sign in sign up
<<
Home , Yuzpe regimen

ReproductiveReproductive healthhealth researchresearch atat WHOWHO

PaulPaul F.A.F.A. VanVan Look,Look, MDMD PhDPhD FRCOGFRCOG

DepartmentDepartment ofof ReproductiveReproductive HealthHealth andand ResearchResearch WorldWorld HealthHealth OrganizationOrganization Geneva,Geneva, 2121 SeptemberSeptember 20012001

Department of reproductive health and research Département santé et recherche génésiques PVL_HUG_STUDS_SEP01/1 Department of reproductive health and research health of reproductive Department “Health isastate ofcomplete “Health isastate ofcomplete absence ofdisease orinfirmity.” being andnot merelythe physical, mental andsocialwell- being andnot merelythe physical, mental andsocialwell- absence ofdisease orinfirmity.” Département santé etrecherche génésiques Département 7 April 1948 7 April 1948

PVL_HUG_STUDS_SEP01/2 Department of reproductive health and research health of reproductive Department 191 Member States (asof September 2001) 191 Member States (asof September 2001) World HealthOrganization World HealthOrganization Département santé etrecherche génésiques Département

PVL_HUG_STUDS_SEP01/3 MissionMission

““TheThe objectiveobjective ofof thethe WorldWorld HealthHealth OrganizationOrganization shallshall bebe thethe attainmentattainment byby allall peoplespeoples ofof thethe highesthighest possiblepossible levellevel ofof health.”health.”

(WHO(WHO Constitution,Constitution, ArticleArticle 1)1)

Department of reproductive health and research Département santé et recherche génésiques PVL_HUG_STUDS_SEP01/4 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_HUG_STUDS_SEP01/5 ““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_HUG_STUDS_SEP01/6 Department of reproductive health and research health of reproductive Department

Billions Growth oftotal worldpopulation 0 1 2 3 4 5 6 7 Growth oftotal worldpopulation Growth oftotal worldpopulation 1600 1700 1 800 Years Years 1804 1 900 éatmn at trcecegénésiques santé et recherche Département 1927 1960 2 000 1974 1987 1999 2100

PVL_HUG_STUDS_SEP01/7 TheThe Programme’sProgramme’s historyhistory

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

19721972--1988:1988: WHO Special Programme

19881988--present:present: UNDP/UNFPA/WHO/World Bank cosponsored Special Programme

Department of reproductive health and research Département santé et recherche génésiques PVL_HUG_STUDS_SEP01/8 Department of reproductive health and research health of reproductive Department rate fertility Total 5 6 7 0 1 2 3 4 fertility Initial Factors contributing tofertilitydecline Factors contributing tofertilitydecline Factors contributing tofertilitydecline fertility Final Reduction in fertilit y r ate 100 -4 -2 80 20 40 60 0 0 0 at marr Higher age Percentage ofreductionbycontributing factor éatmn at trcecegénésiques santé et recherche Département iage breastfeedi Re du ced ng contraception More useof (Source: World Bank,1984) (Source: World Bank,1984)

More induced All factors other

PVL_HUG_STUDS_SEP01/9 Department of reproductive health and research health of reproductive Department PerPer centcent usersusers 60 80 20 40 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 o u r c e: Unit n ite ed d Nat Nati i on ons, 19 s , 199 91 and 1 1 an d 1999) 9 99)

PVL_HUG_STUDS_SEP01/10 Department of reproductive health and research health of reproductive Department Mesigyna Cyclofem Mesigyna Cyclofem Once Once - - a a - - ® ® ® ® month month : : : : the Programme the Programme + 5mg acetate 25 mg 50 mg + 5mg + 5mg acetate 25 mg 50 mg + 5mg injectables injectables medroxyprogesterone medroxyprogesterone norethisterone estradiol estradiol estradiol éatmn at trcecegénésiques santé et recherche Département developed by developed by cypionate valerate cypionate valerate enantate enantate

