Highlights of 2014 Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)
WHO/RHR/HRP/15.01 UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP). Highlights of 2014 © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_ form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Editing and layout: Green Ink (www.greenink.co.uk) Cover photo: Frederic Courbet/Bill & Melinda Gates Foundation Printed by the WHO Document Production Services, Geneva, Switzerland
Contents 1 High-level advocacy for sexual and reproductive health 3 Contraception and family planning 5 Adolescent sexual and reproductive health 6 Preventing unsafe abortion 6 Sexually transmitted and reproductive tract infections 6 Sexual and reproductive health and HIV linkages 9 Improving maternal and perinatal health against women and harmful practices, including female genital mutilation 10 Violence and early marriage 11 Sexual and reproductive health in humanitarian settings 12 Gender equality and human rights 13 Cervical cancer 13 Sexual health 13 Infertility 14 Innovations 15 Research-capacity strengthening and the HRP Alliance 15 Research project review 15 Biostatistics and data management 16 Advocacy and communications
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Our vision “We at the WHO Department of Reproductive Health and Research, including HRP, envision a world where all people, including adolescents and young people, and those who are hard to reach or marginalized, can attain the highest possible level of sexual and reproductive health. We provide leadership within the United Nations system for research in human reproduction, and strive to improve sexual and reproductive health – working to promote universal access to sexual and reproductive health information and services for all people throughout their lives.” Marleen Temmerman, Director, Department of Reproductive Health and Research including HRP
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Highlights of 2014 The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, also known as the Human Reproduction Programme (HRP), is the main instrument and leading research agency within the United Nations system concerned with sexual and reproductive health and rights. The World Health Organization (WHO) serves as the executing agency for HRP, which is housed within, and forms part of, WHO’s Department of Reproductive Health and Research (RHR Department). Established in 1972, the Department supports and coordinates research on a global scale; synthesizes research through systematic reviews of literature; builds research capacity in low-income countries; and develops dissemination tools to make efficient use of an ever-increasing body of research and information. By virtue of its unique co-sponsorship arrangement, the work of HRP is coordinated with, and contributes to, the work of its co-sponsors and partners including the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), WHO, the World Bank, the Joint United Nations Programme on HIV and AIDS (UNAIDS) and the International Planned Parenthood Federation (IPPF).
High-level advocacy and input to global initiatives for sexual and reproductive health • The second Family Planning 2020 (FP2020) progress report was finalized with the leadership of the FP2020 Performance, Monitoring and Evidence working group, co-chaired by the Director of the RHR Department. • The WHO Technical Guidance Note: Strengthening the inclusion of reproductive, maternal, newborn and child (RMNCH) health in concept notes to the Global Fund was completed for the Global Fund to Fight AIDS, Tuberculosis and Malaria. • In support of the 20th anniversary of the ICPD Programme of Action (ICPD Beyond 2014), the Department has produced seven fact sheets on key sexual and reproductive health and rights (SRHR) aspects of the ICPD Programme of Action and has disseminated these at many events, including at a high-level meeting co-organized at the time of the UN Commission on Population and Development in New York. • The Pan-African resolution on gender-based violence was developed with technical support from the Department, and was approved by the Pan-African Parliament. • Reports on child, early and forced marriage legislation in Africa and the Asia-Pacific region were developed in collaboration with the Inter-Parliamentary Union and the Pan-African Parliament. • A paper on Women and health: 20 years of the Beijing Declaration and Platform for Action was prepared in collaboration with other WHO departments and has been submitted for discussion at the WHO Executive Board in 2015.
