Global medicine and women’s health

Professor Alison Fiander, former clinical lead of the Royal College of Obstetricians and Gynaecologist’s Centre for Women’s Global Health and Chair of Obstetrics and Gynaecology at Cardiff University, will be giving a talk on global gynaecology in the developing world at the evening event, Global Medicine and Women’s Health, to be held at the Royal Society of Medicine in London on January 11^th 2019.

‘The lack of gynaecological services for women who are not pregnant in the developing world is a major pandemic, which needs to be addressed as a matter of urgency. There has been a huge emphasis in the past on reducing maternal mortality, and this has been achieved in many countries with worldwide support from governments and NGOs, but very little attention has been paid to broader issues around gynaecological health. In fact, more women now die of cervical cancer than in pregnancy and childbirth – which is shocking, when you consider that cervical cancer is now a preventable disease with highly effective HPV vaccination.

Women in many low income countries suffer with problems such as heavy periods, fibroids, prolapse or reproductive tract infections without medical intervention. Very little consideration is given to this huge burden of disease, which is borne by half of the population but impacts on everyone from children to the wider community. In fact, many people have no idea of the scale of the problem.

The reasons why gynaecological services are so poor are complex but include cultural norms and practices that see women as somehow disposable or dispensable. Gynaecological issues may be considered as bad luck, or the fault of the women herself in some societies and are a major source of stigma.

In some religious communities, a menstruating woman is seen as unclean and has to keep herself separate and apart, which can result in isolation if someone is bleeding constantly due to fibroids for example.

There is also a lack of available health resources and trained medical professionals who can assist women who are in more remote areas as well as lack of funding. Health spending tends to be prioritised in areas of critical care and women’s health has to compete with child health, infectious and non-communicable disease.

So what can be done?

Firstly, we need to raise awareness about the problem so that people are aware of the impact of poor gynaecological health on women, their families and the local community. We need experts and health economists to quantify the real socio-economic impact of gynaecological disease since this is the kind of data that allows Ministries of Health in governments and NGOs to make decisions about spending.

We should ensure that more women are able to have the HPV vaccine. Only one per cent of the world’s HPV vaccinated women live in developing countries yet we could stop this dreadful disease within a couple of generations if it was available to all girls wherever they lived in the world. It costs around £80 a jab but pharmaceutical companies do discount key medicines for developing countries and the cost is also subsidised by the World Health Organisation through the Global Alliance for Immunisation and Vaccination.

If we make contraception more widely available, this could help to prevent unwanted pregnancy and unsafe abortion as well as being useful for controlling some menstrual problems like heavy bleeding.

Finally, we need to ensure that there are enough trained people to look after women. The Royal College of Obstetricians and Gynaecologists has developed an Essential Gynaecology Skills course that has been piloted in Sri Lanka, Bangladesh and Nigeria in 2017 and 2018. This course is aimed at mid-level health providers such as midwives and nurses who tend to work at grass roots level. This is an example of a proactive project, which could really change women’s lives for better in the future.’