PVL_HUG_STUDS_SEP01/11 users users % % 100 40 60 80 20 0 Department of reproductive health and research health of reproductive Department R e gul a r Bleeding patterns experiencedby Bleeding patterns experiencedby pa Depo Depo injectable injectable t t e r n I rre - - provera provera g u l a r p a t t e r n A m e users at1year ofuse users at1year ofuse nor r h oe a users users % % 100 20 40 60 80 éatmn at trcecegénésiques santé et recherche Département 0 Re g u l a r p a t Cyclofem Cyclofem t e r n I rre gu l a r pa t t e r n A m e n o rrho e a

PVL_HUG_STUDS_SEP01/12 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 andLatin Turkey Tanzania Kenya Egypt America (44 countries) Caribbean andLatin Turkey for women for women Schering Schering ) )

PVL_HUG_STUDS_SEP01/13 25 mg 25 mg Department of reproductive health and research health of reproductive Department medroxyprogesterone medroxyprogesterone Regist Regist CYCLOFEM CYCLOFEM ered ered acetate +5mg acetate +5mg Manufacture Manufacture Registration pending Registration pending éatmn at trcecegénésiques santé et recherche Département estradiol cypionate

PVL_HUG_STUDS_SEP01/14 * Department of reproductive health and research health of reproductive Department Levonorgestrel Relative risk(RR) ofpregnancyforLNGcompared with Group Numberof Yuzpe LNG Group Numberof Relative risk(RR) ofpregnancyforLNGcompared with Yuzpe LNG women women 979 976 979 976 for emergencycontraception: efficacy for emergencycontraception: efficacy RR 0.36 RR 0.36 pregnancies rate(%) pregnancies rate(%) Observed Observed 31 11 31 11 (0.18, 0.70) (0.18, 0.70) Pregnancy Pregnancy 95% CI 95% CI éatmn at trcecegénésiques santé et recherche Département 3.2 1.1 3.2 1.1 (2.2, 4.5) (0.6, 2.0) (2.2, 4.5) (0.6, 2.0) 95% CI 95% CI Yuzpe Yuzpe (Source: W : : H O, 1998)

PVL_HUG_STUDS_SEP01/15 Department of reproductive health and research health of reproductive Department Side effect Nausea Vomit Headache Dizziness Fatigue Nausea Vomit Headache Dizziness Fatigue Side effect Levonorgestrel Levonorgestrel i i ng ng for emergencycontraception: side for emergencycontraception: side No. (%)ofcases No. (%)ofcases 494 184 198 163 279 494 184 198 163 279 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 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) LNG LNG

55 (5.6) 55 (5.6)

(

S

o

u

r

c - - e: WHO, 1998) effects effects <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_HUG_STUDS_SEP01/16 Department of reproductive health and research health of reproductive Department Pregnancy rate (%) 1 2 3 4 5 0 Effect ofdelay onpregnancyrates Effect ofdelay onpregnancyrates (n=386) (n=522 (n=326)(n=379) (n=191) (n=386) (n=522 (n=326)(n=379) (n=191) 0 0 - - 12 12 0.5 0.5 13 13 - - 24 24 1.5 1.5 25 25 - - 36 36 Delay (hours) Delay (hours) 1.8 1.8 37 37 - - éatmn at trcecegénésiques santé et recherche Département 48 48 2.6 2.6 49 49 - - 60 60

3.1 3.1 (Sour (n=146) (n=146) 61 61

- -

c 72 72 e: WHO, 1999) 4.1 4.1

PVL_HUG_STUDS_SEP01/17 Department of reproductive health and research health of reproductive Department (asofendMarch2001) Availability oflevonorgestrel Norlevo Norlevo Norlevo Norlevo (OTC) (OTC) éatmn at trcecegénésiques santé et recherche Département p Postinor Postinor Postinor Postinor reparations for - - 2 2

PVL_HUG_STUDS_SEP01/18 Department of reproductive health and research health of reproductive Department Mifepristone éatmn at trcecegénésiques santé et recherche Département ------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 contraception contraception research research s s ter) ter)

PVL_HUG_STUDS_SEP01/19 MifepristoneMifepristone forfor emergencyemergency contraceptioncontraception

