International Federation of Gynecology and Obstetrics

I N T E R N A T I O N A L F E D E R A T I O N O F G Y N E C O L O G Y A N D O B S T E T R I C S

THREE-YEAR REPORT 2009–2012prepared by

The FIGO Secretariat

INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICSFÉDÉRATION INTERNATIONALE DE GYNÉCOLOGIE ET D’OBSTÉTRIQUE

International Federation of

Gynecology and Obstetrics

Photo Credits:Page 12 © 2006 Rose Reis

Page 14 © 2005 Hari Fitri PutjukPage 16 © 2004 Arturo Sanabria

Page 17 © 2007 Khussheed MasoodPage 20 © 2009 Center for Communication Programs

Page 22 © 2005 Don HinrichsenPage 24 © 2005 Karilyn OwenPage 25 © 2007 Paul Jeffrey

Page 27 © 2009 Saikat MojumderPage 30 © 2006 Antony KaminjuPage 31 © 2009 Paul JeffreyPage 34 © 2004 Ruth Kennedy

Page 35 © 2009 Stephanie VandenBergPage 40 © 2007 Khussheed MasoodPage 43 © 2011 Bonnie Gillespie

Page 46 © 2007 Alejandro Jose Pernia ParedesPage 48 © 2004 P MustafaPage 52 © 2008 Vu Anh TuanPage 54 © 2007 Anil GulatiPage 57 © 2004 Soe KyawPage 59 © 2009 RN Mittal

Page 60 © 2005 Emily J PhillipsPage 61 © 2009 Juhee KimPage 62 © 2000 Liz Gilbert

Page 65 © 2002 Tom FurtwanglerPage 67 © 2011 Arturo Sanabria

All photographs courtesy of Photoshare


IntroductionFirst and foremost, during thepast three years I have had thedistinct honour and pleasure tohumbly serve as President ofFIGO and it has been anenriching and rewardingexperience for me.

In my inaugural address in CapeTown October 2009 I said, “FIGObuilding upon its past

achievements is undertaking a

change – a change that will make

FIGO more visible and palpable

to the obstetricians and

gynaecologists around the globe,

particularly those in low–resource

countries”, and I have workedtirelessly over the past three yearsto fulfil my promises. The core ofmy change was education andtraining of obstetricians andgynaecologists to improve thehealth care service of women andnewborns and capacity buildingof member societies indeveloping countries to ensuresustainability.

In Cape Town I proposed an8-point work plan for the period2009-2012 to enable FIGO tobest play its role as a leadingglobal professional organisationto improve women’s andnewborns’ health and toadvocate for women’s andnewborns’ rights for the highestattainable standards of health andwellbeing to achieve thehealth-related MDGs.

Today I can confidently say that Iam delighted to see that thisambitious 8-point work plan hasbeen implemented, and in asustainable way. To make itsustainable to continue, even withthe changing leadership of theFederation, the President-Electand the Vice President were keptwell informed and involved in the

decision making process from thevery first day of my term in office.

Such achievements would nothave been possible without thegroup leadership of theFederation with my fellow FIGOOfficers, FIGO Chief Executive,Chairs of FIGO’S Committeesand Working Groups, membersof the FIGO Executive Board, andthe FIGO Secretariat, to all ofwhom I really am grateful.

The 8-point work plan was:

First: Advocacy,partnerships, andcommitments

FIGO continued its leadingadvocacy role, partnerships, andcommitments to promote therights and access of women toquality reproductive and sexualhealth services; to meet theunmet need for contraception; toreduce maternal mortality,including unsafe abortion; and tofight violence against women,harmful practices and exploitationof women.

The launching of the Women’sHealth Report on “Rights toReproductive and Sexual Health:15 years after the InternationalConference on Population and

Development” in Cape Town2009 was widely disseminatedthrough a large number ofworkshops during the years 2010and 2011 in several countries inAfrica, Asia, Latin America andEastern Europe. The reportenjoyed the widest everdistribution.

FIGO was involved in a largenumber of consultations,dialogues and conjointstatements, and cooperation withthe European Court of Humanrights, WHO, UNFPA, IPA, ICM,USAID, JHPIEGO, FordFoundation, sister membersocieties, governments, and theprivate sector within theuniversally accepted ethical andlegal frames.

Second: Continuing withexisting projects andpursuing new ones

FIGO continued with greatenthusiasm all the good projectsit has been running including theSaving Mothers and NewbornsInitiative led by André Lalonde;the LOGIC Initiative (Leadership inObstetrics and Gynaecology forImpact and Change, 2008–2013),funded by the Bill & MelindaGates Foundation, led byProfessor David Taylor; Ethics inHuman Reproduction andWomen’s Health Initiative led byProfessor Bernard Dickens; theFistula Initiative led by Lord Patel;Adolescent and ReproductiveHealth Initiatives led by ProfessorLesley Regan; Oncology Initiativeled by Professor Lynette Denny;Prevention of Unsafe AbortionInitiative led by Professor AníbalFaúndes; Pelvic Floor DysfunctionInitiative led by Professor OscarContreras Ortiz; MenstrualDisorders Initiative led byProfessor Ian Fraser; andPrevention of Cervical Cancer P A G E 1

Initiative led by Professor JoannaCain. FIGO pursued new projectswith more donors including theMisoprostol for Post-PartumHaemorrhage in Low-ResourceSettings Initiative, with Gynuity,led by Claire Waite; FistulaPrevention and Treatment TrainingProgramme with theestablishment of five fistulatraining centres and accreditationof Fistula Training Centres, withthe support of UNFPA,EngenderHealth and WAHA;implementation of policies forPrevention of Unsafe Abortionwith an anonymous donor;development of BioethicsCurriculum in RSH for developingcountries with the FordFoundation; Adolescent Sexualand Reproductive Healthcurriculum development withUNFPA; promoting advocacy forbetter practices in PPH andpreeclampsia and eclampsia withJHPIEGO; FIGO–World DiabetesFoundation (WDF) initiative onlinks between Maternal and ChildHealth and Non-CommunicableDiseases; and Minimally InvasiveSurgery training centres onlaparoscopy and hysteroscopyestablished in Sudan and theUkraine with the support ofOlympus Surgical TechnologiesEurope.

Third: Establishing aCommittee for CapacityBuilding in Education andTraining

The Committee was establishedand chaired by Professor LuisCabero and composed from thechairs of the other six FIGOCommittees, and Professor EricJauniaux, an expert in thedevelopment of educationalmaterials for low-incomecountries.

Today the Committee has

conducted 46 hands-onworkshops and educationalsessions on Maternal andPerinatal Mortality and Morbidity,PPH, Ultrasongraphy, BasicSurgical Skills, GestationalDiabetes, Maternal Health andNCD, Pelvic Floor Dysfunction,MIS and Infertility in DevelopingCountries. The Committee hasbecome a constant partner inmost of the regional and membersocieties’ scientific meetingsaround the globe. At the FIGOWorld Congress of Gynecology &Obstetrics in Rome in 2012 theCommittee has organised seven“hands-on” Pre-Congresseducational and trainingworkshops for the first time in thehistory of FIGO Congresses.

The Committee contributed toFIGO’s Newsletter and theInternational Journal of

Gynecology & Obstetrics (IJGO)

with cutting-edge knowledge onthe various topics of ourprofession, particularly those ofrelevance to low-incomecountries.

It published a special issue of theIJGO on: “Early Origins of Health:the Role of Maternal Health on

Current and Future Burden of

Chronic Non-communicable

Diseases”.

The Committee is arranging withregional federations in thedifferent continents medium-sizedCongresses to cover the threeyear gap between the triennialFIGO World Congress ofGynecology & Obstetrics. Thefirst one will be held in Colombiafrom 9–11th May 2013.

Fourth: Establishing aReproductive MedicineCommittee:

The Committee was establishedin 2009 and chaired by Professor

David Adamson to address themedical and social infertilityproblems in the developingcountries.

FIGO is well aware that WHO hasrecognised infertility as a diseasethat contributes to the globalburden of diseases and shouldbe alleviated by all means.Infertility prevention and treatmentof 186 million infertile couples inthe developing world, exceptChina, is a reproductive right inline with the agenda of ICPD1994. For successful familyplanning programmes andadoption of small-family norms,couples who are urged topostpone, delay, or widely spacepregnancies should be reassuredthat, should they decide to havea child, they will be helped to doso. As Professor Fathalla said,family planning is not justcontraception; it is also planningfor a family. The Committeeadvocates for protection ofinfertile couples from exploitationthrough over-use and over-pricingof modern technologies forinfertility treatment.

The Committee developed andtested its infertility Tool Box toaddress these issues and helpgovernments, generalobstetricians and gynaecologistsand specialists to developpolicies to prevent infertility,provide infertility care integratedin reproductive and sexual healthservices and adopt evidencebased cost-effective, culturallysensitive treatment of infertility,with appropriate referral systems.The Committee, in collaborationwith CBETC and Al AzharUniversity, WHO, ICMART andESHRE, conducted threehands-on workshops on “Basic &Advanced Clinical and LaboratoryTraining Course in Infertility,P A G E 2


including ART for Developing

Countries". One more workshop

is in the pipeline to be held during

December 2012.

Fifth: Optimising utilisationof FIGO Committees andWorking Groups and theiroutcomes to increase theirvisibility

The various FIGO Committees

and Working Groups held their

annual meetings in several

countries mostly outside the

United Kingdom, and organised a

large number of workshops. The

Committees and Working Groups

published their documents and

guidelines in IJGO, FIGO’s

Newsletter and on the FIGO

website.

Sixth: Ethics curriculumdevelopment in reproductiveand sexual health for thelow-resource countries

The FIGO Committee for the

Ethical Aspects of Human

Reproduction and Women’s

Health supported by Ford

Foundation developed the Ethics

curriculum in Reproductive and

Sexual Health for disadvantaged

women in low-income countries.

This curriculum provides

guidance and help for low-

income countries to introduce a

bioethics curriculum tailored to

their needs in their medical

schools and in their pre-service

and in-service training of

obstetricians and gynaecologists.

Bioethics should speak up for the

powerless and disadvantaged

women in the developing world

and help them to find ways to

speak loud for their health rights.

Seventh: Improvingmanagement,communication, andinvolvement of member

societies and regionalfederations

Over the past three years itbecame incumbent on FIGOmanagement to minimiseexpenditure whenever possible.This has been achieved throughchanging the site of the ExecutiveBoard meetings, minimising thenumber of face to face meetings,and a wide use of electroniccommunications. Membersocieties and regional Federationsactively participated andcontributed to FIGO activitiesthrough various channelsincluding:• FIGO Executive Boardmeetings were held over thepast three years outsideLondon – in Cape Town, Dares Salaam, Mexico City andBeijing – to tie in with amember society or regionalfederation’s meetings; tocontribute to education andtraining in the host society; toexchange expertise withmember societies and countrypolicy makers; and lastly toreduce cost.

• Member societies and regionalfederations were consulted forthe development of the agendaof all FIGO Executive Boardmeetings and guidance forsuggestions for topics to bediscussed at the meeting.

• Officers and members of theFIGO Executive Board,Presidents and Officers of ourmember societies, and regionalfederations were asked torepresent FIGO in the verymany local and regionalmeetings that were of interestto FIGO and could not beattended by the President, VicePresident or Chief Executive.They all reported back to FIGOOfficers. This enabled wider

representation of FIGO withminimal cost to FIGO.

• Member societies and theregional federations wereencouraged to involve FIGO intheir on-going activities.

Eighth: Strengtheningcollaboration with UNorganisations, regionalfederations, worldfederations, NGOs, andmember societies

This three year period 2009–2012has witnessed an unprecedentedstrengthening, collaboration, andcoordination with our old partnersand development of collaborationand MOUs with new onesincluding UN organisations, othersister organisations, NGOs,regional and member societiesand the private sector.

FIGO World Congress ofGynecology & Obstetrics– Rome 2012The 2012 FIGO World Congressof Gynecology & Obstetrics is theclimax of collaborative efforts ofFIGO with the Italian Society ofObstetrics & Gynecology (SIGO)and our Italian colleagues andpartners over the past six yearssince Italy won the bid for theCongress in Kuala Lumpur in2006.

I shall just highlight some of thefeatures which characterise thisCongress:1. Seven educational and

training Pre-CongressWorkshops and courses willbe held in the Italian teachinghospitals and institutes beforethe Congress.

2. The traditional WHO/FIGO/Alliance/SRH Pre-CongressWorkshop will be held on 5thand 6th October. The first dayis dedicated to addressing themost important underlying P A G E 3

factor of maternal mortalityand morbidity, namely theunmet need of contraception,with the support of USAID,EngenderHealth, RESPONDand ACOG. The second daywill address unsafe abortion,HIV/AIDs and adolescent RSHwith the support of WHO,IPPF, UNAIDS, UNFPA andIpas.

3. The updated version of “WhyDid Mrs X Die?” (frompregnancy and childbirth) willbe displayed at the end of theopening ceremony and will beintroduced by the author ofthe original copy: ProfessorMahmoud Fathalla (formerFIGO President).

4. The President’s Plenarysession on Monday October8th, 2012 involves an opendialogue between Presidentsof concerned professionalorganisations and top officialsfrom various UN organisationsand global NGOs.

5. The large number of sessionsdedicated to our membersocieties and regionalfederations including our hostcountry.

6. The large number of sessionsdedicated to varioussubspecialty world societies,global professionalorganisations, UNorganisations and NGOs inrelation with FIGO.

7. An outstanding scientific,social and spiritualprogramme arranged byFIGO’s International Scientificand Organising Committees incollaboration with our Italiancolleagues, including a Papalaudience on Wednesday 10thOctober 2012.

It is now appropriate to expressmy sincere thanks to all those

involved in the preparation for thisCongress, particularly theCongress Organising Committeechaired by Professor JacquesMilliez, and co-chaired by LordPatel; the International ScientificCommittee chaired by ProfessorWilliam Dunlop and co-chaired byProfessor Joanna Cain; and theirItalian counterpart Committeeschaired by Professor GiovanniScambia and Professor GiovanniMonni. Many thanks to all ofthem for their unyielding efforts,dedication and determination tomake this Congress a realsuccess. Very many thanks to ourEvents and Meetings Manager,Miss Marta Collins, for hertremendous efforts over the pastthree years preparing for thisCongress.

International Journal ofGynecology & ObstetricsThis report cannot be completewithout a few words on ourInternational Journal ofGynecology & Obstetrics. Theeditorial office in London is doinga great job. Professor TimJohnson, the innovative andprestigious Editor in Chief, hascontinued the excellence of theJournal and introduced new andexciting features, and attractedmore researchers and cliniciansto publish in and cite the journal’sarticles. No wonder the journal’simpact factor is now 2.045(2011). Clare Addington, theoutstanding Managing Editorbased in London, is doing a greatjob.

The October 2012 supplement tothe Journal is the World Reporton Women’s Health, guest editedby President-Elect Professor SirArulkumaran. Having undertakenthe same task three years ago, Iam well aware of the hard workwhich this task involves, in

putting together such a highlyprestigious publication. The reportwill be available to all delegatesattending Rome 2012 FIGOWorld Congress of Gynecology &Obstetrics and will be launched ata press conference.

I want to put on record that

during my term in office I havebeen most privileged to work withan excellent hard-working team.Team work is the ability to worktogether towards a commonvision and we did.

It is the ability to direct individualaccomplishments towardsorganisational objectives and wedid.

It is the fuel that allows commonpeople to attain uncommonresults and we did.

As my tenure as President of

FIGO comes close to its end it

is now most appropriate to say

to my fellow FIGO Officers, FIGOChief Executive Professor HamidRushwan, Executive Boardmembers, Chairs and membersof FIGO Committees and WorkingGroups, the Secretariat staff atFIGO headquarters (particularlyMr Bryan Thomas –Administrative Director – and MsMarie-Christine Szatybelko –Senior Administrator), and in myCairo Office particularly my PAMrs Azza El Tobgi and MrsGiham El Fiky: you were awonderful team and thank you somuch. You have all shownoutstanding and exceptionalcommitment, enthusiasm,volunteerism and dedicationwhich I greatly treasure. This iswhat makes FIGO the immenselyvaluable and influential globalbody that it has become over theyears and enabled me to fulfil mypromises to the FIGO GeneralAssembly three years ago.P A G E 4


I say to you all: thank you so

much – you have made my term

in office so very productive,

rewarding and enjoyable.

I say to various UN organisations,

global NGOs, governmental

organisations, sister professional

organisations and medical

industry: you all, through your

support and our collaborative and

integrated efforts, have helped

FIGO to play the role it is

supposed to do to improve

women’s health and newborns’

health to the best of its abilities.

Last but not least, many thanks

to my family: Misho my wife, my

sons Ihab and Ahmed and

daughter Menna, and my

patients. During the past three

years there were times when you

needed me most and could not

have me around because of my

heavy commitments to my

beloved FIGO Federation. I really

am grateful for your unlimited

support, sacrifice and

understanding during the past

three years.

Now as I handle the baton to my

dear friend and colleague

Professor Sir Arulkumaran, FIGO

President-Elect, I really am

confident that FIGO, under his

competent leadership, will make

tremendous progress and will be

steered in the right direction to

make a substantial difference to

the health of women and

newborns and their wellbeing,

particularly in less privileged parts

of the world.

My colleagues, I have tried very

hard within the limited space

available to relay to you what we

have achieved together during

the past three years. I just

steered the ship but you all have

voluntarily participated to make it

happen. I do wish you all a happylife, full of health and joy.

God bless you all.

Gamal SerourFIGO President 2009–2012

P A G E 5

P A G E 6


About FIGOFIGO – the InternationalFederation of Gynecology andObstetrics – is the onlyworldwide organisation thatgroups together professionalbodies of obstetricians andgynaecologists.