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Our priorities Contraception and family planning “We envision a rights-based approach that enables individuals and couples to reduce their unmet need for contraception and their burden of sexually transmitted and reproductive tract infections, and also to prevent unintended pregnancies while healthfully reaching their desired family size.” James N. Kiarie, Coordinator, Human Reproduction Team
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Contraception and family planning • Several research studies have been completed during 2014: –– A multicentre randomized clinical trial of two hormonal implant contraceptives – Jadelle® (75 mg levonorgestrel) and Implanon® (68 mg etonogestrel) – in seven countries involving 2963 women showed similar efficacy and safety for both devices. –– A feasibility study of a new indicator for assessment of unmet need for family planning was completed. The indicator was “percentage of women of reproductive age attending HIV care and treatment services with unmet need for family planning”. The study led to the development of a screening tool (by WHO in collaboration with partners) for measurement of the indicator. This tool can be used to collect routine data on family planning needs in a more sustainable way, and in a way that allows for these data to be aggregated in a health information system. –– The sperm suppression study, using norethisterone enanthate and testosterone undecanoate, showed a low pregnancy rate (four pregnancies in 320 participant pairs). However, the high frequency of severe adverse events (such as mood changes and disturbances, emotional disorders, injection site reactions, muscle pain and weakness) needs to be re-examined before further research is pursued. –– A multicentre study on peri-coital use of levonorgestrel has shown a pregnancy rate of 13 among 330 participants, with minimal side-effects. This implies the possibility of using a contraceptive product as needed, when one has coitus. • The process of updating the Medical eligibility criteria for contraceptive use is in progress. The HIV-related recommendations were released earlier than planned, on 24 July 2014, to respond to urgent country needs (in English and Russian). During 2014, the Department launched guidelines on human rights and contraceptive services as well as information on and analysis of existing quantitative indicators in relation to contraceptive services based on human rights. The Department also developed a framework on ensuring human rights in contraceptive services and information. The Implementing Best Practices (IBP) initiative worked with WHO regional and country offices to document best practices and introduce tools for scaling them up, supporting activities in over 25 countries.
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Our priorities Adolescent sexual and reproductive health “We envision a world where all adolescents and young people have universal access to appropriate sexual and reproductive health information and services, and where all adolescents can reach and maintain the highest possible level of sexual and reproductive health.” Lale Say, Coordinator, Adolescents and at-Risk Populations Team
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Adolescent sexual and reproductive health • Two research protocols for testing the effectiveness of interventions to reduce unintended pregnancy in adolescents were developed and fieldwork was initiated. • The Global Early Adolescent Study, exploring gender norms and healthy sexuality among early adolescents, was extended to 10 countries where data collection efforts were initiated in 2014. • Six papers reporting evidence on key adolescent sexual and reproductive health (ASRH) issues were published in peer-reviewed journals, and a special supplement of the Journal of Adolescent Health, reviewing the progress made in various aspects of ASRH and rights in the 20 years since the International Conference on Population and Development (ICPD) was published and launched at multiple high-level meetings.
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Preventing unsafe abortion • A special supplement issue on “Expanding access to medical abortion” was published by Reproductive Health Matters, with articles highlighting the findings of work supported by HRP. • A study in Ethiopia, India and South Africa on the capability of community health workers to assess eligibility for medical abortion yielded mixed results, suggesting that they were more successful in ruling out ineligible cases. • The study on abortion complications in Ghana, Lao People’s Democratic Republic, Myanmar, Nigeria and Sri Lanka generally showed low levels of severe morbidity. • The Clinical practice handbook for safe abortion was launched to facilitate the implementation of the 2012 WHO Safe abortion guidelines. • A series of briefings and workshops were conducted on the WHO Safe abortion guidance for a broad range of United Nations treaty monitoring bodies.
Sexually transmitted and reproductive tract infections • • • • The RHR and HIV Departments jointly launched Global guidance on criteria and processes for validation: elimination of mother-to-child transmission (EMTCT) of HIV and syphilis. The RHR Department established a global system of STI reporting on 10 core indicators within the Global AIDS Response Progress Reporting System (GARPR). The first peer-reviewed supplement on multipurpose prevention technologies was published and widely disseminated. The Department contributed to the development of the Target Product Profiles for pointof-care tests (POCTs) to detect Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, human papillomavirus and syphilis, as well as a comprehensive set of research questions for further validation/development of POCTs for STIs. Laboratory evaluation of the performance of a dual HIV/syphilis POCT was completed in two countries.
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Sexual and reproductive health and HIV linkages • The largest global community survey of the sexual and reproductive health and human rights of women living with HIV was conducted to inform the WHO normative guidance. • SRH and HIV linkages compendium: indicators and tools were finalized and disseminated.
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Our priorities Improving maternal and perinatal health “We envision a world where every mother and newborn receives quality care throughout the pregnancy, childbirth and postnatal periods to end preventable mortality and morbidity.” A. Metin Gülmezoglu, Coordinator, Maternal and Perinatal Health and Preventing Unsafe Abortion Team
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Improving maternal and perinatal health • Secondary analyses of data from the WHO Multicountry Survey on Maternal and Newborn Health were published as a special supplement of the BJOG: An International Journal of Obstetrics and Gynaecology, and in articles published in other journals. An important finding was the significant under-utilization of antenatal corticosteroids in women delivering preterm babies. • In fistula care, short-term catheter stay after surgery was found to be non-inferior to the more conventional two-week catheter stay in the largest fistula care trial to date (publication forthcoming). • The WHO Fetal Growth Study recruitment was completed, with data gathered from 1440 women in 10 countries. • Systematic analysis of causes of maternal deaths published in 2014 indicated that indirect causes and obstetric haemorrhage were the leading causes. • WHO recommendations for augmentation of labour were published. • The WHO statement on the prevention and elimination of disrespect and abuse during facilitybased childbirth has been endorsed by more than 70 organizations. • In May 2014, estimates of maternal mortality, including trends from 1990 to 2013, were published. Globally, there were an estimated 289 000 maternal deaths in 2013, a decline of 45% from 1990.