MifepristoneMifepristone YuzpeYuzpe regimenregimen

NumberNumber ofof womenwomen 597597 589589 treatedtreated ExpectedExpected numbernumber ofof 3535 3434 pregnanciespregnancies ObservedObserved numbernumber ofof 00 (3)(3) 99 pregnanciespregnancies

(after Glasier et al., 1992 and Webb et al., 1992)

Department of reproductive health and research Département santé et recherche génésiques PVL_HUG_STUDS_SEP01/20

* * ALL 1684 10 mg 50 mg 600 mg

10 mg 50 mg 600 mg ALL 1684

Department of reproductive health and research health of reproductive Department according to according to Dos Dos

Efficacy ofthree dosesof e Efficacy ofthree dosesof e

Trussell Trussell in emergencycontraception in emergencycontraception Number of Number of

women women et al., Contraception 1998; 57:363 et al., Contraception 1998; 57:363 565 560 559 565 560 559 pregnancies pregnancies Number of Number of observed observed 20 20 7 6 7 7 6 7 éatmn at trcecegénésiques santé et recherche Département Pregnancy Pregnancy 1.2 1.2 rate rate 1.2 1.1 1.3 1.2 1.1 1.3

mifepristone

mifepristone

- -

69 69 pregnancies pregnancies Number of Number of expected expected 136 136 48 43 45 48 43 45 * * Efficacy Efficacy 85% 85% (%) (%) 85 86 84 85 86 84

PVL_HUG_STUDS_SEP01/21 Department of reproductive health and research health of reproductive Department Cumulative pregnancy rate (per 100 woman-years) 1 2 3 4 5 0 TCu TCu WHO trials 1978-1982 start of 13579 380A IUD:US FDAAPPROVALS 380A IUD:US FDAAPPROVALS 4 y 1984 NDA r s Supplemental Years ofuse 4 y 1988 NDA r s 4 y r 1989 s-6 y éatmn at trcecegénésiques santé et recherche Département r s 6 y r 1991 s-8 y r 8 y s r 1993 s-9 y r s 9 yr 1994 s 1 -10 1 yr s

PVL_HUG_STUDS_SEP01/22 (per 1000 PID rate years) Department of reproductive health and research health of reproductive Department 10 12 0 2 4 6 8 1 2 Months (firstyear) 3 4 (95% confidenceinterval) (95% confidenceinterval) PID INCIDENCERATE PID INCIDENCERATE - 6 7 - Time since insertion 1 2 2 éatmn at trcecegénésiques santé et recherche Département 3 4567 Year 8 +

PVL_HUG_STUDS_SEP01/23 Department of reproductive health and research health of reproductive Department • • • • • • • • • • • • • • safety safety thromboembolism Long Third Safety and efficacyof DMPA and breastcancer Oral contraceptivesand breastcancer Oral contraceptivesand cardiovasculardisease Oral contraceptivesand cancer(benefitsandrisks) thromboembolism Long Third Safety and efficacyof DMPA and breastcancer Oral contraceptivesand breastcancer Oral contraceptivesand cardiovasculardisease Oral contraceptivesand cancer(benefitsandrisks) - - - - term safety and efficacyof Norplant term safety and efficacyof Norplant generation oralcontraceptives andvenous / generation oralcontraceptives andvenous / Important new 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_HUG_STUDS_SEP01/24 PostPost--marketingmarketing surveillancesurveillance ofof NorplantNorplant®

CumulativeCumulative pregnancypregnancy raterate atat fivefive yearsyears

Norplant® Copper Non-Copper 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_HUG_STUDS_SEP01/25 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 Sterilisation 2.33 (0.28, 19.7) 0.44

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

- amenorrhoea Norplant® IUD 4.80 (3.88, 5.95) P<0.001 Sterilisation 6.69 (4.07, 11.0) P<0.001 Anaemia

Haemoglobin <10g/dl Norplant®

IUD 0.78 (0.53, 1.13) 0.19 (Source: WHO, 2001)