Vision Statement• FIGO has a vision that womenof the world achieve thehighest possible standards ofphysical, mental, reproductiveand sexual health andwellbeing throughout their lives.

Mission Statement• FIGO shall be a professionalorganisation that bringstogether obstetrical andgynaecological associationsfrom all over the world.

• FIGO shall be dedicated to theimprovement of women’shealth and rights and to thereduction of disparities inhealth care available to womenand newborns, as well as toadvancing the science andpractice of obstetrics andgynaecology. The organisationpursues its mission throughadvocacy, programmaticactivities, capacitystrengthening of memberassociations and educationand training.

Values• The values of the organisationare those of innovativeleadership, integrity,transparency, professionalism,respect for cultural diversityand high scientific and ethicalstandards.

Commitment• FIGO shall be committed to:– Encouraging all efforts forraising the status of womenand for advancing their role

in all issues related towomen’s health.

– Promoting sexual andreproductive health andrights and services througheducation, research andadvocacy as well as throughthe provision of accessible,efficient, affordable,sustainable comprehensivereproductive health services.

– Emphasising the importanceof achieving the MillenniumDevelopment Goals by2015. FIGO is committed toaccelerating its efforts andactivities to reach MDGtargets, especially in thearea of safe motherhoodand newborn health.

– Continually upgrading thepractice of gynaecology andobstetrics through research,education and training andby maintaining the highestlevels of professionalism andscientific and ethicalstandards.

– Improving communicationwith and between memberassociations and buildingthe capacities of those fromlow-resource countriesthrough strengtheningleadership, management,good practice and thepromotion of policydialogues.

– Strengthening capacities toenable societies to play apivotal role in thedevelopment andimplementation ofsustainable programmesaimed at the improvement ofcare available to women andnewborns, especially forpoor and underservedpopulations.

– Recognising the importanceof collaborative efforts foradvancing women’s health

and rights, FIGO iscommitted to strengtheningpartnerships with otherinternational professionalorganisations, U.N.agencies, and thepublic/private sector toachieve its objectives.

FIGO has grown from anorganisation representing the 42national societies which attendedthe founding meeting on the 26thJuly 1954 in Geneva, Switzerlandinto a worldwide organisationrepresenting obstetricians andgynaecologists in 124 territories.

The original Swiss Federation –whose registered address is ruedu 31 Decembre, Geneva,Switzerland – was incorporatedunder the Swiss Civil Code in1954. A United KingdomRegistered Charity – InternationalFederation of Gynecology andObstetrics (Registered Charity No1113263; Company No 5498067)– registered in England and Waleswas established in June 2005and became fully operational on1st January 2008. It is acompany limited by guaranteeand governed by itsMemorandum and Articles ofAssociation.

FIGO Trading Limited (CompanyNo 5895905), also registered inEngland and Wales, is a whollyowned commercial tradingsubsidiary of the United KingdomRegistered Charity. TheRegistered Office of both theUnited Kingdom RegisteredCharity and FIGO Trading Limitedis FIGO House, Suite 3 –Waterloo Court, 10 Theed Street,London SE1 8ST, Unitedkingdom.

The FIGO Charitable Foundationis a US 501(c)(3) corporationincorporated in the State of

P A G E 7

Illinois, United States of America

on 28th November 2001 as a Not

for Profit Corporation. (EIN No

98-0362884). The Registered

Office of the FIGO Charitable

Foundation is 222 North LaSalle

Street, Suite 2600, Chicago,

Illinois 60601, United States of

America.

The International Federation of

Gynecology and Obstetrics is a

benevolent, non-profit

organisation funded through

subscriptions received from

member societies, grants and the

proceeds of its triennial FIGO

World Congress of Gynecology &

Obstetrics.

GovernanceThe governance of the

International Federation of

Gynecology and Obstetrics is

set out in its Constitution and

Bye-Laws. The charity is also

subject to the requirements of

United Kingdom legislation and

the United Kingdom Charity

Commission. The organisation

has a single management

body, the Board of Trustees,

who are the elected Officers.

An Executive Board, which is

composed of these six Officers

and representatives of 124

affiliated societies, determines

policy and is responsible for

administration. Meetings are

arranged as required by the

demands of the organisation’s

business and, due to the

international nature of this and

the location of the Executive

Board members, as much as

possible is transacted by

correspondence, facsimile and

e-mail. The Executive Board

meets formally at least once a

year and the Trustees/Officers

at least twice yearly.

The General Assembly meetsevery three years at the time ofthe triennial FIGO WorldCongress of Gynecology &Obstetrics and is composed ofdelegates from each affiliatedassociation. It ratifiesrecommendations on thegovernance of the organisationmade by the Executive Boardand elects the Officers and newmembers of the Executive Boardfor the ensuing three-year term.Its most recent meeting tookplace in Cape Town, South Africain October 2009. The nextGeneral Assembly will take placein Rome, Italy during the FIGOWorld Congress of Gynecology &Obstetrics in October 2012.

A Chief Executive – ProfessorHamid Rushwan – was appointedin November 2007 to manage theday to day operations of theCharity.

ActivitiesSince its foundation in 1954,

FIGO has organised a World

Congress of Gynecology &

Obstetrics that takes place

every three years. Some of the

Federation’s other major

activities include, but are not

limited to:

• FIGO Fistula Initiative (page 20)• The FIGO LOGIC Initiative(Leadership in Obstetrics andGynaecology for Impact &Change) (page 52)

• FIGO Misoprostol for PPH inLow Resource SettingsInitiative (page 59)

• FIGO Prevention of UnsafeAbortion Initiative (page 35)

• FIGO Saving Mothers andNewborns Initiative (page 54)

Advocacy andWomen’s RightsFIGO has continued its efforts to:• educate and increaseawareness of ob/gynprofessionals about women'srights relating to reproductivehealth care

• involve obstetric andgynaecologic professionals inan evaluation of their practiceto assess whether they areprotecting and promotingthese rights

• encourage the development ofa code of ethics in the country,by health professionals basedon rights language that willprovide the basis for changesin gender-biased normativeassumptions about health care

• develop and promote aninternational core for a code ofprofessional ethics

• encourage the collaboration ofob/gyn professionals with otherforces in civil society toprotect, promote and advancewomen’s rights to reproductivehealth care

Other activitiesThe Federation’s activities alsoinclude:

Trustees/Officers 2009–2012President G Serour Egypt

Vice-President T Maruo Japan

President-Elect S Arulkumaran United Kingdom

Past-President D Shaw Canada

Honorary Secretary I Fraser Australia

Honorary Treasurer W Holzgreve Germany

P A G E 8

• The provision of assistance to

societies involved in the

organisation of national

workshops on maternal

mortality, safe motherhood or

rights-based issues.

• The organisation of

international workshops

• The organisation of the De

Watteville Lecture in

collaboration with The

international Federation of

Fertility Societies – “IFFS”

(given in memory of Professor

Hubert de Watteville – the

founding father of both FIGO

and IFFS)

• The awarding of fellowships

including those given in

consultation with the Chien-

Tien Hsu Research Foundation

and, at the FIGO WorldCongress of Gynecology &Obstetrics, the host society

• The publication of the WorldReport on Women’s Health,published every three years tocoincide with the FIGO WorldCongress of Gynecology &Obstetrics. This specialsupplement to the InternationalJournal of Gynecology &

Obstetrics represents acomprehensive overview ofwomen’s health issues, bothmedical and social.

Through the work of sevendedicated task-orientedCommittees and three WorkingGroups, FIGO’s work embracesmany aspects of obstetrics andgynaecology such as capacity

building in education and training,

reproductive medicine, oncology,

safe motherhood, social activities

on women’s health, and ethics.

FIGO Secretariat

In an effort to reduce its

long-term expenditure, FIGO

purchased a new headquarters

building located in Theed

Street in London, United

Kingdom in 2004. The premises

are centrally located within a

few minutes’ walk of Waterloo

national rail station with direct

Underground links to the

Heathrow Express terminal at

London’s Paddington station

and Eurostar services from St

Pancras International station.

Executive Board Members 2009–2012Country/Territory Society Current Representative

Argentina Federación Argentina de Sociedades de Ginecología y Obstetricia N C Garello

Australia & New Zealand Royal Australian and New Zealand College of Obstetricians and Gynaecologists C Tippett

Brazil Federaçao Brasileira das Sociedades de Ginecologia e Obstetricia N R de Melo

Canada Society of Obstetricians and Gynaecologists of Canada V Senikas

Chile Sociedad Chilena de Obstetricia y Ginecología H Munoz

China Chinese Society of Obstetrics and Gynecology Z Cao

Costa Rica Asociación de Obstetricia y Ginecología de Costa Rica K-U Sander Mangel

Finland Finnish Gynecological Association S E Grénman

France Collège National des Gynécologues et Obstétriciens Français B Carbonne

Germany Deutsche Gesellschaft für Gynäkilogie und Geurtshilfe W Jonat

Ghana Society of Obstetricians and Gynaecologists of Ghana E Y Kwawukume

Italy Società Italiana di Ginecologia e Ostetricia F Petraglia

Japan Japan Society of Obstetrics and Gynecology T Kimura

Lebanon Société Libanaise d'Obstétrique et de Gynécologie A Adra

Malaysia Obstetrical and Gynaecological Society of Malaysia A A Yahya

Mexico Federación Mexicana de Colegios de Obstetricia y Ginecologia E Castelazo Morales

Palestine Society of Palestinian Gynaecologists and Obstetricians S S Jaber

Paraguay Sociedad Paraguaya de Ginecología y Obstetricia A Acosta

South Africa South African Society of Obstetricians and Gynaecologists B D Goolab

Spain Sociedad Espanõla de Ginecología y Obstetricia J M Laílla Vicens

Taiwan Taiwan Association of Obstetrics and Gynecology T-H Su

Turkey Turkish Society of Obstetrics and Gynaecology I M Itil

United Kingdom Royal College of Obstetricians & Gynaecologists A Falconer

Venezuela Sociedad de Obstetricia y Ginecología de Venezuela R Perez D’Gregorio

Chief Executive H Rushwan United Kingdom/Sudan

Administrative Director B Thomas United Kingdom

In an era of unrivalled expansion

since the property was

purchased, during which the

number of individuals working at

the Secretariat has increased

from three to 14 as activities have

increased, the building provides

space for the existing Secretariat

staff as well as allowing for

modest future long-term

expansion of the staff needed to

support FIGO’s activities. The

Secretariat now houses all of

FIGO’s core activities – including

the IJGO Editorial Office – under

one roof to maximise the

organisation’s efficiency andfacilitate cost reductions.

A number of separate“departments” have beenestablished, each of whichhandles a specific aspect ofFIGO’s work. These include:• Projects• Publications• Events and Meetings• Finance• Administration

In addition, the Chief Executive isresponsible for administering theaffairs of FIGO on a day to daybasis, delegating authority to the

Administrative Director as

appropriate, preparing the

organisation’s strategic plan, and

supervising all of the employees

and departments of FIGO whilst

implementing the policies,

procedures and activities

approved by the FIGO Officers

and Executive Board.

The Secretariat handles all

administrative matters on behalf

of the organisation. Its staff is

multilingual and can

communicate in English, French,

Spanish and a number of other

languages.


P A G E 9

Secretariat StaffChief Executive H Rushwan

Administration

Administrative Director B Thomas

Senior Administrator and Committee Manager M-C Szatybelko

PA to the Chief Executive/Communications Assistant A Gilpin

Administration Assistant D Jeffery

FIGO LOGIC Initiative Project Team

Project Director D Taylor

Senior Management Specialist B Vander Plaetse (Independent Consultant)

Project Manager H Andrews

Administrative Officer C Bruneau

FIGO Misoprostol for Post-Partum Haemorrhage in Low Resource Settings Initiative

Project Manager C Waite

Events and Meetings

Events and Meetings Manager M Collins

International Journal of Gynecology & Obstetrics

Managing Editor C Addington

Manuscript Editor P Chapman

Finance

Independent Consultant G Bialasz

Independent Consultant R Waghela

P A G E 1 0


FIGO Member SocietiesThe membership of FIGO includes the following

affiliated organisations:

Africa-Eastern Mediterranean

• Associação Moçambicana de Obstetras e

Ginecologistas

• Association of Gynaecologists & Obstetricians of

Tanzania (AGOTA)

• Association of Obstetricians and Gynaecologists

of Malawi

• Association of Obstetricians and Gynaecologists

of Uganda

• Association Sénégalaise de Gynécologie-

Obstétrique

• Egyptian Society of Gynaecology and Obstetrics

• Emirates Medical Association Obstetrics &

Gynaecology Society

• Eritrean Medical Association

• Ethiopian Society of Obstetricians &

Gynaecologists (ESOG)

• Jordanian Society of Obstetricians &

Gynaecologists

• Kenya Obstetrical & Gynaecological Society

• Kuwait Medical Association

• Libyan Obstetrical & Gynaecological Association

• Obstetrical & Gynaecological Society of Sudan

• Saudi Obstetric & Gynaecological Society

• Sierra Leone Association of Gynaecologists &

Obstetricians

• Société Algérienne de Gynécologie-Obstétrique

• Societe de Gynecologie et d'Obstetrique de Cote

d'Ivoire

• Societe de Gynecologie et d'Obstetrique du

Benin et du Togo

• Société de Gynécologie et Obstétrique du Niger

• Société des Gynécologues et Obstétriciens du

Burkina

• Société Gabonaise de Gynécologie Obstétrique et

de la Reproduction

• Societe Guineenne de Gynecologie-Obstetrique

• Societe Libanaise d'Obstetrique et de

Gynecologie

• Societe Malienne de Gynecologie-Obstetrique

• Societe Royale Marocaine de Gynecologie

Obstetrique

• Société Tunisienne de Gynécologie-Obstétrique

• Society of Gynaecologists & Obstetricians on

Cameroon (SOGOC)

• Society of Gynaecology & Obstetrics of Nigeria

(SOGON)

• Society of Obstetricians and Gynaecologists ofGhana

• Society of Palestinian Obstetricians andGynecologists

• South African Society of Obstetrics &Gynaecology (SASOG)

• Syrian Society of Obstetricians & Gynaecologists• Zambia Association of Gynaecology andObstetrics

• Zimbabwe Society of Obstetricians &Gynaecologists

Asia-Oceania• Afghan Society of Obstetricians andGynaecologists

• Chinese Society of Obstetrics and Gynecology• Federation of Obstetric & GynaecologicalSocieties of India

• Iraqi Society of Obstetrics and Gynecology• Japan Society of Obstetrics & Gynecology• Korean Society of Obstetrics and Gynecology• Macao Association of Obstetrics & Gynecology• Myanmar Medical Association Obstetrical &Gynaecological Society

• National Association of Iranian Obstetricians &Gynecologists(NAIGO)

• Nepal Society of Obstetricians andGynaecologists (NESOG)

• Obstetrical & Gynaecological Society of HongKong

• Obstetrical & Gynaecological Society of Malaysia• Obstetrical & Gynaecological Society of Singapore• Obstetrical & Gynecological Society ofBangladesh

• Papua New Guinea Obstetrics and GynaecologySociety

• Perkumpulan Obstetri Dan Ginekologi Indonesia• Philippine Obstetrical & Gynecological Society Inc.• Royal Australian & New Zealand College ofObstetricians & Gynaecologists

• Royal Thai College of Obstetricians &Gynecologists

• Society of Obstetricians & Gynaecologists ofPakistan

• Sri Lanka College of Obstetricians &Gynaecologists

• Taiwan Association of Obstetrics & Gynecology• Vietnam Gynaecology & Obstetrics Association(VINAGOFPA)

Europe• Albanian Association of Obstetrics andGynecology

P A G E 1 1

• Association of Gynecologists and Obstetricians ofMacedonia

• Austrian Society of Obstetrics & Gynecology• Bulgarian Society of Obstetrics and Gynecology• Collège National des Gynécologues etObstétriciens Français

• Croatian Society of Gynecologists andObstetricians

• Cyprus Gynaecological and Obstetrics Society• Czech Gynecological & Obstetrical Society• Dansk Selskab for Obstetric og Gynaekologi• Deutsche Gesellschaft für Gynäkologie undGeburtshilfe

• Estonian Society of Gynaecologists• Federacao das Socidedades Protuguesas deObstetricia e Gineologia (FSPOG)

• Finnish Gynaecological Association• Georgian Association of Obstetricians &Gynecologists (COGRA)

• Gynecologic Association of the Slovenian MedicalSociety

• Hellenic Obstetrical & Gynecological Society• Icelandic Association of Obstetricians andGynecologists

• Institute of Obstetricians & Gynaecologists of theRoyal College of Physicians of Ireland

• Israel Society of Obstetrics & Gynecology• Kosovo Obstetric Gynaecology Society (KOGS)• Kyrgyz Association of Obstetricians,Gynecologists & Neonatologists

• Latvian Association of Gynaecologists andObstetricians

• Lithuanian Association of Obstetricians &Gynecologists

• Magyar Noorvos Tarsasag• Malta College of Obstetricians & Gynaecologists• Nederlandse Vereniging voor Obstetrie &Gynaecologie

• Norwegian Society of Gynecology and Obstetrics• Polskie Towarzystwo Ginekologiczne• Republic of Armenia Association ofObstetrician/Gynecologists & Neonatologists

• Romanian Society of Obstetrics & Gynaecology• Royal Belgian Society of Obstetrics &Gynaecology

• Royal College of Obstetricians & Gynaecologists• Russian Society of Obstetricians &Gynaecologists

• Association of Gynecologists and Obstetricians ofSerbia, Montenegro and Republic Srpska

• Slovak Gynecological & Obstetrical Society• Sociedad Espanola de Ginecologia y Obstetricia

• Societa Italiana di Ginecologia e Ostetricia• Societe de Gynecologie et d'Obstetrique deLuxembourg

• Société Suisse de Gynécologie & Obstétrique• Society of Obstetricians and Gynecologists ofRepublic of Moldova

• Svensk Forening For Obstetrik & Gynekologi• Turkish Society of Obstetrics and Gynecology• Ukrainian Association of Obstetricians andGynecologists

Latin America• Asociacion de Ginecologia y Obstetricia deGuatemala

• Asociacion de Obstetricia y Ginecologia de CostaRica

• Federaçao Brasileira das Sociedades deGinecologia e Obstetrícia (FEBRASGO)

• Federación Argentina de Sociedades deGinecología y Obstetricia, FASGO

• Federación Colombiana de Asociaciones deObstetricia y Ginecología

• Federación Ecuatoriana de Sociedades deGinecología y Obstetricia

• Grabham Society of Obstetricians &Gynaecologists

• Sociedad Boliviana de Ginecologia y Obstetricia• Sociedad Chilena de Obstetricia y Ginecologia• Sociedad Cubana de Obstetricia y Ginecologia• Sociedad de Ginecologia y Obstetricia de ElSalvador

• Sociedad de Ginecología y Obstetricia deHonduras

• Sociedad de Obstetricia y Ginecologia deVenezuela

• Sociedad Dominicana de Obstetricia yGinecologia

• Sociedad Ginecotocologica del Uruguay• Sociedad Nicaraguense de Ginecologia yObstetricia

• Sociedad Panamena de Obstetricia y Ginecologia• Sociedad Paraguaya de Ginecologia y Obstetricia• Sociedad Peruana de Obstetricia y Ginecologia• Société Haitienne d'Obstetrique et deGynécologie SHOG

North America• American College of Obstetricians andGynecologists

• Federación Mexicana de Colegios de Obstetriciay Ginecologia

• Society of Obstetricians and Gynaecologists ofCanada

P A G E 1 2


FIGO Committeesand Working Groups

Committee StructureThe Executive Board discussed

the priorities for action for the

2009–2012 “term” in depth and

decided to approve the

continuation of the following “task

oriented” Committees: the

Committee for the Ethical

Aspects of Human Reproduction

and Women’s Health, Committee

for Fistula, Committee on

Gynaecologic Oncology,

Committee for Safe Motherhood

and Newborn Health and

Committee for Women’s Sexual

and Reproductive Rights. In

addition, two new Committees

were established: Committee for

Capacity Building in Education

and Training, and Committee for

Reproductive Medicine.

