Improving women’s health worldwide

Sharing skills across borders is an important part of making a practical difference to improving women’s lives. I have always been a great supporter of global health programmes where young trainee doctors choose to spend a period of time in a host country to share their knowledge and skills and in turn benefit from the lessons gained from the people already working on the ground. It is definitely a two way learning process and our trainees gain hugely from the experience.

In fact, they often find it difficult to re-adapt when they come back to their work in the UK, since they have frequently been given huge amounts of responsibility in the host country and have learned how to improvise and be effective with limited resources. For this reason, it is important to develop methods to help them adapt when they return to working in the NHS, where the culture is much more focused and to the returning trainee may seem hierarchical and rigid.

When it comes to improving maternal mortality and morbidity globally, we have tended to focus on tackling the principal causes of death and disability at the time of delivery, such as bleeding, infection, high blood pressure, thrombosis, unsafe abortion and obstructed labour.

At the RSM summit, where I will be closing the debate, I want to emphasise the fact that in order to achieve sustainable improvements to women’s healthcare, we have to move back upstream and offer women and girls the education and tools that they require to control their own fertility and decide if, when and how often they become pregnant and have a baby. And that means that we have to tackle the two elephants in the room – abortion and contraception – and this requires overcoming a variety of clinical and political challenges.

I have already spoken about my concern regarding the Trump administration’s decision to reinstate the so-called Mexico City Policy, which bars international non-governmental organisations that perform or promote family planning and abortion from receiving US government funding.

This decision could endanger millions of women and children. It is going to adversely affect many aspects of women’s health, not just the availability of contraception and abortion services. It is a very frightening step and will affect those most in need. If we are truly committed to improving women’s health, it is imperative that access to safe abortion care remains an integral part of comprehensive reproductive health services.

Equipping healthcare providers to deliver high- quality abortion and post-abortion care is vital if we are to reduce the tragic consequences of unsafe abortion.

However, we are facing an imminent service failure in abortion care. This is true for the UK as well as globally.

I am concerned that so few gynaecologists are developing the skills to provide abortion care and believe that we have a responsibility to ensure that there are enough doctors to provide safe abortion care in the future. As a mother I would like to think that if my daughters ever needed an abortion, they be by competent and compassionate doctors.
While the standard of care women receive is generally good, there is inequitable access to this care and in particular for women with complex co- morbidities and women in the later stages of pregnancy.

In order to tackle this looming crisis, I have set up a task force on abortion care to address these issues and we are working with government departments, the NHS and external bodies to raise awareness amongst healthcare professionals of their roles and responsibilities in service provision.

Nevertheless, we still have a far way to go. I believe that women have the right to make an informed choice about whether to continue or end their pregnancy. We need to ensure that we are in the position to support them and provide them with safe care, whatever decision they make.

The RSM meeting, The Challenge of Delivering Women’s Health Globally will take place in London on April 28th 2017. Registration at 6.15pm for a 7pm start.