Department of reproductive health and researchSterilisation 1.10 Département(0.40, 3.02) santé et recherche0.85 génésiques PVL_HUG_STUDS_SEP01/26 MainMain areasareas ofof ongoingongoing researchresearch inin fertilityfertility regulationregulation

Method development 1. Male 2. Improved -only injectable for women 3. Dual protection methods (non-latex male ; ; microbicides/) 4. Immunocontraception Surveillance 1. Long-term IUD safety and efficacy 2. Hormonal contraceptives and bone mineral density 3. Hormonal contraceptives and HIV 4. Contraceptive use and cervico-vaginal HIV shedding 5. Male condom efficacy against STIs 6. Female condom efficacy against pregnancy and STIs

Department of reproductive health and research Département santé et recherche génésiques PVL_HUG_STUDS_SEP01/27 Department of reproductive health and research health of reproductive Department MMR (maternal deaths per 100,000 live births) 1000 1200 200 400 600 800 0 Averag Wor Estimated maternal mortalityratios, Estimated maternal mortalityratios, 400 l d e Af 1000 ri ca Total =515,000deaths Total =515,000deaths by region,1995 by region,1995 Asi 280 a O cean 260 éatmn at trcecegénésiques santé et recherche Département i a L 190 AC (WHO/UNICEF/UNFPA,2001) (WHO/UNICEF/UNFPA,2001) E u 28 ro p e Ameri No 12 rt h c a

PVL_HUG_STUDS_SEP01/28 InterventionsInterventions evaluatedevaluated duringduring 19991999--20002000 withwith leading/activeleading/active rolerole ofof thethe ProgrammeProgramme

CENTRES WOMEN STATUS

Antenatal care 5 24,678 Published (2001)

Postpartum haemorrhage 9 18,530 Published (2001)

Caesarean section 5 149,206 For publication

Treatment of pre-eclampsia 28 10,000 Ongoing

Prevention of pre-eclampsia 6 8,500 Ongoing

Department of reproductive health and research Département santé et recherche génésiques PVL_HUG_STUDS_SEP01/29 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_HUG_STUDS_SEP01/30 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

Need for additional 15.2 % 10.9 % 1.40 (1.29-1.51) uterotonics

Department of reproductive health and research Département santé et recherche génésiques PVL_HUG_STUDS_SEP01/31 WHOWHO MisoprostolMisoprostol TrialTrial SideSide--effectseffects

Side-effect Misoprostol Oxytocin RR (95% CI)

Any shivering 17.6 % 5.0 % 3.48 (3.15-3.84)

Severe shivering 1.3 % 0.2 % 8.58 (4.93-14.91)

Body temperature >38oC 6.1 % 0.8 % 7.17 (5.67-9.07)

Nausea 0.8 % 0.4 % 2.27(1.52-3.39)

Vomiting 0.7 % 0.3 % 2.64 (1.67-4.18)

Diarrhoea 0.4 % 0.1 % 4.38 (2.03-9.43)

Department of reproductive health and research Département santé et recherche génésiques PVL_HUG_STUDS_SEP01/32 • • • Key findings: Countries: Kenya, Nigeria,Tanzania,Uganda,Zambia Key findings: Countries: Kenya, Nigeria,Tanzania,Uganda,Zambia • • • Department of reproductive health and research health of reproductive Department marriage andfor prevention ofSTD/HIV potential forincreased condom use, especially outside embarrassment asreasonsfor notusingit men report lossofpleasure, inconvenience and safety ofcondom interspousal use ofcondomwithin marriageisconstrainedbylackof marriage andfor prevention ofSTD/HIV potential forincreased condom use, especially outside embarrassment asreasonsfor notusingit men report lossofpleasure, inconvenience and safety ofcondom interspousal use ofcondomwithin marriageisconstrainedbylackof Acceptability of MaleCondom: Acceptability of MaleCondom: communication andmisperceptions about communication andmisperceptions about Key Findings Key Findings éatmn at trcecegénésiques santé et recherche Département