The Committees reflect a

continuing determination to

realise and expand FIGO's

mission to improve women’s

health and rights and to reduce

disparities in health care available

to women and newborns as well

as its commitment to advancing

the science and practice ofobstetrics and gynaecology.

The Executive Board also agreedthat the Working Group on thePrevention of Unsafe Abortion,the Working Group on PelvicFloor Medicine andReconstructive Surgery and theWorking Group on MenstrualDisorders should continue theirinvaluable work.

A number of FIGO “business”Committees are also in place:• The Alliance for Women’sHealth, which provides an on-going forum for collaboration

P A G E 1 3

between FIGO and otherorganisations and acts as anAdvisory Board to variousprojects including the triennialPre-Congress Workshop.

• The FIGO Congress OrganisingCommittee, which continues tobe responsible for theorganisation of the FIGO WorldCongress of Gynecology &Obstetrics and the policyaspects of FIGO Congresses.

• The FIGO Audit & FinanceCommittee, which aims toensure that FIGO’s strategicplan has been developed andimplemented in an appropriateand clear fashion withappropriate goals, whilst beingopen in the conduct of itsaffairs as well as undertakingperiodic reviews of FIGO’sfinances and financial planningand strategy.

• The FIGO PublicationsManagement Board, whichoversees the business andfinancial management ofFIGO’s publications

Alliance for Women’sHealthThe Alliance for Women'sHealth began life as theWHO/FIGO Task Force in 1982.Its objective was to advancethe health of women,particularly in low- and middle-income countries, bypromoting an increasedawareness and commitmentabout public health and socialissues among obstetrician-gynaecologists throughcollaboration between FIGOand the World HealthOrganization (“WHO”) and withother organisations. TheAlliance for Women’s Healthremains a forum where FIGOshares information with other

agencies to gain collectivewisdom in dedicated andcollaborative areas of FIGOactivity and to identify furtherpotential areas of collaboration.

Besides FIGO and WHO, thefollowing organisations arerepresented:• International Confederation ofMidwives

• International PediatricAssociation

• IPPF (The International PlannedParenthood Federation)

• UNAIDS• UNFPA (United NationsPopulation Fund)

• UNICEF (United NationsChildren’s Fund)

• The World Bank

Ipas also attends meetings in an“observer” capacity.

Professor Mahmoud Fathalla – a

former President of FIGO – actsas a Senior Advisor to theAlliance, whilst ProfessorRebecca Cook of the Universityof Toronto, Canada serves as anhonorary advisor on mattersrelating to reproductive healthand the law.

The Alliance met in February2011 at the Royal College ofObstetricians and Gynaecologistsin London, United Kingdom. Atthe meeting, the main focus ofthe discussions revolved arounda review of the terms of referenceof the Alliance and its future.

On 5th and 6th October 2012, aPre-Congress Workshoporganised under the auspices ofthe Alliance for Women’s Health isbeing held in Rome, Italy prior tothe FIGO World Congress ofGynecology & Obstetrics.

Members of the Alliance for Women’s Health 2009–2012D Shaw (Co-Chair) FIGO

M Mbizvo (Co-Chair) WHO

S Arulkumaran FIGO

H Belhadj UNAIDS

A Bridges International Confederation of Midwives

M Chopra UNICEF

S Chowdhury The World Bank

I Fraser FIGO

W Holzgreve FIGO

W Keenan IPA

T Maruo FIGO

N Ortayli UNFPA

I Rondinelli IPPF

G Serour FIGO

Ex-officioH Rushwan FIGO

Senior AdvisorM Fathalla

AdvisorR Cook

ObserverB Crane Ipas

P A G E 1 4


FIGO Committee forCapacity Building inEducation andTrainingThe FIGO Committee forCapacity Building in Educationand Training was one of twonew “task-oriented”Committees established byFIGO’s Executive Board inOctober 2009.

The aims of the Committee are:• To provide leadership in theeducational and trainingactivities of FIGO;

• To promote the educationalobjectives of FIGO in the fieldof women’s sexual andreproductive health and rights;

• To share the values of FIGO ofinnovative leadership, integrity,transparency, professionalism,respect for cultural diversity

and high scientific and ethicalstandards;

• To ensure that training isaccompanied by animprovement in women’shealth evaluated byappropriate indicators;

• To work with FIGO’s membersocieties to enhanceeducational and trainingcapabilities; and

• To upgrade the practice ofobstetrics and gynaecologythrough education and training.

FIGO, conscious of itsresponsibility, has placed aspecial emphasis on the fact thatthe Committee for CapacityBuilding in Education and Trainingshould, in conjunction withvarious global institutions, act insuch a way that it will achieve itsobjectives; education,preparation, training and capacity

building are the only logical routethat exists to improve andadvance opportunities for allwomen of the world.

The vision of the Committee isthat all countries of the worldshould have effective educationaland training programmes thatincrease the capabilities ofwomen’s healthcare professionalsand enable them to continue toincrease their own professionalcapabilities through nationaleducational and trainingprogrammes created bythemselves to meet thehealthcare needs of all womenand children in their country.

The Committee aims to promoteFIGO’s educational objectives inthe field of women’s sexual andreproductive health worldwideand will develop training andcapacity building programmes for

P A G E 1 5

professionals involved in the fieldof women's sexual andreproductive health, includingreproductive rights. TheCommittee is based on thestructure of FIGO itself andshares its values, being those ofinnovative leadership, integrity,transparency, professionalism,respect for cultural diversity andhigh scientific and ethicalstandards.

The Committee’s activities,according to its Terms ofReference, will be carried out incollaboration with nationalsocieties.

Professional training isaccompanied by an improvementin performance indicators. Thereare many areas, especially inlow-resource countries, in whichtraining different levels ofwomen’s health careprofessionals can be improved,so that better outcomes can beachieved from the care ofwomen, especially with respect tomaternal and neonatal morbidityand mortality.

Strengthening communicationwith and among memberassociations and building thecapabilities and capacity of thosefrom low-resource countriesthrough strengthening leadership,management, good practice andthe promotion of policy dialogueswill enable societies to play apivotal role in the developmentand implementation of projectsand policies aimed at theimprovement of care available towomen and their babies.

The Committee for CapacityBuilding in Education and Trainingis committed to:• Improving communication withand among memberassociations and building the

capacities of those from low-resource countries throughstrengthening leadership,management, good practiceand the promotion of policydialogue.

• Enabling all countries of theworld to have effectiveeducational and trainingprogrammes that increase theprofessional capabilities ofwomen’s healthcareprofessionals and enable themto continue to increase theirown professional capabilitiesthrough national educationaland training programmescreated by themselves to meetthe healthcare needs of allwomen and children in theircountry. Regarding maternalmortality, it is well establishedthat there are three factors fordelays in providing adequatecare that account for mostmaternal deaths and this couldbe reduced to a minimumwhen all professionals involved(doctors, midwives, nurses,etc.) are better skilled andwork together.

• Sharing the values of FIGO ofinnovative leadership, integrity,transparency, professionalism,respect for cultural diversityand high scientific and ethicalstandards.

• Ensuring that professionaltraining is accompanied by animprovement in performanceindicators. There are manyareas, especially inlow-resource countries, inwhich training different levels ofwomen’s health careprofessionals can be improved,so that better outcomes canbe achieved from the care ofwomen, especially with respectto maternal and neonatalmorbidity and mortality.

• Promoting sexual and

reproductive health rights andservices through education,research and advocacy as wellas through the provision ofaccessible, efficient, affordable,comprehensive reproductivehealth services.

To achieve its goals, theCommittee acts by:• Organising meetings,workshops, courses, etc.,

• Organising training courses• Designing the appropriateeducational material for thepurposes of education (videos,slides, pamphlets, books, etc.)

• Maintaining the high calibre ofFIGO‘s triennial WorldCongress of Gynecology &Obstetrics as an inspirationalforum for obstetricians andgynaecologists from all overthe world, as well as theorganisation of educationalpre-Congress courses.

• To participate in relevantnational, regional andinternational meetings andactivities promoting women’shealth.

• To organise regional FIGOmeetings on a differentcontinent every year. Thetopics for these meetings willbe in accordance with FIGO’sobjectives and goals.

• To organise the FIGOeducational aspects of FIGO’sofficial website. This will includeeducational and trainingmaterial used in the differentcourses and meetingsorganised in various countries.It will also contain different linksto other educational websites,with the appropriatepermissions.

• To prepare different tools to beused in training courses suchas videos, slide sets,pamphlets, etc.

P A G E 1 6

• To prepare guidelines andreviews that will be publishedin the IJGO.

• The usual means ofcommunication among themembers will be electronic, bye-mail, Skype, etc.

Developing a competent healthpromotion workforce is a keycomponent of capacity buildingfor the future and is critical todelivering on the vision, values

and commitments of globalhealth promotion.

Recognising the importance ofcollaborative efforts for advancingwomen’s health and rights, FIGOand the Committee arecommitted to strengtheningpartnerships with otherinternational professionalorganisations, UN agencies, andthe public/private sector toachieve their objectives.

Members of the FIGO Committee for Capacity Buildingin Education and Training 2009–2012Luis Cabero-Roura (Chair) Spain

E Jauniaux (Co-Chair) United Kingdom

D Adamson United States of America

L Denny South Africa

B Dickens Canada

A Lalonde Canada

N Patel United Kingdom

L Regan United Kingdom

Current and future healthchallenges demand new andchanging competencies to formthe basis for education, trainingdevelopment and workforceplanning. Internationaldevelopments in health promotionand evidence-based practiceprovide the context fordeveloping health promotioncompetencies, standards, qualityassurance and accountability inprofessional preparation andpractice. In addition to filling thetraining and development gap,there is a need to develop acomprehensive system forcompetency-based standardsand accreditation to strengthenglobal capacity in healthpromotion, which is a criticalelement in achieving goals for theimprovement of global health.

In its first three years, theCommittee has undertaken 48activities in more than 20countries with a participation ofmore than 5,000 attendees and350 speakers from 29 countries.

FIGO would like to thank anumber of donors, includingBayer Schering Pharma MiddleEast, Ferring PharmaceuticalsNorth-East Africa, and OlympusSurgical Technologies Europe forsupporting the educational andtraining activities of the FIGOCommittee for Capacity Buildingin Education and Training.

FIGO Committee forthe Ethical Aspectsof HumanReproduction andWomen’s Health

The FIGO Committee for the


Reproduction and Women’s

Health was established in 1985

to identify and study the

important ethical problems

confronting health care

practitioners in human

reproduction. These ethical

problems were to be brought

to the attention of physicians

and the public in high-income

and low- and middle- income

countries and ethical

guidelines provided where

appropriate. The Committee is

composed of a broad range of

international members who

represent low- and middle-

income countries and high-

income countries as well as

having a significant interest

and/or expertise in medicalethics.

The Committee’s charge hasassumed greater importance withthe continuing world-widechallenge of ensuring that womenare granted human andreproductive rights. Furthermore,the complexity of incorporatingthe many ethical aspects ofreproductive issues in differingsocieties for issues such ascloning, or patenting of thehuman genome argue for theneed for such a consensus body.There is no other bodyinternationally that confrontsthese issues with a view towardsthe health care impact onwomen. Because of this, theCommittee’s opinions are usedby women’s health practitionersworldwide to assist them insetting national and localstandards, to expand the depthof discussion of these issueslocally and to support theiradvocacy for improvements in thehealth and status of women. This

is a critical role and of greaterneed now in the face of rapidcultural and scientific changethan ever before. Women areclearly vulnerable in territorieswhere their health care rights areeither non-existent or threatenedand thus the Committee'sguidelines can be a powerfulforce to support the rights ofwomen worldwide.

The FIGO Committee for theEthical Aspects of HumanReproduction and Women’sHealth considers the ethicalaspects of issues that impact thediscipline of obstetrics,gynaecology and women’s health.The guidelines produced by theCommittee represent the result ofthat carefully researched andconsidered discussion. Thismaterial is intended to providematerial for consideration anddebate about the ethical aspectsof the discipline for memberorganisations and theirconstituent membership.

The Committee has issued


P A G E 1 7

P A G E 1 8

guidelines on a number of ethicalissues, which are to be publishedin collected form in October 2012in a booklet entitled“Recommendations on Ethical

Issues in Obstetrics and

Gynaecology by the FIGO

Committee for the Study of


Reproduction”. The text of thebooklet is available in English,Spanish and French and mayalso be downloaded from theFIGO website.

The aims of the Committee are:• To record and study thecontemporary ethical issueswhich emanate from researchand practice in obstetrics,gynaecology, and reproductivemedicine;

• To focus on internationalissues;

• To recommend guidelines onethical problems in training,education, science and thepractice of obstetrics andgynaecology;

• To bring ethical issues to theattention of FIGO membersocieties, physicians, and thepublic in developed anddeveloping countries;

• To address the question ofFIGO’s policy towardssponsorship and relationshipswith industry; and

• To develop a bioethicscurriculum in reproductive andsexual health for developingcountries.

The FIGO Ethics Committee metin London, United Kingdom, inFebruary 2010, in Cairo, Egypt, inNovember 2010, in Goa, India, inMarch 2011, and again inLondon, United Kingdom, inMarch 2012. Overall, 15Recommendations weredesigned, updated and/orsubstantively factually or

otherwise amended, which will bepublished in the FIGO booklet tobe distributed to delegates at the2012 FIGO World Congress ofGynecology & Obstetrics and invarious issues of the IJGO. Inaddition, all Recommendationswere forwarded by e-mail to FIGOnational member societies, with arequest for comments, additionalinformation, and suggestions forfurther topics to be submitted fordebate. E-mail and the Internetappear to be promising means ofcommunication on ethics withFIGO member national societiesand this tool will hopefully begreatly developed in the nearfuture.

One of the objectives of theEthics Committee has been togain heightened visibility and tospread the ethical aspects ofhuman reproduction at the “grassroot” level and integrate itsreflections andRecommendations into regularmedical practice. Ethics is notintended to be an abstruse orpurely philosophical speculationabout moral behaviour, butshould be a guide for allpractitioners as to the conduct oftheir professional lives and thedecisions they make. Theseguidelines aim at being universaland applicable worldwide sincethe Committee members belongto all continents, all traditions,cultures, religions, societies,medical practices and tocountries ruled by different lawsand regulations. For instance inMay, 2011, the European Courtof Human Rights afforded FIGOEthics Committee Statementsand Recommendations the samestatus as UN and WHOdeclarations of principle, toidentify the standards of practiceand performance by which

medical professionals,professional associations andgovernmental health services willbe assessed in their observance,or violation, of women’s humanrights to reproductive health care.

Despite the wide disparity of itsmembership, the FIGO EthicsCommittee always achieves aconsensus and usually unanimitybefore finalising itsRecommendations. Despite this,practitioners are warned that theFIGO Recommendations shouldnot be applied in countries wherethey would contradict nationallegislation, legally enforceableregulations or binding judgmentsof courts of authority. However, iflaws, regulations or judgmentsprejudice women’s health, forinstance by upholding orimplementing discriminationagainst HIV positive patients orlimitations in access to familyplanning, obstetricians andgynaecologists, national societies,and professional bodies all havean obligation to act. Under theethical duty to serve asadvocates for women’s health,they should make every possibleeffort to convince theirgovernments to improve women’sreproductive health by legalreform, enlightened administrationor other effective means, toenable women’s full enjoyment oftheir human and reproductiverights.