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Violence against women and harmful practices, including female genital mutilation and early marriage • Three scientific papers were published on: (i) research gaps in the care of women with female genital mutilation (FGM); (ii) a systematic review of the evidence on clitoral reconstruction after FGM/cutting, and (iii) case studies on clitoral reconstruction after FGM/cutting. • The Department developed a research protocol to evaluate the safety and efficacy of clitoral reconstruction following FGM, and the impact of comprehensive psychosexual care on health outcomes. • A clinical handbook, Health care for women subjected to intimate partner violence or sexual violence (a derivative of the 2013 WHO clinical and policy guidelines Responding to intimate partner violence and sexual violence against women) was published in November 2014 and has been disseminated in several countries. • A Lancet Series on violence against women and girls was coordinated by the Department and the London School of Hygiene and Tropical Medicine’s Centre for Gender, Violence and Health, and was launched on 21 November 2014 to mark the “International Day for the Elimination of Violence Against Women”. • The Department supported the development and adoption of a Member-State-led World Health Assembly Resolution 67.15 on “Strengthening the role of health systems in addressing violence, in particular against women and girls and against children”.
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Sexual and reproductive health in humanitarian settings • The Department collaborated with UNICEF and Save the Children in publishing a guidance document for safe delivery and newborn care in regions affected by Ebola virus disease (EVD, and this was disseminated widely. • The Department published an evidence brief on EVD and seminal fluids, collating the current scientific knowledge surrounding the length of time EVD can be traced in seminal fluid, the infectiousness of such fluid, and any documentation of secondary infection cases.
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Gender equality and human rights • The RHR Department, including HRP, is a key actor on human rights and sexual and reproductive health (SRH) among development partners, including international and regional nongovernmental organizations and academic institutions, and has built partnerships with these actors at the international, regional and national levels. • The Department has contributed to normative development at the international and regional levels on SRH, human rights and gender equality, and remains a significant actor in strengthening the content and meaning of sexual and reproductive health and rights. • The Department has been assisting UN human rights bodies to ensure that their interpretations of international human rights standards are evidence-based and thereby contribute to the improvement of SRH worldwide. • In order to foster the respect, protection and fulfilment of human rights related to SRH, the Department has developed tools that can assist stakeholders to integrate human rights and gender equality into SRH law, policy and programme development and implementation. • The Department has played a leadership role by underscoring the need to achieve and exceed all health-related Millennium Development Goals (MDGs), which include ending preventable maternal deaths and improving SRH, and to ensure that the new development framework, including the Sustainable Development Goals, highlights these priorities as part of completing the unfinished work of the health-related MDGs.
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Cervical cancer • The RHR Department, together with the Department of Immunization, Vaccines and Biologicals, and the Department of Noncommunicable Diseases, Disability, Violence and Injury Prevention jointly launched the new WHO guidelines Comprehensive cervical cancer control: a guide to essential practice in December. It has been welcomed by countries, partners and a wide range of stakeholders. • An important research collaboration was established between HRP and the International Agency for Research on Cancer (IARC) on the validation of new rapid tests for human papillomavirus (HPV), new screening strategies for cervical cancer prevention and control, and operations research to strengthen cervical cancer prevention and control programmes in countries with the introduction of new tools.
Sexual health • A WHO guideline was developed: Brief sexuality-related communication: recommendations for a public health approach. • A report on sexual health, human rights and the law was developed.
Infertility • The current basic Consolidated Standards of Reporting Trials (CONSORT) guidelines for clinical trials have been identified for modification when reporting studies with interventions to resolve infertility. In 2014, as a founding member of the Infertility Harbin Consensus Group, the Department provided technical support in the generation of the SHORT and LONG versions and adaptations of the basic CONSORT guidelines for clinical trials, defined as “Improving the reporting of clinical trials of infertility treatments” (IMPRINT). These IMPRINT CONSORT guidelines are being endorsed by journals that publish reproductive medicine studies.