PVL_HUG_STUDS_SEP01/33 Department of reproductive health and research health of reproductive Department Non Non - - latex MaleCondom latex MaleCondom éatmn at trcecegénésiques santé et recherche Département

PVL_HUG_STUDS_SEP01/34 Department of reproductive health and research health of reproductive Department Female Condom Female Condom éatmn at trcecegénésiques santé et recherche Département

PVL_HUG_STUDS_SEP01/35 Department of reproductive health and research health of reproductive Department • • • • • • • • • • • • • • • • cellulose sulphate as COL dual protection male andfemalecondoms post male circumcision andHIV transmission infant feeding andMTCTofHIV nevirapine cellulose sulphate as COL dual protection male andfemalecondoms post male circumcision andHIV transmission infant feeding andMTCTofHIV nevirapine - - - - exposure prophylaxis exposure prophylaxis 1492 (nonoxynol 1492 (nonoxynol Activities inHIVduring 2000 Activities inHIVduring 2000 and prevention ofMTCTHIV and prevention ofMTCTHIV microbicide microbicide - - 9) 9) éatmn at trcecegénésiques santé et recherche Département

PVL_HUG_STUDS_SEP01/36 Department of reproductive health and research health of reproductive Department 1. 2. 3. 4. 5. 6. 1. 2. 3. 4. 5. 6. Attitudes towardsmale condomuse abortion Determinants andconsequences ofinduced Role ofmen inreproductivehealth Fertility regulation intheera of HIV/AIDS Adolescent sexualandreproductive health Quality ofcare inreproductive health Attitudes towardsmale condomuse abortion Determinants andconsequences ofinduced Role ofmen inreproductivehealth Fertility regulation intheera of HIV/AIDS Adolescent sexualandreproductive health Quality ofcare inreproductive health Global research initiativesin Global research initiativesin Global research initiativesin social sciences social sciences social sciences éatmn at trcecegénésiques santé et recherche Département

PVL_HUG_STUDS_SEP01/37 Ad RH servicemodel olescent services Department of reproductive health and research health of reproductive Department Bra z il Bolivia DMPA quality ofcarereproductive healthservices quality ofcarereproductive healthservices Chile Broadening choices andimproving Broadening choices andimproving Burkina Faso South Africa Ba rrie Stage I Zambia r me EC DMPA EC thods Stage II éatmn at trcecegénésiques santé et recherche Département National RH stra Hormonal me Ethiopia Myanmar Implants Yo RTIs ut h thods tegy S tage III Vietnam Abortion ( DMPA C hongqui China Lao Mate health n g) P rnal DR PVL_HUG_STUDS_SEP01/38 Research and Development Research and Development Department of reproductive health and research health of reproductive Department Emphasis on Research Capability Emphasis on Research 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_HUG_STUDS_SEP01/39 Department of reproductive health and research health of reproductive Department AFRO Countries Collaborating withtheProgramme Countries Collaborating withtheProgramme in theyear2000(N =81countries) in theyear2000(N =81countries) AMRO EMRO EURO éatmn at trcecegénésiques santé et recherche Département SEARO WPRO

PVL_HUG_STUDS_SEP01/40 Department of reproductive health and research health of reproductive Department PerPer centcent usersusers 20 40 60 80 0 Trends inuse ofcontraception Trends inuse ofcontraception Developing countries Developing countries 1960-1965 1990 éatmn at trcecegénésiques santé et recherche Département Developed countries Developed countries ( (Source: U S o u r c e: Unit n ite ed d Nat Nati 1998 i on ons, 19 s , 199 91 and 1 1 an d 1999) 9 99)

PVL_HUG_STUDS_SEP01/41 Department of reproductive health and research health of reproductive Department