In the wake of the work achievedby the past Chairs of the EthicsCommittee, (including ProfessorsJoanna Cain, Gamal Serour andJacques Milliez and theirpredecessors), the most recentRecommendations of the EthicsCommittee addressed a widerange of issues, including socialissues such as negativestereotyping of women, whether


P A G E 1 9

as patients or professionalcolleagues, non-consensualsterilisation of vulnerable womensuch as members of minority,socially or politically subordinatedpopulations, and storage of cordblood as a social asset ratherthan an individual safeguard.Each meeting of the Committeeembraced a broad field ofreflections that focused on a richvariety of aspects of humanreproduction. These deliberationsunderline the unique role of theFIGO Committee in the field ofEthics relating to Women’sHealth. Indeed, theRecommendations issued duringthe past three years concerned awide range of clinical and widerissues including:• prenatal diagnosis andscreening;

• management of severecongenital anomalies;

• gynaecological care of severelydisabled women;

• care of patients seekinginfertility care across nationalborders; and

• task-shifting whenobstetrician/gynaecologists areunavailable.

A major commitment of theCommittee over its three-yearterm was development of abioethics training curriculum,particularly for students inresource-poor settings. Entitled“The FIGO Introduction to

Principles and Practice of

Bioethics: Case Studies in

Women’s Health”, this trainingtool presents key principles ofmodern bioethical analysis, andinvites their application to a seriesof 27 simple case scenarios towhich all participants in theCommittee contributed. The casestudies are accompanied byquestions to provoke ethical

analysis, allowing a choice ofresponses on which studentsmay differ among themselves,and references to FIGO and othersources of guidance. Students’conclusions of appropriateconduct may be in conflict withprevailing requirements of ethicalpractice, but others inconsistentwith each other may conform toethically acceptable conduct. Thisteaches that there may bedifferent ways to act ethically,depending on priority given tocompeting principles and levels ofcase analysis. A brief Instructors’Guide reinforces that there arenot necessarily “right” answers tothe questions, and that studentsmust be left to reach flawedanalyses, and defend ethicallyuntenable conclusions, beforecorrection.

In addition to working on ethicalrecommendations, Committeemembers also published textsand articles on ethics for variousprofessional readerships,delivered lectures andparticipated in the name of FIGOin meetings or workshops incollaboration with various nationaland international organisations,

such as the Indian College ofObstetricians andGynaecologists, and ESHRE.

The Recommendations of theFIGO Ethics Committee are ofpractical use to many. On severaloccasions, for instance,supported by the standard-setting role of FIGO EthicsCommittee Recommendations,the Centre for ReproductiveRights, based in New York, USA,brought cases of denials andviolations of women’sreproductive rights to internationaltribunals. These included theEuropean Court of HumanRights, and the Inter-AmericanCourt of Human Rights. Onecase, for instance, concernedtubal sterilisations withoutpatients’ consent, and anotherconcerned denial of prenataldiagnosis for a malformed baby.

These advances demonstratethat Ethics is not only an abstractnotion, but also serves topromote the health and legitimateinterests of people in general, andwomen in particular, in thestruggle to overcome traditionsand cultures that deny womentheir human rights.

Members of the FIGO Committee for the EthicalAspects of Human Reproduction and Women’s Health2009–2012B Dickens (Chair) Canada

F Shenfield (Co-Chair) United Kingdom

J Milliez France

A Mohsin Ebrahim South Africa

D Shah India

J C Vargas Colombia

Y F Wang People’s Republic of China

AdvisorsJ Cain United States of America

N Patel United Kingdom

Ex OfficioH Rushwan United Kingdom/Sudan

FIGO Committee forFistulaFIGO’s activities in the area offistula prevention andtreatment had, until 2007, beenundertaken under the auspicesof the FIGO Committee for SafeMotherhood and NewbornHealth. The topic was deemedto be of such importance,however, that a dedicated task-oriented Committee wasestablished.

The aims of the Committee are:• To co-ordinate effectivelyFIGO’s activities in the field offistula treatment andprevention;

• To produce effective proposalsfor the possible expansion andenhancement of the invaluablework undertaken in theprevention and treatment offistula;

• To co-ordinate the productionof a competency-basedtraining manual aimed attrainers and individualpractitioners in low- andmiddle-income countries;

• To continue liaison with UNFPAand others on theestablishment of trainingcentres and dedicated fistulahospitals in Africa andelsewhere;

• To work with alliedorganisations – includingUNFPA – on projects devotedto the prevention andtreatment of fistula;

• To monitor and evaluate third-party projects supportedcurrently or in the future byFIGO (such as the AMREFproject in Tanzania);

• Unless there is a valid reasonfor not doing so, to involveFIGO member societies where

relevant in the activities

proposed for their countries;

• To recommend ways in which

FIGO and its constituent

societies can collaborate with

national governments and

other organisations to reduce

unacceptably high levels of

fistula in their countries. This

should include, where

appropriate, collaboration with

member societies in countries

with a high incidence and/or

expertise in fistula; and

• Encourage and coordinate

South to South collaboration

where relevant and

appropriate.

The six year programme of

working with the Royal Dutch

Embassy for training of doctors

and nurses in Tanzania came to

an end in July 2011, but work

continued a little longer. The FIGOP A G E 2 0


Executive Board has been givenreports regularly, and during itsvisit to Dar es Salaam in 2010had the opportunity to see thefistula hospital there and itsfacilities. Overall, the programmehas been judged a success with– during the six year period –nearly 1,500 patients treated andover 40 doctors and 50 nursestrained. We have had regularreports from AMREF, whomanaged the programme for us.The total FIGO support for sixyears was in the region ofUS$450,000 with the RoyalDutch Embassy contributing overUS$1.8 million.

Over the last three years activityhas continued to develop trainingcentres, producing a competencybased training manual (in Englishand French – now available), andrunning “training the trainers”courses for those that train. Tothis end, FIGO now haspartnership with UNFPA,EngenderHealth, WAHA, Johnson& Johnson, the FistulaFoundation USA, and the RCOG.Others who work in the field havealso agreed to adopt the FIGOassisted core programme.

Courses have been run for fistulasurgeons already training to learnhow to use the Training Manual.ISOFS have adopted the manualand it will now be the only manualused globally.

With WAHA, FIGO has devised astandardised data collectionsystem, now being implementedto be used in all training centres.

With the assistance of theorganisation mentioned above,we now have funding for over 40trainees, 20 of whom haverecently been allocated tocentres.

To date, training centres have

been developed or upgraded, orgiven approval for training, inSudan, Ethiopia, Tanzania, Nigeriaand Dakar. Centres are onlyapproved for training on conditionthat they follow the approvedtraining, and have the appropriatefacilities. Further “training thetrainers” courses are planned totrain French-speaking fistulasurgeons.

Funding has been obtained toascertain the needs of centres toupgrade to full training centres.The evaluation visits will becarried out by fistula surgeons.

There is a commitment from theabove group to at least have twonew centres for training andtreatment every year.

All centres will also have needsassessments carried out toidentify their requirement fortraining materials. Modest fundingfor this has been obtained.

A computerised model ofinteractive training is beingdeveloped that will be unique inconcept. Initial work has beencompleted, and it is hoped thatthis will be finalised by the end of2012. It will follow the trainingmanual at every stage and allowstrainees to use it themselves fortraining. The overall cost ofproducing the module will be inthe region of US$250,000. Mostof the funding has now beensecured.

The most important developmentover the past three years hasbeen that there is nowcommitment and agreement withall the organisations involved inthis field to work jointly towardsthe same agreed goals and, forthose that have funding, tochannel the funding towardsthese aims.

FIGO’s role will be to coordinateactivities, develop trainingmaterials and the criteria foraccreditation of centres, and bethe international organisation thatprovides academic credibility.

There will be a separate meetingof fistula surgeons from aroundthe world and organisationsinvolved in developing the aboveagenda at the FIGO WorldCongress of Gynecology &Obstetrics in Rome. The meetingwill aim to take stock ofdevelopment, and to decide whatworks and what does not.

The FIGO Committee for Fistulaworks slightly differently to theother FIGO task-orientedCommittees. Most of the work isdone centrally at the Secretariat,and individuals and organisationswho have been involved arebased on need and purpose. Thishas had the advantage ofinvolving more people, and thebenefit of them feeling involved.There has always been a coregroup for advice, and theseindividuals are listed below.

Members of the FIGO Committee for Fistula 2009–2012N Patel (Chair) United Kingdom

M Muleta (Co-Chair) Ethiopia

A Browning Ethiopia

S Elneil United Kingdom

T Raassen Kenya

C-H Rochat Switzerland

H Rushwan United Kingdom/Sudan

K Waaldijk NigeriaP A G E 2 1

FIGO Committee onGynaecologicOncologyThe primary objectives of theFIGO Committee onGynaecologic Oncology for theperiod from 2009–2012 havebeen:• To monitor and facilitate theimplementation of a newStaging System of the vulva,endometrium and cervix, whichwas finalised in 2009.Monitoring is accomplished bycollating the published datafrom units using the newstaging system and facilitationby ensuring that all nationalsocieties are aware of and areusing the new staging system– one way of making sure thishappens is through the officialFIGO website;

• To discuss and call forproposals for Ovarian and

Fallopian Tubes cancers’

changes to staging. This

process is completed and has

had the approval of the UICC,

the American Joint

Commission on Cancer, the

European and Japanese

Societies of Gynaecology

Oncology, and the International

Gynecologic Cancer Society.

Final edits are in process and

the staging will be ready for a

presentation to membership at

the FIGO conference in Rome,

October 2012.

• To develop the concept of

Molecular Staging, which is

likely to be the future direction

of staging of all malignancies;

• To prepare classifications of:

– Radical Hysterectomy

– Lymphadenectomy

– Vulvectomy

– Complications and Adverse

Events

– Although not finalised some

of this work is presented in

the new FIGO CANCER

REPORT

• To prepare a revised version of

the former “Annual Report on

The Results of Treatment in

Gynaecologic Cancer” – now

renamed the “FIGO Cancer

Report” – as a volume that

includes guidelines on

screening, staging, clinical

guidelines, quality of life and

palliative care, pathology in

various resource settings and

international cancer data;

• To ensure the link to the

Cervical Cancer Guidelines

developed by a dedicated sub-

committee on Cervical Cancer

is placed on the FIGO website.

This has been accomplished

and this committee continues

to be very active and to forge

strong collaborations withP A G E 2 2


other national and internationalorganisations working incervical cancer prevention. Ameeting was held in Goa, Indiain March 2011 to co-ordinateand synergise efforts, as wellas to outline the Ethical issuesrelated to the inequity ofaccess of poor women toeither cervical cancerprevention or treatment as wellas HPV vaccination;

• To ensure that cervical cancerbe placed on the ‘healthagenda’ of developingcountries by disseminatingknowledge and understandingof the burden of cervicalcancer in these countries, andthe necessity of allocatingresources to cervical cancerprevention, early detection,treatment and palliation for theadvancement of women’shealth. This will be achievedthrough regional meetings,creation of educationalwebinars and linkage withsister societies to synergiseactivities;

• The totality of the healthimplications of cervical canceralso need to be framed withinthe context of the MDGs(Millennium DevelopmentGoals) and the FIGO OncologyCommittee is working closelywith the UICC and otherorganisations on the UnitedNations programme againstNon-Communicable Diseases(NCDs). This has become animportant focus of the UN anda high-level meeting to addressthe issue was held inSeptember 2011.

• To encourage all countries tocreate national cancerregistries to monitor diseaseincidence, with particularemphasis on cervical cancer,and to evaluate the impact of

various prevention of cervicalcancer strategies, such asscreening and vaccination. Tothis end, members of the FIGOOncology Committee havecollaborated with the WHO onupdating a comprehensive texton all aspects of cervicalcancer control andmanagement.

• To ensure that the rationalebehind HPV vaccination, thepotential benefits ofvaccination and theprogrammatic challenges areclearly understood by policymakers, health ministries andhealth care professionals;

• To advocate for theestablishment of adolescenthealth care infrastructure tofacilitate dissemination of theHPV vaccine and to use thisplatform for the promotion ofadolescent health; and

• To promote screening forsecondary prevention ofcervical cancer which isresource appropriate andevidence-based. In addition, topromote key messages andbest practice documentsproduced by FIGO and itscounterparts.

• To ensure effectivecommunication with all relevantstakeholder groups includingFIGO member societies,Women’s Health advocacygroups and educationalestablishments – includingthose representing other keyprofessional groups such asGeneral Practitioners,Paediatricians, Midwives, andNurses – Ministries of Health,and pharmaceutical companiesinvolved in the production ofHPV vaccines or cervicalcancer prevention activities.

The latest edition of the good

practice guidelines bookletprepared in collaboration with theInternational Gynecologic CancerSociety (IGCS) will be published.The publication includes chapterson site specific gynaecologicalcancers with the latest stagingand best-evidence basedguidelines for diagnosis andtreatment. All chapters have beenwritten by recognisedinternational experts in their fields.The report has added threeseparate chapters on Pathology,Chemotherapy and Radiotherapyand is aimed at health careworkers in both developed anddeveloping countries. A separatepublication on Palliative care inGynaecologic Oncology will bepublished in 2012/13 either as aseparate booklet or a journalsupplement.

The former Annual Report on the

Results of Treatment in

Gynecologic Cancer wassupervised by the Committee andco-ordinated by Immediate PastCommittee Chair ProfessorSergio Pecorelli and a dedicatedteam based in Milan, Italy withsupport from the EuropeanInstitute of Oncology. This grouphas performed outstanding workand ensured that the FIGOcancer staging is usedinternationally. They are to becongratulated and thanked.

Due to a number of factors thisreport will not be published untilthe next FIGO World Congress ofGynecology & Obstetrics in 2015,and will be incorporated into anupdated and retitled “FIGO

Cancer Report”. Currently newdata collection forms are beingdesigned and the OncologyInstitute of Catalonia, under theleadership of Dr Xavier Bosch,has agreed to help theCommittee design new and P A G E 2 3

simplified data collection forms,create a web-based data entrysite and to analyse both theintegrity and validity of the data.The interpretation of the data willbe supervised by a speciallyappointed Editorial Board. Aworldwide survey of allinternational FIGO affiliatedsocieties has been performedand the Committee has verifiedover 250 institutions that arewilling to contribute data onincidence, treatment modalitiesand survival of women withgynaecological cancers. Thesedata will be published in 2015 atthe next FIGO World Congress ofGynecology & Obstetrics.

In 2011, permission was grantedby the President of FIGO toexpand the Committee to creategreater regional and disciplinaryrepresentation. It was alsodecided not to include breastcancer as the responsibility of theCommittee as it was felt thatthere was not sufficient expertiseto allow this. However, plans arebeing developed for a FIGOWorking Group on Breast Cancerunder the auspices of theCommittee that will be chaired byProfessor Walter Jonat.

P A G E 2 4

Members of the FIGO Committee on GynaecologicOncology 2009–2012L Denny (Chair) South AfricaA Bermudez ArgentinaJ Cain* United States of AmericaK Fujiwara JapanN Hacker AustraliaE Å Lundqvist SwedenD Mutch United States of AmericaS Pecorelli ItalyJ Prat SpainM Quinn (Deputy Chair) AustraliaM A-F Seoud LebanonS K Shrivasta India

*Dr Cain is also Chair of the Sub-Committee on Cervical Cancer Prevention


FIGO Committee forReproductiveMedicine

Mission and ActivitiesThe FIGO Committee forReproductive Medicine (CRM)was one of two new “task-oriented” Committees establishedby FIGO’s Executive Board inOctober 2009.

The mission of the FIGO CRM isto create access to qualityreproductive medical care for allwomen of the world. The FIGOCRM is focused on helpinginfertile women become pregnant

and/or on alleviating the burdenof infertility.

FIGO CRM members haveparticipated in professionalmeetings lecturing on infertilitymanagement in low-resourcesettings at ASRM, ESHRE,FOGSI, ISAR, Al Azhar Universityin Cairo and FIGO annual boardmeetings. It has also developedMemoranda of Understandingwith the World HealthOrganization (WHO), InternationalPlanned Parenthood Association(IPPF), ESHRE, InternationalFederation of Fertility Societies(IFFS) and the International

Committee Monitoring ART

(ICMART) to collaborate on

achieving its goals. Additionally,

FIGO CRM has contributed

documents and participated in

the FIGO Committee on Capacity

Building in Education and

Training.

The FIGO Fertility ToolBox™The major activity of the FIGO

CRM is development of The FIGO

Fertility Tool Box™. This is a

“How To” document intended for

use by stakeholders in infertility to

provide a comprehensive and P A G E 2 5

integrated set of tools that willincrease access to treatment andprevention, and so reduce theglobal burden of infertility.

The FIGO CRM recognises andappreciates the vastly differentsocioeconomic, cultural, religiousand healthcare systems, andother differences among andwithin FIGO’s 124 membersocieties. Therefore, the FIGOFertility Tool Box™ focuses onuniversal principles, recognisingthat each country and region willdecide how to utilise thisresource in a unique way that ismost appropriate for them.