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Innovations To support health systems innovations, the RHR Department, including HRP, aims to foster the development and validation of innovations that improve sexual and reproductive health in populations with the greatest need; develop and support mechanisms that improve the awareness, availability and use of innovations that improve sexual and reproductive health; and support research that aims to understand and overcome barriers that prevent innovations from achieving widespread adoption. • The RHR Department launched the Technologies for Health Registries, Information, and Vital Events (THRIVE) Multi-site Study. • The mRegistry web platform was launched by the RHR Department, the UN Innovations Working Group, UNICEF, and other partners, for systematically registering and cataloguing mHealth initiatives for reproductive, maternal, newborn and child health (RMNCH) and other health areas. • The Department and partners launched the Open Smart Register Platform website (smartregister.org) – the smartphone-specific version of an application focused on civil registration and vital statistics. • Articles reporting on the Department’s work in this area were published in Science, PLOS ONE and Politico, as well as a chapter in a book published by Oxford University Press.
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Research-capacity strengthening and the HRP Alliance • In 2014, HRP awarded Long-term Institutional Development (LID) grants to 12 institutions. Four of these completed their research projects and disseminated results as publications and at regional seminars and conferences. • HRP awarded 21 individual research training grants. Most of these were within the WHO regions, ensuring cost-effective participation at the country level and South–South collaboration. • HRP established new partnerships to strengthen research capacity by joining ESSENCE on Health Research (Enhancing Support for Strengthening the Effectiveness of National Capacity Efforts). This network of funding agencies aims to improve the coordination and harmonization of research capacity strengthening investments.
Research project review • Overall, the Research Project Review Panel (RP2) conducted 43 successful project reviews during 2014, as either a “First submission”, a “Resubmission” or for “Continuing review”. • Fourteen new projects were submitted to the RP2, and an additional six projects were resubmitted, following a first review by the RP2 in 2013. Of these new projects, 10 were initially only reviewed electronically (i.e. a technical and budgetary/financial review, but no meeting review) when first submitted, and then forwarded to the WHO Ethics Review Committee (WHO-ERC) for ethical review. • Twenty-nine RP2 members were involved in committee review meetings (face-to-face, video or teleconferencing). For continuous and repeated assessments, the RP2 ensured that the same members were involved in subsequent committee reviews of a project.
Biostatistics and data management • Statistics, data-management, research-coordination and monitoring support was provided for 16 clinical trials and epidemiological studies during 2014. • The Unit conducted on-site research training on data entry and data management for staff in three collaborating centres participating in projects with the Department, in Kyrgyzstan, Mozambique (twice) and South Africa.
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Advocacy and communications • A new communications strategy for the RHR Department, including HRP, was developed in 2014, with the participation of partners, funders and staff, and with the support and guidance of a leading global communications firm. The new strategy is focusing our communications work on a smaller number of key events, but with much more intensive communications for each, including social media. • In 2014, 49 new publications in English were produced and distributed. • The Department produced and distributed 41 translations of existing RHR Department publications. • Research results and knowledge synthesis were published in the scientific press, in 123 peer-reviewed articles. There was a sharp increase in the number of times these articles were cited by others, indicating increased relevance and impact. • There were 2 million page views of the Department’s “Reproductive health” webpage, 2.8 million of the WHO Reproductive Health Library (RHL) website and 239 000 video views on the HRP YouTube channel. • The Department’s outputs were widely disseminated, and high-level advocacy for sexual and reproductive health was carried out, at 28 different conferences, symposia and international meetings. • A number of international days were marked by the Department, including International Day of Zero Tolerance to Female Genital Mutilation; Obstetric Fistula Day; World Contraception Day; International Day of the Girl Child; International Day for the Elimination of Violence against Women; World AIDS Day; Human Rights Day and World Prematurity Day. Web features were prepared for these days which were well supported by the WHO central web services. The WHO home page also regularly highlighted aspects of the Department’s work throughout 2014. • A new Twitter channel was opened for HRP in mid-September, with the @HRPresearch handle. The number of followers had reached 310 by the end of 2014 and is growing steadily. • During 2014, 10 issues of the Department’s electronic newsletter were sent out. • The Reproductive Health Update newsletter was redesigned and re-launched in December 2014 as HRP News: Sexual and Reproductive Health. The number of subscribers, who have all “opted in” to this newsletter, now stands at over 3000.
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Special Programme of Research, Development and Research Training in Human Reproduction
For more information, please contact: Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland Fax: +41 22 791 4171 E-mail: reproductivehealth@who.int
www.who.int/reproductivehealth