Population size (in billions) 15 20 25 30 10 0 5 World population size accordingtothe World population size accordingtothe main fertilityscenarios, 1950 main fertilityscenarios, 1950 1950 1950 L H M o i e g w d h f i f u e m e r 2000 2000 r t f t ilit ilit e r y y t s ilit s c c y e e

scenar n n a a Ye 2050 2050 r r i i o o a : : r T T i o F F éatmn at trcecegénésiques santé et recherche Département : R R T ( ( F 2 2 R 0 0 ( 5 5 2100 2100 2050) 0 0 ) ) 2 1 . . 5 5 - 2. - 0 0 2150 2150 - - 2 1 05- (Source: U (Source: U . . 6 6 0 0 2 . 2150 2150 0 9 n n ited Nati ite 3.2 3.2 9.7 9.7 24.8 24.8 d Nati ons, 2000) o n s, 20 00 )

PVL_HUG_STUDS_SEP01/42 Department of reproductive health and research health of reproductive Department 1. 2. 3. 4. 1. 2. 3. 4. Increasing contraceptive prevalence Increasing contraceptive prevalence Better accesstofamily planningservices Improved qualityof careinserviceprovision methods Wider choice ofacceptableand affordable Availability ofnew andimproved methods Better accesstofamily planningservices Improved qualityof careinserviceprovision methods Wider choice ofacceptableand affordable Availability ofnew andimproved methods éatmn at trcecegénésiques santé et recherche Département

PVL_HUG_STUDS_SEP01/43 Department of reproductive health and research health of reproductive Department Estimated newcases ofcurableSTI*among Estimated newcases ofcurableSTI*among Latin America& The Caribbean Latin America& The Caribbean North America North America 38 million 38 million 14 million 14 million * gonorrhoea, chlamydial infect * gonorrhoea, chlamydial infect Global total:340 million Global total:340 million North Africa&MiddleEast North Africa&MiddleEast Western Europe Western Europe adults, 1999 adults, 1999 17 million 17 million 10 million 10 million Sub-Saharan Africa Sub-Saharan Africa 69 million ion, syphilis andtrichomoniasis ion, syphilis andtrichomoniasis 69 million éatmn at trcecegénésiques santé et recherche Département Eastern EuropeandCentralAsia Eastern EuropeandCentralAsia South &South-East Asia South &South-East Asia 22 million 22 million Ea Ea 151 million 151 million st Asia&Pacific st Asia&Pacific 18 million 18 million Au Au 1 million 1 million stralasia stralasia

PVL_HUG_STUDS_SEP01/44 Department of reproductive health and research health of reproductive Department • • • • • • of whom: About 13 000 areinpersons aged15to49years, About 1700areinchildren under15yearsofage More than95%are indevelopingcountries of whom: About 13 000 areinpersons aged15to49years, About 1700areinchildren under15yearsofage More than95%are indevelopingcountries – – – – About 15000new HIVinfections About 15000new HIVinfections over 50%are 15 47% arewomen over 50%are 15 47% arewomen a dayin2000 a dayin2000 - - 24 yearolds 24 yearolds éatmn at trcecegénésiques santé et recherche Département

PVL_HUG_STUDS_SEP01/45 Department of reproductive health and research health of reproductive Department

Life expectancy (years) 40 45 50 55 60 65 50. 1985- Life expectancyat birth in29African Life expectancyat birth in29African 2 49. countries withand without AIDS countries withand without AIDS 90 2 51. 1990- 7 48. 95 5 Wit 1995- 54. hout 1 47. 2000 A 5 I D S 2000- 56. éatmn at trcecegénésiques santé et recherche Département W 4 i 47. t 05 h 4 AI DS 58. 2005- 4 49. 10 (Source: U (Source: U 4 60. 2010- 4 N N 52. A A 15 ID ID 6 S, S, 2000) 2000)

PVL_HUG_STUDS_SEP01/46 Department of reproductive health and research health of reproductive Department 1000 1200 1400 1600 1800 200 400 600 800 0 W O RL D Estimated maternal mortalityratios Estimated maternal mortalityratios A F R I C (per 100000livebirths) A (per 100000livebirths) A S I A (n= 585,000) 1990 E URO P E éatmn at trcecegénésiques santé et recherche Département (n= CA L 1995 . A 515,000) RI AN M B E B R D E I C A A N N. A M E R I C A O CE A N I A

PVL_HUG_STUDS_SEP01/47 ““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_HUG_STUDS_SEP01/48