FIGO is comprised ofobstetrician/gynaecologistorganisations globally. The vastmajority of FIGO physicianmembers practice inenvironments with otherhealthcare providers such asmidwives and mid-level providers.Very few provide thetechnologically-sophisticatedaspects of fertility treatment suchas in vitro fertilisation (IVF) andother assisted reproductivetechnologies (ART) or performcomplex reproductive surgeries.Therefore, The FIGO Fertility ToolBox™ is directed towards mid-level primary women’s healthcarepractitioners who can providereproductive healthcare services,namely women’s health nurses,nurse-midwives, andobstetricians/gynaecologists.Importantly, the Tool Box is notintended to address the moresophisticated infertility treatments,despite their importance inmanaging infertility, but it doesinclude a Tool with instructions onappropriate referral to theseresources.

While the FIGO Fertility ToolBox™ is intended primarily forwomen’s healthcare providers, it

can also be used by policymakers/organisational leadersand patients. Different Tools areintended for use as appropriateand possible by stakeholders intheir unique situations.

Development of Tool BoxThe Tool Box was developedthrough a consensus processthat was initiated with aconceptual discussion of theglobal status of infertility, unmetneeds, problems and challenges,successes and failures of currentapproaches, the need forinnovation, and goals. This wasfollowed by a comprehensiveliterature search and identificationof the best evidence andinformation that would be used.Much discussion ensued tocreate The FIGO Fertility ToolBox™. The FIGO CRM focusedon reorganization and integrationof content in an innovative andtechnologically usable format.

Current StatusThe FIGO Fertility Tool Box™consists of 7 Tools:• Tool 1: The FIGO FertilityDaisy™ (Why you should careabout infertility)

• Tool 2: Personal Barriers• Tool 3: Societal Barriers• Tool 4: Diagnosis• Tool 5: Treatment• Tool 6: Referral/Resolution• Tool 7: Prevention.

These tools provide a

comprehensive approach to

infertility as both an individual and

a global problem. Application of

the principles of the Tool Box has

been initiated in three pilot

countries: Chile, India and South

Africa.

The Tool Box will be launched at

the FIGO World Congress of

Gynecology & Obstetrics in Rome

at the Pre-Congress course on

Sunday 7th October 2012 at

Hospital G B Grassi (Ostiaas),

and during the Congress on

Wednesday 10th October 2012

at 9.55am in Hall 9B in the

Scientific Session “Management

of Infertility in Low Resource

Settings”.

A programme to introduce and

teach the Tool Box to FIGO

national members societies,

thought leaders and other

stakeholders is available and can

be presented whenever a FIGO

meeting or FIGO related meeting

is held. Web dissemination and

teaching will be done through the

FIGO website.

FIGO would like to thank a

number of donors, including

Merck Serono Egypt and Institut

Biochimique SA, for supporting

the activities of the FIGO

Committee for Reproductive

Medicine.

P A G E 2 6

Members of the FIGO Committee for ReproductiveMedicine 2009–2012G D Adamson (Chair) United States of America

S Bhattacharya United Kingdom

J Collins Canada

E R te Velde The Netherlands

K Diedrich Germany

S Dyer South Africa

C Robinson United Kingdom

P C Wong Singapore

F Zegers Chile


FIGO Committee forSafe Motherhoodand Newborn HealthThe FIGO Committee for SafeMotherhood and NewbornHealth was originallyestablished in January 2004and aims to:• Act as a focal point for all FIGOactivities related to safemotherhood and newbornhealth;

• Oversee FIGO’s SavingMothers and NewbornsInitiative. The Committee willprovide support, supervise andtroubleshoot as required;

• Provide technical support tothe FIGO LOGIC Project and torespond to requests from thePresident and Chief Executive;

• Identify and present newopportunities and/or projectsfor FIGO;

• Monitor and, where agreed

and appropriate, participate ininternational initiatives aimed atimproving maternal andnewborn health such asPrevention of PostpartumHaemorrhage Initiative(POPPHI), Global Alliance toPrevent Prematurity andStillbirth (GAPPS), Maternaland Child Health IntegratedProgram (MCHIP) and anyother organisation that may berequested by the FIGO Officersor Executive Board. Committeemembers will ensure therepresentation of FIGO at thesemeetings, independently and incollaboration with ICM;

• Identify any other area whereFIGO might take an active rolein safe motherhood activitieswith a view to makingrecommendations to the FIGOofficers and Executive Boardby creating guidelines, positionpapers, etc.

• Act as a liaison, on behalf of

FIGO, with organisations

concerned with maternal or

child health such as the

Partnership for Safe

Motherhood & Child Health

(PMNCH), the Global Health

Worker Alliance (GHWA), and

the Maternal Health Task Force

(MHTF) by representing FIGO

at relevant and worthwhile

meetings.

• Establish close liaison with

WHO, UNFPA, UNICEF, IPA,

ICM.

Over the last three years, the

Committee has been very active

in its efforts to contribute to

maternal/newborn health. During

the period from 2009–2012, the

Committee has diversified its

work and has been working in

three areas:

• Taking a leadership role in

initiatives and advocacy aimed P A G E 2 7

at reducing maternal morbidityand mortality globally.

• Country projects in 10 low-resource countries.

• Representing FIGO at variousinternational fora.

FIGO SafeMotherhoodGuidelines

1. Task ShiftingIn 2009-2010 FIGO published theTask Shifting Paper and Guidelinedeveloped by the Committee.This calls upon all countries tomake sure that the healthprofessional closest to the patienthas the ability to use essentialmedications for given indications.

2. PPH GuidelinesThe PPH Guidelines have beenpublished in the May 2012 issueof the International Journal ofGynecology & Obstetrics. Thisinnovative Guideline talks aboutprevention and treatment of PPH.It starts with physiology andmoves to active management ofthird stage of labour and thendiscusses individual drugs andprocedures to treat PPH. Theseshould be made availablewherever a woman is birthing.

3. Breastfeeding in HIVPositive WomanThis Guideline was published inJune 2011 and addresses animportant issue in low resourcecountries.

4. Management of SecondStage of LabourThis quite extensive Guidelineaddresses a very urgent issue inobstetrical care given the rise incaesarean section, the decreasein instrumental delivery. There is aconcern that practicingphysicians are not properlytrained in the use of forceps, and

vacuum extraction. The Guideline

also defines staffing required for

safety in all birthing units.

5. Prevention of Rhdisease in lower resourcecountriesThis joint statement is now

produced with the International

Pediatric Association and will be

submitted to the World Health

Assembly in the next few weeks.

It calls upon all countries to

establish this as part of the

essential care in pregnancy.

Collaboration with other

organisations

1. WHO/PMNCH

a. Essential interventions

FIGO, with partners in ICM

and IPA, have worked for at

least three years through

PMNCH and WHO to reduce

the number of essential

interventions that are

proposed to health care

professionals in low resource

settings. These interventions

have been proven to be

lifesaving and they can be

applied in a graduated

manner in all units that offer

obstetrical care. These are

publicised by WHO and

available throughout the

world.

b. Countdown 2015

FIGO has worked hard to be

part of the Countdown 2015,

especially in regards to

maternal health and maternal

indicators. We have worked

very closely with WHO and

recently two members of our

Committee have been named

to the Countdown 2015

Maternal Group. These

indicators will be used for the

2013–2014 reports.

c. WHO PPH GuidelinesWe have collaborated in the

final review of these

Guidelines which offer advice

similar to those published by

FIGO, but using a different

method of recommendations.

Our recommendations are

also evidence based, but add

clinical experience in areas

where RCTs are lacking,

whereas the WHO Guidelines

are strictly based on review of

trials and leave very little

space for clinical practice

experience.

2. IPA (InternationalPediatric Association)We are discussing future projects

with IPA such as prematurity and

low birth weight. We hope to

continue this close collaboration,

which has been established with

joint representation at PMNCH.

3. ICM (InternationalConfederation ofMidwives)We have sent to the President of

ICM our Guidelines and have

asked for endorsement and/or

support. We have met the

President of the ICM in London,

UK to discuss the possibility of

having midwives represented on

our committee. They will be

discussing this at their next

executive meeting and we hope

that this will become a reality

soon.

4. MCHIPThis is a USAID programme that

is aiming to reduce maternal

mortality due to PPH and pre-

eclampsia. FIGO has nominated

its Chair, Dr André Lalonde, to

represent the organisation at

various meetings and

discussions. There is an on-going

discussion about a possibleP A G E 2 8


project with MCHIP that willoccur in the next 18 months.

FIGO Projects

1. FIGO Saving Mothersand Newborns InitiativeFinal ReportThe five-year project in 10low-resource countries has justended and the final report hasbeen submitted to SIDA. Theexternal evaluation by UK Optionsrevealed the wealth of positiveimpact of these projects in eachdifferent country. The projectswere all different, were all chosenby the country itself and/orconducted in collaboration with amentor from a high-resourcecountry. The tremendouschallenges faced by theseprojects were clearly met byOb-Gyn Societies in thesecountries and individualvolunteers. From a very smallbudget, the success andcontinuing involvement ofmembers of these countries inaddressing maternal health issuesis continuing. An example of amajor breakthrough was theUruguay Project. In a country withrestricted laws on abortion, wesucceeded in bringing a changein attitude of the health careprofessionals receiving womenwho had had or planned to havean illegal abortion. The public wasalso involved in forums wherethese were discussed and wherewomen were counselled that theonly drug safe for an abortionwas misoprostol. The Programmewas so successful that the finalreport was honoured to have thePresident of the country, theHonourable Jose Mujica, attendthe dissemination meeting wherehe declared that no womanshould die because of illegalabortion in Uruguay. This will

definitely become a model forprogress towards abortionservices in Latin America andother countries where restrictionof laws are great.

2. Booklet for FIGO WorldCongress of Gynecology& ObstetricsThe Committee Chair is workingon producing a booklet on the10-country FIGO Save TheMothers Projects. This willillustrate the Project outline, thechallenges and successes ofthese Projects.

3. FIGO Misoprostol forPPH ProjectFIGO has obtained a grant fromGynuity to run a misoprostol forPPH project for the next fouryears. Guidelines on theprevention and treatment of PPHwith misoprostol have beendeveloped and were submittedfor approval to the FIGOExecutive Board meeting in May2012.

4. FIGO LOGIC (GatesProject, Gates funded)The Committee has beencollaborating with the project andthe Committee Chair and Co-Chair are members of theAdvisory Team for support andsupervision of this Projectdirected from FIGO Headquartersin London under the direction ofProfessor David Taylor.

5. FIGO representationThe following are just someexamples of the representation ofCommittee members throughoutthe last three years:

a. FIGO Saving Mothers &Newborns InitiativeMost members of theCommittee have been busybeing utilised to providesupport-supervision to various

projects of the FIGO Saving

Mothers and Newborns

Initiative.

b. WHO

Drs Rushwan, Lalonde and

Okong have participated in

various meetings of WHO

towards the study of

Guidelines, position papers

and consensus documents.

c. MCHIP

Drs Hamid Rushwan and

André Lalonde

d. Gynuity

Drs Hamid Rushwan and

André Lalonde

e. PMNCH

Dr Lalonde finished

representation in late 2010.

The representatives of FIGO

have been Dr Pius Okong,

seconded by Dr Farrukh

Zaman.

f. GHWA

Dr Pius Okong

6. Special collaboration ofPre-Eclampsia/EclampsiaProjectDirected by Dr Peter Von

Dadelszen. The FIGO Committee

is collaborating with this project

which is set up for the next three

years.

FIGO WorldCongress ofGynecology &ObstetricsPreparation1. The Committee Chair has

been involved in preparation

of the FIGO World Congress

of Gynecology & Obstetrics.

We are coordinating three

symposia as well as

organising a pre-Congress

Workshop. P A G E 2 9

a. Maternal Mortality In Low

Resource Countries.

b. Postpartum Haemorrhage

Prevention and Treatment

Guidelines.

c. FIGO Saving Mothers

and Newborns Initiative

10-country reports.

2. FIGO Pre-Congress

Workshop: Postpartum

Haemorrhage. This will be a

didactic and practical session

given on Sunday 7th October

prior to the FIGO World

Congress of Gynecology &

Obstetrics.

Future ProjectConsiderations1. IPA/FIGO low birth weight

prematurity.

2. PPH treatment proposal. Thiswill be a large project toreduce PPH mortality andmorbidity.

3. PPH essential drugs and tray.4. Prevention of first caesarean

sections.5. NASG research collaboration.6. ICM representation on a

committee.7. Partogram.

ConclusionThe FIGO Committee for SafeMotherhood and NewbornHealth has nine standingmembers and a number ofcorresponding members (seelist below). Teleconferenceshave been held every sixweeks during these last threeyears and the Committee has

met every year, usually at the

time of another meeting in

order to reduce expenses. It

has been very active in

production of guidelines and

representation and keeping

FIGO members at the forefront

of discussions on maternal and

newborn health.

The FIGO Saving Mothers and

Newborns Initiative project

2006–2011 was the first FIGO

long term project involving a

partnership between countries

and within countries to reduce

maternal mortality and morbidity.

The final report and external

evaluation may be found on the

FIGO website at

http://www.figo.org/

projects/newborns.

P A G E 3 0

Members of the FIGO Committee for Safe Motherhoodand Newborn Health 2009–2012A Lalonde (Chair) Canada

P Okong (Co-chair) Uganda

A Abdel Wahed Jordan

L Adrien Haiti

S Z Bhutta Pakistan

P Dadelszen Canada

C Fuchtner Bolivia

C Hanson Germany

W Stones Kenya

Corresponding MembersS Arulkumaran United Kingdom

B Carbonne France

J Liljestrand Cambodia

S Miller United States of America

D Taylor United Kingdom

C Waite United Kingdom

Ex-officio MembersH Rushwan United Kingdom/Sudan

G Serour Egypt


FIGO Committee forWomen’s Sexual andReproductive RightsAt its meeting in Cape Town inOctober 1998, the FIGOExecutive Board approved theestablishment of a FIGO StudyGroup on Women's Sexual andReproductive Rights. Theactivities of the Working Groupwere so successful that it wasreinstated as a full Committeefrom 2001 under the leadershipof Dorothy Shaw. During herFIGO presidential term(2006–09) Dr Shaw workedtirelessly to raise the profile ofreproductive rights andwomen’s health. When theCommittee met in 2008, underthe chairmanship of Dr KaminiRao, FIGO had already agreedto produce a booklet that couldbe used by medical students toraise awareness of

reproductive rights issues andto clarify the terminology inuse.

Following the 2009 FIGO WorldCongress of Gynecology &Obstetrics, Professor LesleyRegan was invited to chair thecommittee in its nextdevelopmental stage – the designof a generic medical schoolcurriculum that integrates theteaching of women’s health andhuman rights, thereby ensuringthat the next cadre of qualifiedyoung doctors appreciate theimportance of a rights-basedapproach to women’sreproductive healthcare.

BackgroundWhen FIGO charged theCommittee with developing thiscurriculum, its membersrecognised the challenges ofdesigning an educational processthat could a) be adapted to the

local healthcare needs of women

and b) be accepted into the

myriad curricular requirements

and course work of medical

schools around the world. They

also realised that, to accomplish

this transformational change in

physician education, they must

respond to four demands:-

1. create generic tools that can

be adapted to local health

and educational needs;

2. make the materials easily

available and accessible;

3. ensure they are

understandable with minimal

training and easily delivered

so that instructors will

welcome the approach and

integrate the content into

established coursework.

The result is a competency-

based educational approach that

simultaneously advocates for

human rights and health, by P A G E 3 1

enhancing their wellbeing is less afunction of technology andsophisticated medical skills thanof changes in the way thatwomen access and benefit fromestablished standards of care.Such changes require us to alterthe way we educate our healthcare providers to uphold thehighest possible standards ofhuman dignity and health. Thetools and dissemination of theproject are designed to integratethe teaching of women’s healthand human rights within casestudies. The FIGO approachencourages medical faculties toadapt the framework to local andnational curriculum standards.

WSRR CurriculumObjectives1. Describe the medical

competencies and the humanrights principles that underpinthe delivery of high standardsof women’s health care.

2. Develop clinical case studiesthat promote inquiry aboutthe fundamental linksbetween human rights andquality health care around theworld.

3. Provide instructional tools forutilising the case studies andrights framework within awide range of learningenvironments.

4. Develop workshops for faculty(training the trainers) who canthen adapt the tools to theirlocal educational needs forteaching students and otherfaculty.

5. Conduct workshops atmeetings of professionalsocieties and educators todisseminate and improve thetools and methods in differentsettings.

6. Make the materials freelyavailable through FIGO via on-

site dissemination and

internet downloads.

7. Plan for global dissemination

using a variety of media,

including formal

presentations, interactive

workshops and

internet–based videos.

The WSRR curriculumproject – progress reportBy January 2010 the core

members of the new WSRR

working party (four ob/gyn

clinicians, a medical educator and

a reproductive rights lawyer) had

been identified and recruited to

the project. This talented group of

professionals met in London in

March 2010 in order to define the

project and determine how they

could produce a teaching

curriculum for clinicians in the

field of reproductive healthcare

based on human rights principles.

The first step was to draft an

outline document describing ten

universal human rights and the

health care competencies that

are necessary to ensure them in

the course of daily medical

practice. It was proposed that

each statement of rights would

be accompanied by a case study

or exemplar, references to

relevant medical, ethical and legal

literature and followed by a list of

specific discussion questions that

would guide the student and

teacher to consider local

practices, laws and governance.

The Committee recognised that

guidelines for the teachers of this

new curriculum would need to be

produced along with

recommendations for

dissemination and

implementation in medical

schools around the world. A

provisional plan and time frame

for future work was consideredP A G E 3 2

Integrated Human Rights and Women’sHealth Check list to DetermineCompetencies for Clinical PracticePhysicians must be able to apply the principles ofhuman rights to the daily practice of women’shealth care.1. Right to life: Everyone has the right to life.2. Health: Everyone has the right to the highest

attainable standard of physical and mentalhealth.

