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Empowering Women 2020

Tackling stigma in gynaecology care globally

Credit: Dr Del Wijeratne

Dr Ranee Thakar

Vice President, Royal College of Obstetricians and Gynaecologists

Gynaecology is a neglected area of global health with conditions often highly stigmatised, investment inadequate and millions of lives lost as a result.

This is compounded to devastating levels in low-resource environments with many conditions known to be highly preventable and often easily manageable.

The RCOG (Royal College of Obstetricians and Gynaecologists) believes all women have the right to a healthy life, throughout their life course.

Why the focus on gynaecology?

Maternal mortality is discussed widely as a global epidemic, and with 810 women dying from preventable causes related to pregnancy and childbirth every day in 2017, this is no surprise.

However, gynaecological conditions have a higher mortality rate than maternal causes, especially in low-resource contexts, and they also contribute to significantly greater life impairment.

Moreover, we must keep in mind that women living in many low-resource contexts are often battling not just one, but many of these potentially life-limiting conditions, throughout their lives.

I recently heard a story about a woman in India suffering from anaemia, who was forced to sit in a corner, exhausted and unable to even dress her children, because she had heavy periods.

This common problem could have been addressed with medication, or long-acting reversal contraception, but instead she was given a hysterectomy. She was just 25 years old.

Robbed of her choice to have more children, she also has to live with fistula, causing debilitating health problems, because the surgery was not performed correctly.

I know that we can stop women and girls suffering like this.

Further education in gynaecological training for low-resource contexts

Improving the quality of gynaecological care is the most effective and immediate way of preventing such suffering, especially in places where a lack of investment, infrastructure and training can exacerbate poor health outcomes.

Solutions are often preventative, low-cost and evidence based. They include advocacy and training, but these need to be implemented in a way that is sustainable.

With all this in mind, the RCOG created an essential gynaecological skills training programme that aims to improve the clinical care skills of multi-disciplinary, frontline, staff working in low-resource contexts.

It focuses on conditions responsible for large burdens of morbidity and mortality, including cervical cancer, contraception, abnormal uterine bleeding, infertility, fistula as well as gender-based violence. It also supports health professionals with clinical auditing to improve the quality of their services.

The impact so far

In 2018, the training was delivered during a pilot initiative in Nigeria.

This pilot programme trained 78 healthcare providers with extra assistance given to six local ‘master trainers’ who were equipped with teaching advice.

It included information on prevention and methods that could be utilised to minimise women presenting at a late stage of disease, including addressing stigmatisation that inhibits early diagnosis.

Qualitative analysis conducted after the pilot saw an increased focus on patient-centred care and quantitative analysis demonstrated an increase in positive responses about healthcare provider willingness to provide key gynaecological services, such as contraception and post abortion care.

Taking the programme forward

Our focus now is to develop the programme further because we know it will contribute to health system strengthening for gynaecological services by enabling staff to deliver high quality gynaecological care and developing local teaching capacity.

Our ambition is to roll out this programme more widely, across the globe, to ensure that no women or girls are left behind.

For more information on the RCOG’s global work

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