of the Programme

Countries Women Status

Antenatal care 4 24 678 Published (2001) Postpartum haemorrhage 9 18 530 Published (2001) Caesarean section 5 149 276 Publications submitted (2002) Treatment of pre-eclampsia (MAGPIE trial) 31 10 141 Published (2002) The WHO Reproductive Health Library 2 76 053 Ongoing (evaluation phase) Primary prevention of pre-eclampsia 6 8 500 Ongoing (calcium supplementation) (6500 recruited) Screening and treatment of urinary tract 4 18 000 ReRecruitmentcruitment startstart infection 2003 Treatment of postpartum haemorrhage 4 1 000 ReRecruitmentcruitment startstart 2003 Total 25* 306 178

* Some countries have been involved in more than one study

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/41 WHOWHO AntenatalAntenatal CareCare TrialTrial

Primary outcome New model Standard model Adjusted odds ratio (95% CI)

Low birthweight 7.68 % 7.14 % 1.06 (0.97-1.15) (<2500g)

Pre-eclampsia/ 1.69 % 1.38 % 1.26 (1.02-1.56) eclampsia

Postpartum 7.59 % 8.67 % 1.01a anaemia

Treated urinary 5.95 % 7.41 % 0.93 (0.79-1.10) tract infection a Confidence interval not computed because of heterogeneity between sites and strata

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/42 WHOWHO MisoprostolMisoprostol TrialTrial PrimaryPrimary outcomesoutcomes

Outcome Misoprostol Oxytocin RR (95% CI)

Blood loss 4.0 % 2.9 % 1.39 (1.19-1.63) > 1000 ml

Use of additional 15.2 % 10.9 % 1.40 (1.29-1.51) uterotonics

(Gülmezoglu et al.,The Lancet, 2001)

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/43 DoDo womenwomen withwith prepre--eclameclampsiapsia,, andand theirtheir babies,babies, benefitbenefit fromfrom magnesiummagnesium sulphate?sulphate? TheThe MagpieMagpie Trial:Trial: aa randomizedrandomized placeboplacebo--controlledcontrolled trialtrial..

(The Magpie Trial Collaboration Group. Lancet 2002; 359: 1877-90)

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/44 TheThe MagpieMagpie TrialTrial

Magnesium Placebo Relative risk sulphate (n=5055) (n=5055) (95% CI)

Eclampsia 40 (0.8%) 96 (1.9%) 0.42 (0.29 to 0.60)

Maternal death 11 (0.2%) 20 (0.4%) 0.55 (0.26 to 1.14)

Baby death (total) 576 (12.7%)* 558 (12.4%)† 1.02 (0.92 to 1.14)

* n=4538; † n=4486 (Lancet 2002; 359: 1877-90)

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/45 Department of reproductive health and research health of reproductive Department Activities inSTIand HIVduring2001 Activities inSTIand HIVduring2001 • • • • • • • • • • COL Infant feeding andMTCTof HIV HAART during breastfeeding (pregnancy andSTI prevention) Male andfemalecondoms Cellulose sulphate as COL Infant feeding andMTCTof HIV HAART during breastfeeding (pregnancy andSTI prevention) Male andfemalecondoms Cellulose sulphate as - - 1492 (nonoxynol 1492 (nonoxynol éatmn at trcecegénésiques santé et recherche Département microbicide - microbicide - 9) 9) - - 2002 2002

PVL_RHCourse_MAR03/46 GettingGetting researchresearch intointo practicepractice

EvidenceEvidence--basedbased technicaltechnical andand policypolicy guidanceguidance -- familyfamily planningplanning (global(global consensusconsensus guidelines)guidelines)

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/47 Department of reproductive health and research health of reproductive Department éatmn at trcecegénésiques santé et recherche Département

PVL_RHCourse_MAR03/48 GettingGetting researchresearch intointo practicepractice

EvidenceEvidence--basedbased technicaltechnical andand policypolicy guidanceguidance -- familyfamily planningplanning (global(global consensusconsensus guidelines)guidelines) -- WHOWHO ReproductiveReproductive HealthHealth LibraryLibrary IssueIssue No.5No.5

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/49 Department of reproductive health and research health of reproductive Department éatmn at trcecegénésiques santé et recherche Département

PVL_RHCourse_MAR03/50 Guatemala Bolivia Department of reproductive health and research health of reproductive Department Chile quality ofcarereproductive healthservices quality ofcarereproductive healthservices Dominican Republic Broadening choice andimproving Broadening choice andimproving Burkina Faso Romania Brazil Ghana Latvia South Africa Ethiopia Zambia India éatmn at trcecegénésiques santé et recherche Département Kyrgyzstan Myanmar Cambodia Viet Nam Lao PDR China

PVL_RHCourse_MAR03/51 Department of reproductive health and research health of reproductive Department • • • • – – – – – – – – – – Making pregnancy safer Family planning Making pregnancy safer Family planning ongoing/planned research ongoing/planned research asymptomatic urinarytractinfections prevention of pre long emergency contraception male hormonalcontraception asymptomatic urinarytractinfections prevention of pre long emergency contraception male hormonalcontraception - - term safety (IUDs;bonemineraldensity) term safety (IUDs;bonemineraldensity) Main areasof Main areasof - - eclampsia eclampsia éatmn at trcecegénésiques santé et recherche Département

PVL_RHCourse_MAR03/52 Department of reproductive health and research health of reproductive Department • • • • – – – – – – – – – – – – Controlling Preventing unsafeabortion Controlling Preventing unsafeabortion ongoing/planned research ongoing/planned research post provision of abortionbymid non HAART for breastfeedingwomen contraceptives andHIV ( dual protectionmethods post provision ofabortion bymid non HAART for breastfeedingwomen contraceptives andHIV ( dual protectionmethods microbicides microbicides - - - - surgical termination ofpregnancy surgical termination ofpregnancy abortion care abortion care Main areasof Main areasof RTIs/STIs RTIs/STIs , femalecondom) , femalecondom) éatmn at trcecegénésiques santé et recherche Département - - level providers level providers

PVL_RHCourse_MAR03/53 Department of reproductive health and research health of reproductive Department • • – – – – – – – – – – Technical cooperation withcountries Technical cooperation withcountries health sectorreform andreproductive health Approach widening scope anduseoftheStrategic strengthening ofregionalresearch networks improved utilizationof researchfindings enhancing operations research capability health sectorreform andreproductive health Approach widening scope anduseoftheStrategic strengthening ofregionalresearch networks improved utilization ofresearchfindings enhancing operations research capability ongoing/planned research ongoing/planned research Main areasof Main areasof éatmn at trcecegénésiques santé et recherche Département

PVL_RHCourse_MAR03/54 ““EradicatingEradicating polio,polio, curbingcurbing thethe tobaccotobacco epidemic,epidemic, stimulatingstimulating researchresearch inin thethe developingdeveloping worldworld —— thisthis isis ourour corporatecorporate strategystrategy inin practice.”practice.”

Dr Gro Harlem Brundtland, Statement to the Executive Board at its 105th session, 29 January 2000

Department of reproductive health and research Département santé et recherche génésiques PVL_RHCourse_MAR03/55