3. Privacy: Everyone has the right to respect forprivacy in the field of health care.

4. Confidentiality: Everyone has the right toconfidentiality in relation to information onhealth care and health status.

5. Autonomy and decision making: Everyone hasthe right to autonomous decision-making inmatters concerning their health.

6. Information. Everyone has the right to receiveand impart information related to their health.

7. Non-discrimination: No one shall be subject todiscrimination on any grounds in the course ofreceiving health care.

8. Right to decide number and spacing of children:Everyone has the right to decide freely andresponsibly on the number and spacing ofchildren and to have access to the information,education and means to enable them toexercise these rights.

9. Freedom from inhumane and degradingtreatment: Everyone has the right to be freefrom torture or cruel, inhuman or degradingtreatment or punishment in the field of healthcare:

10. Benefit from scientific progress: Everyone hasthe right to enjoy the benefits of scientificprogress and its applications.

developing standards forperformance and tools for trainingteachers and students in both theclassroom and clinical settings.The competencies are currentlydescribed for graduating medicalstudents; however the materialsand the approach could easily beadapted for use in training a widevariety of individuals in the healthcare and legal professions. Thisapproach recognises the fact thatsaving the lives of women and


and approved by the FIGOExecutive Board in June 2010.

The WSRR committee met againin May 2011 in London to finalisethe list of ten human rights andthe Sexual and ReproductiveHealth care competencies thatneeded to be developed tocomplement them. A finaldocument of competenciesembedded into a framework often human rights was producedalongside plans and a timetablefor dissemination and thesedocuments were presented to theFIGO executive board meetingheld in Mexico City in June 2011.This included a request to hold aplenary session and a trainingworkshop at the Rome 2012FIGO World Congress ofGynecology & Obstetrics. TheFIGO Executive Board approvedthe human rights checklist andcompetencies in autumn 2011and agreed that the project wouldbe enhanced by the addition ofcase studies and referencematerials.

During the next six months draftoutlines for case studies toillustrate the human rights andhealth care competencieschecklist were proposed by theWSRR team. The Committeeheld a weekend workshop inJanuary 2012 at which theyreviewed and completed theediting for eight of the ten clinicalcase studies which now includethe case narrative, questionsspecific to each and references.The references have beendeliberately weighted moreheavily towards human rightsstandards on the assumption thatmedical teachers and theirstudents have more ready accessto texts and references describingthe health conditions than theydo human rights literature. There

is a common theme to the fiveover-arching questions beginningwith the medical dilemma and thethreat to rights, then progressingto explore the complexities of therelationship of health and rightsfor the case scenario and for thegeneral health care system whichis in place locally for that studentand teacher.

List of five over-archingquestions1. What is the nature of the

health care problem?2. What is the threat to human

rights posed by the scenario?3. How does the health care

system support or infringehuman rights?

4. What are the local regulationsgoverning delivery of care?

5. How can the health caresystem be improved torespect human rights andensure health care?

The WSRR Committee welcomedFIGO President-Elect ProfessorSir Sabaratnam Arulkumaran onthe second day of their January2012 workshop and heparticipated in the discussion andediting of one of the cases. It wasencouraging to note howrelatively easily a newcomer tothe project could both follow theformat and swiftly move to aposition in which they wereactively contributing. Followingthis meeting, Professor Reganwas invited to present a conceptdocument for the project togetherwith plans for dissemination andimplementation to the Presidentand Chief Executive of FIGO, inorder to inform them of thefinancial resources that will berequired to ensure that thecurriculum project is successfullycompleted.

In May 2012 a small subgroup of

the WSRR Committee met againfor a weekend workshop tocomplete the last two cases andreference materials and now needto start designing the format ofthe teaching materials guide andcurriculum assessment tools. TheCommittee will hold their nextmeeting in Rome during the FIGOWorld Congress of Gynecology &Obstetrics in October 2012 butwill be using every opportunitybefore that to start disseminatingits project in the form ofpresentations and interactiveworkshops. For example, DorothyShaw and Lesley Regan pilotedthe first interactive workshopentitled “Women at the centre offamily health: a human rightsapproach” at the Royal Society ofMedicine’s Global Healthconference held in London inMarch 2012. The workshopsparked considerable interest andmany requests for furtheropportunities by both ob/gynphysicians and medicaleducators.

Plans for the FIGO WorldCongress of Gynecology& Obstetrics in Rome –October 2012The WSRR Committee has beengiven the opportunity todisseminate its project at the nextFIGO World Congress ofGynecology & Obstetrics to beheld in Rome. A plenary sessionentitled “Integrating HumanRights and Health – introducingthe FIGO project to transformwomen’s healthcare” is scheduledfor Monday 8th October. The aimis to attract global leaders inwomen’s health and HumanRights, representatives of ob/gynspecialist societies, together withEducation and Ethics teachers,as the target audience. Followingan introduction and brief history P A G E 3 3

of the project by Dorothy Shaw,

the core Committee will describe

the educational tools they have

developed and demonstrate how

the checklist of Human Rights

can be applied to an individual

case study and hence easily

incorporated into the day to day

teaching of women’s reproductive

health. This will be followed by a

moderated panel discussion with

the audience invited to

participate. At the end of this

plenary session the audience will

be invited to download and use

the educational materials on the

FIGO website and to register for

the Congress workshop on

Tuesday 9th October 2012.

This interactive workshop

“Integrating Human Rights and

Women’s Health into your

educational and clinical practice”

has been designed for invited

leaders from national societies

and training colleges who will

have the opportunity of role

playing a health care encounter

and leading a rights-based

discussion. In this way it is hoped

to recruit a cadre of future

trainers who will help to

disseminate the project more

widely across the globe. Every

workshop participant will be

actively encouraged to contribute

critical feedback in order to

improve and refine the materials

and tools that are being

developed.

SummaryThis is an ambitious

transformational project that is

still evolving. The WSRR

Committee is not writing atextbook which would be arelatively simple task. Instead theyhave been charged withdeveloping a novel medicalcurriculum to train the next cadreof young doctors about theimportance of Sexual andReproductive Healthcare. Thiscurriculum aims to moveWomen's Health andreproductive needs from themarginal position that theycurrently occupy in most curriculato mainstream thinking. The goalis to turn the tables on traditionalapproaches to medical teachingand student learning and ensurethat in the future Sexual andReproductive Healthcare teachingand practice has a central focusbased on Human Rightsprinciples.

P A G E 3 4

Members of the FIGO Committee for Women’s Sexualand Reproductive Rights 2009–2012L Regan (Chair) United Kingdom

P C Ho Hong Kong

D Magrane United States of America

D Apter Finland (2009–11)

A Faúndes Chile (2011–12)

S Munjanja Zimbabwe

Legal ResourceC Zampas United States of America (2009–11)

A Lamackova Croatia (2010–12)

Collaborating AgenciesB Crane Ipas

K Culwell IPPF

M Haslegrave Commat

S Kabir BRAC UK

E Kismodi World Health Organization

N Ortayli UNFPA

K O Rogo The World Bank

S Schlitt Amnesty International


P A G E 3 5

FIGO Working Groupon the Prevention ofUnsafe AbortionIn January 2007, the FIGOExecutive Board approved theestablishment of a FIGOWorking Group on thePrevention of Unsafe Abortion.

The aims of the Working Groupare:• To understand the extent towhich unsafe abortion poseshealth risks to women in themember countries/territories ofFIGO, and the policy andservice delivery factors thatneed to be addressed toreduce the size of the problem;

• To build national andinternational consensus for

overcoming the constraints to

providing evidence-based

methods for reducing the

burden of unsafe abortion;

• To increase awareness of

ob/gyn professionals about

their ethical obligations to

increase women’s access to

evidence-based methods and

solutions for reducing the

burden of unsafe abortion;

• To develop situational analyses

on unsafe abortion in FIGO’s

member countries and

territories;

• To organise national

workshops to construct plans

of action to reduce unsafe

abortion, based on the results

of the situational analyses;

• To organise regional

workshops to develop

collaboration between

countries and territories;

• To follow up on the

implementation of

national/regional plans for

reducing the burden of unsafe

abortion;

• To identify potential areas of

collaboration and engagement

between ob/gyn professionals

with other stakeholders in the

civil society; to promote and

advance women's access to

safe abortion and post-

abortion services; and

• To develop – in consultation

with allied organisations such

as IPPF, ICM, WHO, UNFPA

and Ipas – statements, position

papers, guidelines and policy

P A G E 3 6

documents on the followingtopics:– Education and evidence-based information providedto women

– Creating awareness onevidence-based methods ofcontraception (incollaboration with otherprofessional associations,such as midwifery andnursing associations)

– The empowerment ofwomen

– Documenting and obtainingcountry specific data onunsafe abortion, needed forspecific actions withinindividual countries andterritories

– Advocacy by FIGO tonational societies, andadvocacy by nationalsocieties to their localpolicymakers andcommunities

– Promotion of pre-servicetraining on methods ofmanaging safe abortion andthe complications of unsafeabortion, and thedecentralisation of theseprocedures to mid-levelproviders

– Exchange of experiences onabortion between FIGOmember countries andterritories

• Membership should be multi-national, multi-cultural, andpossibly multi-disciplinary.Ideally, it should be drawn fromcountries with differentexperiences on abortion – fromcountries that have always hadliberal abortion laws, thosewho moved from a regime ofrestrictive laws to more liberallaws, and those who havealways had different forms ofabortion restrictions. This willencourage exchange of

information and views withinthe group. While the groupshould encourage diversity ofopinion among the groupmembers, we believe thatextremists on both sidesshould be excluded in ordernot to derail the work of theGroup;

• The Group should include oneor two non-FIGO memberswith long standing experienceworking on unsafe abortion. Agood representation by womenwould also be critical; and

• The Working Group shouldwork in collaboration with theFIGO Committee on WomenSexual and ReproductiveRights, but should beindependent of the Committeeand should report directly tothe FIGO Officers and theExecutive Board.

The Working Group works incollaboration with the FIGOCommittee on Women’s Sexual &Reproductive Rights.

The FIGO initiative for thePrevention of Unsafe Abortion isfinancially supported by a grantfrom an anonymous donor. Theproject has two phases:• Phase one started with aninvitation to FIGO membersocieties to participate in theinitiative, giving priority tocountries with an inducedabortion rate of 30 per 1,000women 15-44 or an unsafeabortion rate of 10/1000.Those who agreed toparticipate were required toname a focal point and to carryout a situational analysis of theunsafe abortion situation intheir respective countries. Aftercompletion of the analysiseach country was to hold anational workshop with theparticipation of the government

and other interested parties todiscuss the results and set thebases for the development ofan action plan that respondedto the deficiencies identified bythe analysis. Those plans ofaction were to be adopted as acountry commitment by thegovernment and the civilsociety.

The next step was to organise aregional workshop in each ofseven regions, where the differentproblems and actions to solvethem were presented and therepresentatives of thegovernments would be asked tocommit themselves toimplementing the plan of actionduring the ensuing two years.• Phase two consists of theimplementation of an actionplan by each country. Thisphase originally extended fromthe launching of the action planuntil November of 2009. Lateron it was extended for anunlimited period, in theunderstanding that theproblem of unsafe abortion andits consequences was notgoing to be completely solvedin a relatively short period oftime.

All these activities were carriedout in collaboration with anumber of other internationalorganisations and governmentalagencies that have similarobjectives.

Management Structure ofthe ProjectA Project Coordinator wasnamed, who is also the Chair ofthe Working Group, avoidingduplications and overlapping offunctions. The projectCoordinator reports directly to theFIGO President and ChiefExecutive. The FIGO Secretariat


P A G E 3 7

provides general administrativesupport.

The Project Coordinator identifiedand contacted six RegionalCoordinators, one for each of thesix regions of the world includedin the project. The ProjectCoordinator commits 100% of histime to the project and theRegional Coordinators between25% and 30% of their time. TheProject Coordinator (AnibalFaúndes) is based in Campinas,SP, Brazil; the original RegionalCoordinators were as follows:Luis Távara for Latin America inLima, Peru; Robert Leke forWestern and Central Africa(WCA), in Yaounde, Cameroon;Florence Mirembe for Eastern-Central-Southern Africa (ECSA),in Kampala, Uganda; EzzeldinOsman Hassan for North Africaand Eastern Mediterranean(NAEM), in Cairo, Egypt; ShahidaZaidi for South-Southeast Asia(SSEA), in Pakistan; and StelianHodorogea for Eastern-CentralEurope (ECE), in Chisinau,Moldova. An Assistant RegionalCoordinator for Central Americaand the Caribbean (CA&C) wasalso identified and enrolled in theproject – Dr Marina Padilla, basedin San Salvador, El Salvador.

A few changes in the RegionalCoordinators have occurred overtime. Since 2009, the AssistantCoordinator CA&C becameRegional Coordinator becauseLatin America had more thantwice the number of countriesthan any other region, and wasdivided into South America (SA)and Central America and theCaribbean. In addition DrFlorence Mirembe requested thatshe be replaced by Dr JosephKaranja who was the regionalCoordinator for ECSA during2010 and 2011, when he also

asked to step down. The currentRegional Coordinator for ECSA isDr Guyo Jaldesa, from Nairobi,Kenya.

The focal points from eachparticipating member societycomplete the managementstructure of the project.

Scope of the FIGOInitiative for thePrevention of UnsafeAbortion and itsConsequencesThe 43 countries whichcommitted to implement plans ofactions approved by thegovernment were: Eight fromCentral America and Caribbean(Costa Rica, Cuba, DominicanRepublic, El Salvador, Guatemala,Honduras, Nicaragua andPanama), eight from SouthAmerica (Argentina, Bolivia,Brazil, Chile, Colombia, Peru,Uruguay and Venezuela), five fromWestern Central Africa (Benin,Cameroon, Côte d’Ivoire, Gabon,Nigeria), seven from EasternCentral Southern Africa(Ethiopia, Kenya, Mozambique,South Africa, Tanzania, Uganda,Zambia), five from NorthAfrica/Eastern Mediterranean(Egypt, Syria, Sudan, Tunisia,Turkey), six from South-Southeast Asia (Bangladesh,India, Nepal, Pakistan, Sri Lanka,Thailand), and four from Centraland Eastern Europe (Georgia,Kyrgyzstan, Macedonia,Moldova).

During the last three years therehave been a few changes: Since2011 we have lostcommunication with the Syriansociety, meaning that we arecurrently working with only fourcountries in the NAEM region.Other countries in that regionhave shown interest in being part

of this FIGO Initiative and haveattended some of the RegionalWorkshops, but have failed toprepare a situational analysis andplan of action as yet. They areIraq, Lebanon and Jordan. In theCA&C region there has been amisunderstanding between theNicaragua Government andFIGO, causing a temporarysuspension of communication,which should be resolved soon.

In the South America region,Ecuador had originally prepared aplan of action, but in 2008 haddecided not to participate in theinitiative. In 2011, however, itrequested re-admission, prepareda plan of action, which waspresented at the last RegionalWorkshop of 2012, and has beenofficially admitted as part of thisFIGO Initiative. Finally, Cambodiaexpressed interest in being partof this initiative, so much so thatthe last Regional Workshop forSSEA was held in Phnon Penh,Cambodia. It means that SA hasnow nine member societies andSSEA has seven countries, whilethe total number increased to 44,in spite of the temporary loss ofSyria.

Implementation of theplans of actionDuring the period from November2009 to 2012, the 43 membersocieties have continued with theimplementation of their plans ofaction, with different levels ofachievement. It should beremembered that most societiesdo not have the capacity ofproviding services, but many areactively involved in training andinfluence their governments andprovide political support to anumber of international andnational agencies for theimplementation of the activitiesincluded in the plans of action.

Plans of ActionThe FIGO Working Group on thePrevention of Unsafe Abortionhas proposed that the Plansinclude all or some of the fourlevels of prevention: PrimaryPrevention, to reduce unintendedpregnancies and abortions;Secondary Prevention, to makeunavoidable abortion safer;Tertiary Prevention, for timely andcorrect treatment of abortioncomplications; and QuaternaryPrevention, to reduce therepetition of abortion. Examplesof these four levels of preventionwill be presented at the Sessionon Prevention of Unsafe Abortionat the FIGO World Congress ofGynecology & Obstetrics 2012, inRome.

A number of international andnational agencies and NGOs areworking in all or some of thesefour prevention strategies.Consequently, they arecontributing to theimplementation of the plans ofaction in the different countries.The list of collaborating agenciesis large and includes:1. ACMS2. Amnesty International3. CLACAI4. Concept Foundation5. EngenderHealth6. Family Care International (FCI)7. Global Doctors for Choice8. Gynuity9. Ibis10. ICMA11. Ipas12. IPPF13.Marie Stopes14.MSI/K15. OPS/OMS16. Orientame/ESAR17. PAHO/CLAP18. PATH19. Pathfinder20. Population Council

21. PSI22. RHN23. RHRA(PPFA)24. UNFPA25. UNICEF26.WHO

The plans of action are dynamicand change over time. As someof the objectives areaccomplished new ones areadded to the plan or the sameobjective is expanded to servelarger populations orgeographical areas. Mostcountries have achieved greatprogress, but mostly haveunderstood and adopted theconcept that abortion is aproblem that exists, cannot beignored for its public healthsignificance and its meaning towomen’s lives, and consequently,action needs to be taken toreduce its number and itsconsequences.

FIGO support for theimplementation of theplans of action

The main mechanisms throughwhich the FIGO Initiative has toensure that the plans are properlyimplemented are the frequentcommunications with the focalpoints and the collaborativeagencies, the monitoring visits bythe Regional Coordinators andthe General Coordinator to thecountries, and the RegionalWorkshop, one for each of theseven regions every year.

All focal points have beencontacted periodically to check ifthey need assistance, particularlyin their contact with agencieswhich are potential collaboratorswith different components of theplans.

It is convenient for the continuityof the execution of the plans ofaction that the focal points remain

in their position for a long period

and do not change with each

new society directive. In fact, they

have remained largely the same

since the beginning of the project,

although some societies have

changed the focal point every two

years or so. It is interesting that in

many countries, the government

representative in charge of the

plan of action has also remained

the same even after changes in

the respective national

government.

The monitoring visits to each

participating country are carried

out by the Regional Coordinators

at least once a year and

sometimes more than once a

year, with a few exceptions. The

General Coordinator also

collaborates with such visits after

special requests from the country

or when there are political or

geographic limitations for the

Regional Coordinator (for

example, Dr Tavara does not

tolerate the high altitude of La

Paz, capital of Bolivia; Dr Zaide

has had problems in getting a

visa for India).

The Regional Workshops are

carried out once a year, with the

attendance of at least the

society’s focal points, one

representative of the Ministry of

Health and representation from

the agencies that collaborate in

the implementation of the plans.

Sometimes the societies and the

governments send additional

members, such as the President

of the national society or more

than one representative from the

government.

The following table shows the

sites and dates of the Regional

Workshops carried out in 2010,

2011 and 2012.P A G E 3 8


P A G E 3 9

Colombo, Sri LankaJune 13 and 14

Dhaka, BangladeshAugust 1 and 2

Phnom Penh, CambodiaJune 9 and 10

SSEA SiteDates

Istanbul, TurkeyJuly 13 and 14


Riga, LatviaMay 28 and 29

ECE SiteDates

Alexandria, EgyptMay 10 and 11


Istanbul, TurkeyMay 9 and 10

NAEM SiteDates

Alexandria, EgyptMay 10 and 11

Momabasa, KenyaJuly 28 and 29

Johannesburg, S. AfricaMay 7 and 8

ECSA SiteDates

Douala, CameroonJune 24 and 25

Cotonou, BeninJuly 20 and 21

Yaounde, CameroonMay 15 and 16

WCA SiteDates

Panama, PanamaJune 29 and 30

Panama, PanamaAugust 8 and 9

San Jose, Costa RicaMay 31 and June 1

CA&C SiteDates

Lima, PeruJuly 2 and 3

Lima, PeruJuly 11 and 12

Lima, PeruMay 28 and 29

SA SiteDates

Region 2010 2011 2012

In addition, during 2011 and

2012 we obtained financial

support from the anonymous

donor to offer emergency funds

of up to US$15,000 to a group of

17 priority countries, when some

activities included in the plans of

action got delayed due to a delay

in obtaining funding from other

sources. These priority countries

are four from SSEA (Bangladesh,

Nepal, Pakistan and Sri Lanka),

six from ECSA (Ethiopia, Uganda,

Kenya, Tanzania, Zambia and

Mozambique), four from WCA

(Ivory Coast, Cameroon, Benin

and Gabon), two from CA&C

(Nicaragua and Honduras) and

one from SA (Bolivia). Most, but

not all, countries have benefited

with these funds.

The futureAs expressed earlier, the task of

reducing unsafe abortion and its

consequences is not an easy one

and cannot be achieved in a

short period of time. Thus, the

FIGO Officers believe that the

Working Group and the FIGO

Initiative for the Prevention of

Unsafe Abortion should continue

its work for the foreseeable futurewith the same or a different team.Moreover, it is possible that a fewadditional societies may join thisFIGO Initiative. The current donorhas expressed its intention to

continue its support and a newthree-year proposal is beingreviewed. The whole team iscommitted to continue workingregardless of the financialsituation.

Members of the FIGO Working Group on thePrevention of Unsafe Abortion 2009–2012A Faúndes (Chair) Brazil

K Gemzell Sweden

S Hodorogea Moldova

G W Jaldesa Kenya

E Osman Hassan Egypt

M Padilla de Gil El Salvador

I Shah Switzerland

D Shaw Canada

L Tavara Peru

S Zaidi Pakistan

Partner organisationsK Culwell IPPF

B Ganatra World Health Organization

N Ortayli UNFPA

B Crane Ipas

S Chowdhury The World Bank

S Schilt Amnesty International

P A G E 4 0


FIGO Working Groupon Pelvic FloorMedicine andReconstructiveSurgery

The FIGO Working Group in

Pelvic Floor Medicine and

Reconstructive Surgery was a

proposal accepted by FIGO in

2006.

The current proposed

denomination is Pelvic Floor

Medicine and Reconstructive

Surgery, Pelviperineology or

Pelvic Floor Dysfunction and

Reconstructive Surgery

denominations that included

genital prolapse, urinary

incontinence, faecal incontinence,

vesicourethral dysfunction, pelvic

floor rehabilitation, genital fistulaeand pelvic pain syndrome.

Due to the advances of theseareas aimed at giving adequatehealth care tools to obstetriciansand general gynaecologists,residents and fellows is that wehave convened internationalopinion leaders independently ofthe society they belong to.

Upon this basis, we have workedfollowing an action plan with theobjectives outlined in threesubgroups:

Subgroup 1: “EducationalProgramme on Pelvic FloorMedicine and ReconstructiveSurgery”, Chairman: MortonStenchever;

Subgroup 2: “Pelvic FloorDysfunction Classification”,Chairman: Stefano Salvatore;

Subgroup 3: “Pelvic Organ

Surgery in Women”, Chairman:

Mohamed Hefni.

Our goal is to identify the

knowledge and skill that should

be required from each of the

three educational levels, which

concerns to OB/GYN:

Level 1: General obstetrics and

gynaecology practitioners

Level 2: OB/GYN Residents

Level 3: Pelvic Floor Medicine

and Reconstructive Surgery

fellows

Due to the impact of quality of life

and the socioeconomic one of

this area that have numerous

aspects under discussion, is that

we try to give care tools to the

different groups that work in

OB/Gyn.

P A G E 4 1

Subgroup 11. The initial proposal of

guidelines corresponding tothis subgroup (FIGOguidelines for trainingresidents and fellows inUrogynaecology, femaleurology and female pelvicmedicine and reconstructivesurgery. International Journalof Gynecology and Obstetrics107 (2009) 187-190) weredeveloped and published.

2. A brief questionnaire wasconstructed in order to knowthe point of view of theOB/GYN societies of eachcountry.

3. The outcomes of thequestionnaire show the needof adding to these answers,societies from other countriesin order to obtain globalizeand agreed educationalobjectives in the differentlevels of OB/GYN care. Thegood news is that we did getan assortment of replies fromboth developed anddeveloping countries.

4. In January 26–28 2012 ameeting of the FIGO WorkingGroup with the threesubgroups was held in Rome,Italy. The main proposal wasto offer FIGO minimum globalrequirements of knowledge inthis area.

5. In the near future we aim atdeveloping learning andenabling objectives for theFIGO objectives.

Subgroup 2

1. Up to this moment theclassification of the PelvicFloor lesions were addressedto the acknowledgement ofthe magnitude of thesymptoms and the signs ofpelvic dysfunctions accordingto the classification of Baden

y Walker, POP-Q or ModifiedPOP-Q (Swift S., et al. IntUrogynecol J 2006; 17:615-620).

The first step was to analysethe existing classifications andthe frequency with which theywere used in the differentOB/Gyn centres.

A score was made based onsymptoms, signs and a formof quality of life questionnairewith an holistic concept ofPelvic Floor Dysfunction wasaccepted in the meeting inRome last January.

2. We have been working duringthese years in designing andvalidating an holistic score.

3. Plans for the future

Further testing of these FIGOpelvic floor dysfunctionassessment-scoring systemswill be performed in order toassess their ability to provideprognostic information onoutcomes. In addition, we willassess their ability todetermine response totherapies of various levels ofcomplexity ranging from non-invasive behaviouraltreatments to complicatedsurgical procedures.

Subgroup 3

1. Due to:• The different therapeuticalproposals

• The different designs aboutthe material and theanalysis of the surgicaltherapeutical answers

• The different criteria in theconsideration of cure/improvement

• The numerous proposedtechniques

• The interpretation of thegrades of evidence that

allow delimiting grades ofrecommendation, is thatspecific groups wereestablished for theconsideration of thetreatment of pelvicreconstructive surgery.Group 1: “Anteriorcompartment repair”Group 2: “Posteriorcompartment repair”Group 3: “Middlecompartment includingvaginal vault prolapse”Group 4: “Surgery ofurinary incontinenceincluding intrinsic sphincterdeficiency”

2. The bibliography of the last 10years and the proposal of theuse of different medicaldevices for the treatment ofpelvic floor dysfunction andreconstructive surgery wereanalysed.

Taken into account were:• The FDA alert communicationof July 13, 2011 and others.

• Due to the fact that manyreports come from centres withconflict of interests, we countwith the importantcollaboration of Subgroup 3 inorder to give FIGO asepticinformation based on levels ofevidence and grades ofacknowledgement togetherwith the agreed opinion ofinternational leaders.

• Recommendations withbibliography and level ofevidence andRecommendations based onexperience and expert opinionreferred to each one of thesurgeries, risk factors,recommended procedures thatwill be presented during theFIGO World Congress ofGynecology & Obstetrics inRome.

P A G E 4 2

Members of the Working Group on Pelvic FloorMedicine and Reconstructive Surgery 2009–2012Oscar Contreras Ortiz (Chair) Argentina

Subgroup 1: “Educational Program on Pelvic Floor Medicineand Reconstructive Surgery”

Morton Stenchever (Chair) United States of America

Diaa E Rizk Egypt

Gabriele Falconi Italy

Adolf Lukanovic Slovenia

Subgroup 2: “Pelvic Floor Dysfunction Classification”

Stefano Salvatore (Chair) Italy

Teresa Mascarenhas Portugal

Adolf Lukanovic Slovenia

Diaa Rizk Egypt

Steven Swift United States of America

Alessandro Di Gesu United Kingdom

Jittima Manonai Thailand

Vik Khullar United Kingdom

Suzy Elneil United Kingdom

Ruwan Fernando United Kingdom

Subgroup 3: “Pelvic Organ Surgery In Women”

Mohamed Hefni (Chair) United Kingdom

Oscar Contreras Ortiz Argentina

Christian Falconer Scandinavia

Carlos Medina United States of America

Heinz Koebl Germany

Giuliano Zanni Italy

Fillipo La Torre Italy

Harry Vervest The Netherlands

Sherif Mourad Egypt

Bruce Farnsworth Australia

Stergios Doumouchtsis United Kingdom

Jorge Milhem Haddad Brazil

Eckhard Petri Germany

Mauro Cervigni Italy

Michelle Fynes United Kingdom

Masayasu Koyama Japan

Ajay Singla United States of America

Elisabetta Costantini Italy

Ajay Rane Australia

Ali Abdel Raheem Egypt

Helio Retto Portugal

Martin Jomaa Sweden

Biagio Adile Italy

Mickey Karram United States of America

Christiana Nygaaard United Kingdom


P A G E 4 3

FIGO Working Groupon MenstrualDisordersThe FIGO Working Group on

Menstrual Disorders was

formally established in 2006 in

order to extend the progress

made at two initial Workshops

convened in Paris in April 2004

and in Washington in February

2005 to explore agreements on

terminologies, definitions and

classifications around

abnormal uterine bleeding

(initially focussing on

coagulopathies).

Its main objectives during the

2009–2012 “term” have been:

• To bring together a small group

of experienced individuals to

provide an international review

and recommendation process

around developing issues in

the fields of menstruation and

menstrual disorders;

• To, initially, finalise and publish

a series of documents settingout internationally agreedrecommendations forterminologies and definitionsaround normal and abnormalmenstruation;

• To publish a document, forinternational debate, with newdirections for the classificationof causes underlying abnormaluterine bleeding for use atfamily practitioner, specialistand research levels;

• To develop a program forwidespread dissemination ofproposed menstrualterminologies, definitions andcauses, and revision ofinternational documentation;

• To develop a structuredmenstrual history questionnairefor widespread clinical use;

• To further define the issueswhich affect the burden ofillness from menstrualdisorders in different cultures;

• To identify, investigate andmake recommendations on

other matters relevant tomenstrual disorders, whichrequire an internationalperspective; and

• To review and update these“living documents” on anapproved, regular basis(nominally at the time of eachFIGO World Congress).

Immediately prior to the FIGOWorld Congress held in CapeTown in 2009, a very successfulPre-Congress Workshop washeld to plan the next three yearsof work and the publicationstrategy. This Workshop alsofinalised the content of anextremely successful two-hoursymposium on ‘Abnormal UterineBleeding’, which was held duringthe main part of the scientificCongress. This symposiumsuccessfully incorporatedaudience responder questions,which gave valuable insight intoaudience understanding.

Over the last three years,

P A G E 4 4


significant progress has beenmade. Many of the ideas from theCape Town Congress have beendeveloped into publications (seebelow). Notably, a whole issue ofthe journal ‘Seminars inReproductive Medicine’ with eightseparate chapters on aspects ofabnormal uterine bleeding waspublished in September 2011.Various individuals associatedwith the Group have spoken atmany meetings in differentcountries, and the FIGOmessages are now being widelydisseminated. There have beenmany positive reactions to theFIGO MDWG proposals andmany organisations haveaccepted that these offer a usefulbasis for international agreement.The FIGO Executive Board haskindly approved – after dueconsideration – all the proposalson terminologies, definitions andclassification of underlying causesof AUB from the Working Group,and these now appear on theFIGO website.

Recent work has focussed onpreparations for the FIGO WorldCongress in Rome, October2012, where anotherPre-Congress Workshop isscheduled, followed by a majorsymposium in the Congress on“Current Challenges in Abnormaluterine Bleeding”. It is recognisedthat there continue to be severalareas of immediate importancewithin the ambit of abnormaluterine bleeding which requirefuture research and internationalattention. The Working Group hasalready identified an importantwork plan for the next threeyears.

PublicationsThirty publications have alreadyresulted from the work of theGroup since 2005:

2005:Munro MG, Lukes AS, AUBConsensus Group. Abnormaluterine bleeding and underlyinghemostatic disorders: report of aconsensus process. Fertil Steril2005; 84: 1335–1337.

Lukes AS, Kadir RA, Peyvandi F,Kouides PA. Disorders ofhemostasis and excessivemenstrual bleeding: prevalenceand clinical impact. Fertil Steril2005; 84: 1338–1344.

Kouides PA, Conard J, PeyvandiF, Lukes AS, Kadir RA.Hemostasis and menstruation:appropriate investigation forunderlying disorders ofhemostasis in women withexcessive menstrual bleeding.Fertil Steril 2005; 84:1345–1351.

Kadir RA, Lukes AS, Kouides PA,Fernandez H, Goudemand J.Management of excessivemenstrual bleeding I women withhemostatic disorders. Fertil Steril2005; 84: 1352–1359.

Fraser IS, Bonnar J, Peyvandi F.Requirements for researchinvestigations to clarify therelationships and management ofmensyrual abnormalities inwomen with hemostaticdisorders. Fertil Steril 2005; 84:1360–1365.

2007:Fraser IS, Critchley HOD, MunroMG, Broder M. Can we achieveinternational agreement onterminologies and definitions usedto describe abnormalities ofmenstrual bleeding?

Hum Reprod 2007; 22:635–643; Simultaneouspublication in Fertility and Sterility;

Fraser IS, Critchley HOD, MunroMG, Broder M. A processdesigned to lead to international

agreement on terminologies anddefinitions used to describeabnormalities of uterine bleeding.Fertil Steril 2007; 87:466–476;Simultaneous publication inHuman Reproduction.

Fraser IS, Critchley HOD, MunroMG. Abnormal uterine bleeding –getting our terminology straight.Curr Opinion Obstet Gynecol2007; 19: 591–595.

2008:Fraser IS, Munro MG, CritchleyHOD. Terminologies anddefinitions around abnormaluterine bleeding. In: O’DonovanPJ, Miller CE, eds; ModernManagement of AbnormalUterine Bleeding. Chapter 3.Milton Park, Oxon: InformaHealthcare. 2008;17–24;

Critchley HOD, Warner PA, FraserIS. Practical Assessment andMeasurement of AbnormalUterine Bleeding. In: O’DonovanPJ, Miller CE, eds; ModernManagement of AbnormalUterine Bleeding. Chapter 5.Milton Park, Oxon: InformaHealthcare. 2008, pp 29–33.

Munro MG, Fraser IS.Pathogenesis of abnormal uterinebleeding. In: O’Donovan PJ, MillerCE, eds; Modern Managementof Abnormal Uterine Bleeding.Chapter 6. Milton Park, Oxon:Informa Healthcare. 2008, pp34–41.

Woolcock J, Critchley HOD,Munro MG, Broder M, Fraser IS.Review of the confusion in currentand historical terminology anddefinitions for disturbances ofmenstrual bleeding. Fertil Steril,2008; 90: 2269-2280;2007, e-pub; DOI:10.1016/j.fertnstert.2007.10.060.

Fraser IS. Menstrual confusion.Int J Gynecol Obstet 2008; 100:1–3;

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2011:Fraser IS, Munro MG, CritchleyHOD. The FIGO Classification ofcauses of abnormal uterinebleeding. A Special Editorial. Int JGynecol Obstet 2011; 113: 1–2.

Munro MG, Critchley HOD,Broder MS, Fraser IS. The FIGOclassification system (PALM-COEIN) focauses of abnormaluterine bleeding in non-gravidwomen of reproductive age, Int JGynecol Obstet 2011; 113:3–13.

Munro MG, Critchley HOD, FraserIS. The FIGO classificationsystem (“PALM-COEIN”) forcauses of abnormal uterinebleeding in non-gravid women inthe reproductive years includingguidelines for investigation. Int JGynecol Obstet 2011; 113:3–13.

Munro MG, Critchley HOD, FraserIS. The FIGO Classification ofcauses of abnormal uterinebleeding in the reproductive years(Executive Summary). Fertil Steril2011; 95: 2204–2208.

Munro MG, Critchley HOD, FraserIS. Outcomes from leiomyomatherapies: comparison withcontrols. Obstet Gynecol (letter)2011; 117: 987–988.

Fraser IS, Munro MG, CritchleyHOD (Issue editors). Abnormal

uterine bleeding. Semin ReprodMed 2011, September Issue; 29:375–458.

Fraser IS, Critchley HOD, MunroMG. (Eds) An internationalperspective on abnormal uterinebleeding; Preface. Semin ReprodMed 2011, 29: 375–376.

Critchley HOD, Munro MG,Broder M, Fraser IS. A five yearinternational review processconcerning terminologies,definitions and related issues

around abnormal uterinebleeding. Semin Reprod Med2011, 29: 377–382.

Fraser IS, Munro MG, Broder M,Critchley HOD. The FIGOrecommendations onterminologies and definitions fornormal and abnormal uterinebleeding. Semin Reprod Med2011, 29: 383–390.

Munro MG, Critchley HOD,Broder M, Fraser IS. The flexibleFIGO concept for classification ofunderlying causes of abnormaluterine bleeding. Semin ReprodMed 2011, 29: 391–399.

Critchley HOD, Maybin J.Molecular and cellular causes ofabnormal uterine bleeding ofendometrial origin. SeminReprod Med 2011; 29: 400–409.

Munro MG, Heikinheimo O,Hathtootuwa R, Tank J, Fraser IS.The need for investigations toelucidate causes and effects ofabnormal uterine bleeding. SeminReprod Med 2011, 29: 410–422.

Matteson K, Munro MG, FraserIS. The structured menstrualhistory: developing a tool tofacilitate diagnosis and aid insymptom management. SeminReprod Med 2011, 423–435.

Munro MG, Broder M, Critchley

HOD, Matteson K, Hathtootuwa

R, Fraser IS. An international

response to questions about

terminologies, investigation and

management of abnormal uterine

bleeding: use of an electronic

audience response system.

Semin Reprod Med 2011, 29:

436–445.

Hathtootuwa R, Desai S,

Senanayake L, Goonewardena

M, Tank J, Fraser IS Management

of abnormal uterine bleeding in

low and high resource settings.

Consideration of cultural issues.

Semin Reprod Med 2011, 29:

446–458.

2012:

Fraser IS, Munro MG, Critchley

HOD. Abnormal uterine bleeding

– terminologies, definitions and

classifications. UpToDate 2012;

in press.

Munro MG, Critchley HOD, Fraser

IS. The FIGO systems for

nomenclature and classifications

of abnormal uterine bleeding in

the reproductive years. Who

needs them? Am J Obstet

Gynecol 2012; doi:

10.1016/j.ajog.2012.01.046.

Main contributors to the FIGO Working Group onMenstrual Disorders leading up to and through2009–2012

I S Fraser (Co-Chair) Australia

H O Critchley (Co-Chair) UK

M G Munro (Co-Chair) USA

M Broder USA

O Heikinheimo Finland

F Petraglia Italy

K Matteson USA

R Haththtootuwa Sri Lanka

J Maybin UK

P Warner UK

S Sheth India

Z van der Spuy South Africa

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FIGO Audit &Finance CommitteeFollowing a decision by theExecutive Board in October2009, the former “FIGO AuditCommittee” and former “FIGOFinance Committee” weremerged to form the new “FIGOAudit & Finance Committee”.

The aims of the new Committeeare:• To ensure that FIGO’s strategicplan has been developed andimplemented in an appropriateand clear fashion withappropriate goals by theOfficers and committees;

• To ensure that FIGO is open inthe conduct of its affairs,except where there is a needto respect confidentiality;

• To ensure that FIGO complies

with all relevant legal andregulatory requirements;

• To ensure that FIGO carries outits aims in accordance with theConstitution and Bye-Laws;

• To encourage membersocieties to take into accountgender representation whenselecting their delegates to theFIGO General Assembly withthe aim of achieving aminimum of 20% femalerepresentation and to reviewthe composition of delegationsfollowing each FIGO GeneralAssembly to bring this aim tothe attention of those societiesthat fall short of this goal;

• To fulfil its responsibilities theAudit Committee should becomposed of a minimum offour representatives from fourregions of FIGO and meet at

the end of the first, secondand third years of the FIGO“term” following completion ofthe annual audit of FIGO;

• To fulfil its responsibilities, eachCommittee Chair and Projecthead should file the goals ofthe committee or project at theonset of the programme andsupply the Audit Committeewith an update on thecompletion of the goals andobjectives every six months,the annual report being sentprior to the Audit Committeemeeting;

• To regularly (at least once peryear) carry out a solid review ofFIGO’s finances (expenditure,incomes, investments,accounting, sponsorships;budget when applicable);

• On the basis of these reviews,

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to suggest where appropriatealternative arrangements forthe Chief Executive, Officers,and, when appropriate, theExecutive Board to consider. (Itis anticipated that thesereviews would not take morethan half a day, and that theycould take place in connectionwith other FIGO meetings,notably the Executive Board);

• To provide an independent andobjective view of systems ofinternal control and to reviewthe annual financial audit ofFIGO; and

• To ensure that FIGO managesand accounts for its resourcesin the most economic andefficient manner.

The FIGO Audit & FinanceCommittee should be consultedon any expenditure of FIGO fundsover £50,000.

The merged FIGO Audit &Finance Committee has held atwo-session meeting a day beforethe Executive Board meetingevery year since it first convenedin June 2010.

Typically, the first session wasdevoted to a structured individualinterview of Chairs of all the othertask-oriented FIGO Committeesto assess the progress of theirwork, goals achieved andhurdles/constraints that the Chairand the Committee membersmay have faced. The secondsession comprised a review ofthe Honorary Treasurer’s Report,comprehensive scrutiny of theyearly statement of the accountsand investments, detailed reviewof the auditors’ report, anddiscussion regarding theproposed budget for thesubsequent year.

At the FIGO Executive Boardmeeting in June 2010, it was

agreed that, in order to properlymonitor and evaluate theprogress of the task-orientedFIGO Committees and WorkingGroups, the FIGO Audit &Finance Committee shouldreceive a written progress reportfrom each Committee/WorkingGroup on a semi-annual basis sothat, if necessary, the FIGO Audit& Finance Committee couldidentify any shortfalls that mayhave arisen and suggestsolutions. To facilitate thisprocess, “reporting templates”were developed based on eachgroup’s individual approvedAction Plan. A summary withrecommendations of these semi-annual reports was provided forthe FIGO Officers.

At the end of the 2009–12 term,the FIGO Audit & FinanceCommittee reports with a senseof satisfaction that, with a fewinevitable exceptions, all of theCommittees have accomplishedtheir assigned tasks and madeimportant contributions to FIGOobjectives that will have asignificant impact on women’shealth globally both now and inthe future. Commendable as it is,this becomes all the morelaudable as eminent members ofthe ob-gyn community fraternity

contribute a huge amount of theirtime and effort without anyremuneration.

The periodic reviews of FIGO’sstatement of accounts indicatethat the financial matters of FIGOare handled with care. Theauditors did not have any issuesand the statement of accountsfulfilled all their requirements. Theyearly budgets were made withprudence and were based onrealistic assumptions. Keeping inview the current market trendsthe Committee recommendedthat the current arrangement forthe investments should becontinued.

As a matter of importance,strategies for fund raisingremained a recurring subject. TheAudit & Finance Committeediscussed various ways toimprove the financial position ofFIGO through increasing thefrequency of Congresses,collaborations with otheragencies, and funding fromvarious donors for FIGO projects.Being the major source ofincome, the proposal of morefrequent Congresses has its prosand cons. This committee is ofthe view that a programme ofregional meetings/conferencesshould be initiated.

Members of the FIGO Audit & Finance Committee2009–2012

F Zaman (Chair) Pakistan

W Holzgreve Germany

A Yahya Malaysia

B Carbonne France

N R de Melo Brazil

C Tippett Australia

A Rogers United Kingdom

Ex-officio

H Rushwan United Kingdom /Sudan

B Thomas United Kingdom

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FIGO PublicationsManagement BoardAt its meeting in September2001, the FIGO ExecutiveBoard agreed that aPublications ManagementBoard should be established tosupervise and monitor all FIGOPublications (including theInternational Journal ofGynecology & Obstetrics).

The Editorial Board of theInternational Journal ofGynecology & Obstetricscontinues to work towardsensuring the excellencespecifically of the Journal,whereas the PublicationsManagement Board looks at thebusiness side of publications toensure that the publisher(s) workto obtain the maximum benefit forFIGO.

The Publications ManagementBoard meets annually to:

• Oversee the business andfinancial management ofFIGO’s publications;

• Invite tenders for thepublication of individualpublications with a view tomaximising both income toFIGO and distribution;

• Select from tenders received apublisher for the publication inquestion;

• Negotiate and review with thechosen publisher the terms ofthe contract for publication;

• Review periodically with thepublisher marketing strategieswith a view to maximisingprofitability for FIGO and toincreasing distribution;

• Appoint the editor and editorialboard for specific publications;and

• Report to the Officers andExecutive Board on theforegoing

In 2011, the Board undertook amajor review of the publicationarrangements for the“International Journal ofGynecology & Obstetrics” thatinvolved seeking tenders from awide range of potentialpublishers. After an exhaustive,transparent and open tender andreview process, it was agreedthat Elsevier Ireland Ltd should beawarded the contract to producethe Journal until the end of 2016.

Members of the Publications Management Board2009–2012

W Holzgreve (Chair) Switzerland

T Johnson United States of America

H Rushwan United Kingdom/Sudan

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FIGO Publications

International Journal ofGynecology & Obstetrics(IJGO)

Since its inception, the

International Journal of

Gynecology & Obstetrics (IJGO)

has had two primary purposes:

• To serve an international

audience by publishing original

scientific articles and

communications originating in

low- and middle-income

countries, emphasising the

important obstetric and

gynaecologic problems, issues,

and perspectives of these

regions of the world, such as

maternal mortality and family

planning, as well as publishing

original articles and

communications from the

scientific community of high-

income countries, with

particular emphasis on sharing

advances in the specialty of

obstetrics and gynaecology;

• To further the organisational

purposes of FIGO by providing

a means of bringing to the

readership articles of worldwide

interest in the field of women's

health and information from the

FIGO Secretariat, and by

providing information from the

World Health Organization andthose other importantinternational organisations thatdeal with women's health andthe specialty of obstetrics andgynaecology.

The IJGO publishes approximately1,320 printed pages in fourvolumes each year. Clinicalarticles form the basis of theIJGO, and the Editor strives tomaintain an appropriate balancebetween obstetrics andgynaecology articles.

All submitted manuscripts receiveeditorial review followed by peerreview if the topic is consideredappropriate. The editorial processis similar to most quality medicaljournals.

In accordance with the mission ofthe IJGO, the Editor seeks topublish a balance of articlesaddressing the interests of theconstituencies of the journal:low-, middle- and high-incomecountries, as well as a broad andrepresentative geographicdistribution of authors.

Total annual submissions haveincreased dramatically in the pastfew years. In 2009, 1,280manuscripts were submitted. Ofthese, 280 (22%) were acceptedand 1000 (78%) were notaccepted. In 2010, 1,316manuscripts were submitted, ofwhich 280 (21%) were acceptedand 1036 (79%) were notaccepted. In 2011, 1,323manuscripts were submitted – atthe end of March 2012, 244 hadbeen accepted (18%), 1,006(76%) were not accepted, and 73(6%) were pending a decision.

Between 2009 and 2011, thegeographic origin of the 804accepted and published paperswas:• Africa (10.3%)

• Asia/Australia (29.1%)• Europe (24.0%)• Latin America (6.6%)• Middle East (14.7%)• North America (15.3%).

Journal sections includeContemporary Issues in Women’sHealth, Ethical and Legal Issues inReproductive Health, SpecialEditorials to highlight FIGOOfficers and Executive Boardmembers and their interests,Special Communications, FIGOGuidelines and CommitteeReports, and FIGO jointstatements. The Journal’s impactfactor is 2.045 (June 2011) andhas increased each year since2001.

The International Journal ofGynecology & Obstetricsrepresents a successfulcollaboration between FIGO andthe Publisher, the Editor, and thecontributing authors. The IJGOcontinues to grow in scientificquality, breadth and scope ofcontents, and in representation ofits constituencies. While thescientific community ofhigh-income countries is wellrepresented in the IJGO as well asin many other specialty journals,for authors in low- and middle-income countries, some of whichhave no journal in our specialty,the IJGO is an important, andperhaps the sole, venue forpublication. The InternationalJournal of Gynecology &Obstetrics provides an essentialservice to FIGO and itsconstituent societies, to theinternational obstetrics-gynaecology community, and tothe journal readership worldwide.

The Editor of the InternationalJournal of Gynecology &Obstetrics is Dr Timothy Johnson,who is based in the University ofMichigan, Ann Arbor, United

OBSTETRICSGYNECOLOGYInternational Jou

rnal of

Official publication of FIGO

The International Federation

of Gynecology and Obstetrics

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States of America and has

undertaken the role since 2007,

when the Editorial Office was

relocated to the FIGO Secretariat

in London, United Kingdom.

World Report onWomen’s Health

Every three years, FIGO publishes

a World Report on Women’s

Health to coincide with the

triennial FIGO World Congress of

Obstetrics & Gynecology. This

special issue of the International

Journal of Gynecology &

Obstetrics represents a

comprehensive overview of

women’s health issues, both

medical and social. The sixth

edition of the World Report on

Women’s Health – to be

published to tie in with the 2012

FIGO World Congress of

Gynecology & Obstetrics – has a

broad focus and is titled

“Improving Women’s Health”.

As in previous years, the articles

aim to meet the objectives of

FIGO as they reflect on the

realities that affect women in most

parts of the world and the dire

need for advocacy, expertise and

collaboration to promote health,

well-being and the status of

women through the obstetrics-

gynaecology community, usingavailable evidence.

The 2012 edition of the World

Report on Women’s Health hasbeen produced with the generoussupport of WAHA International,Ipas, and Gynuity Health Projects.Its Guest Editor is the incomingPresident of FIGO – Professor SirSabaratnam Arulkumaran fromthe United Kingdom.

FIGO Cancer Report

Despite its title, the former FIGOAnnual Report on the Results of

Treatment in Gynaecologic

Cancer was published every threeyears by the FIGO Committee onGynaecologic Oncology up until2006.

The Annual Report had its roots inwork originally produced by theRadiological Sub-commission ofthe Cancer Commission of theHealth Organisation of the Leagueof Nations. In 1928, this groupwas asked to explore thepossibility of having uniformstatistical information on theresults of radio-therapeutictreatment methods for uterinecervical cancer. Therecommendations of theseexperts were adopted by theSub-commission and published in1929. One of the major items thatemerged from this activity was aclassification system for groupingcarcinoma of the uterine cervixinto different stages according tothe extent of the growth. Thissystem became known as theLeague of Nations Classificationfor Cervical Cancer and wasamongst the first attempts athaving an international stagingsystem for this disease. In July1934, the Health Organisationheld a conference thatrecommended that a publication,in the form of an annual report,

should be issued by the HealthOrganisation analysing the resultsof treatment by radiotherapy incancer of the uterine cervixestimated after an observation offive years or more.

The first three Annual Reportswere issued in 1937, 1938 and1939. In 1958, FIGO became theofficial patron of the AnnualReport and Volume 12, issued in1961, was the first publishedunder its auspices.

The current FIGO Committee forGynaecologic Oncology hasundertaken an exhaustive reviewof the purpose of, and informationcontained in, the Annual Report.The Committee has decided tomodernise the Annual Report andhas renamed it the FIGO Cancer

Report, the unique feature ofwhich will be the collection of datafrom many different countries in allcontinents where it is known fromepidemiological studies thatcancer incidence, prevalence,treatments, and survival may bestrikingly different. Such diversityenables a worldwide picture to beobtained for each cancer site ofthe female reproductive systemand to evaluate the validity of thestaging requirements. Theprocess of collecting internationaldata has commenced and over250 organisations willing to sharedata with FIGO have beencontacted and verified. Thesubmission of data will beginshortly with newly designed datacollection forms and through aweb-based data entry site. Thenew data analysis will becompleted by 2015 and will besupervised by a specially selectedEditorial Board. Staging and thebest-evidenced based guidelinesfor the diagnosis and treatment ofindividual gynaecological cancersare included as well as special

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chapters on Pathology,Chemotherapy and Radiotherapy,all taken from both a developedand a developing worldperspective.

The FIGO Cancer Report 2012will be guest edited by ProfessorLynette Denny, Chair of the FIGOCommittee for GynaecologicOncology, as a supplement to theInternational Journal ofGynecology & Obstetrics. It willalso be available for purchaseduring the Congress.

FIGO Newsletter

The FIGO Newsletter – containingnews and information aboutFIGO’s activities and projects – ispublished three times per year,and is circulated to approximately2,750 addresses, including allFIGO-affiliated societies, heads ofdepartment of obstetrics andgynaecology world-wide, medicallibraries and internationalorganisations in official relationswith FIGO.


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FIGO “LOGIC”(Leadership inObstetrics andGynaecology forImpact and Change)Initiative in Maternal& Newborn HealthThe FIGO “LOGIC” Initiative,funded by the Bill & MelindaGates Foundation, waslaunched at the XIX FIGOWorld Congress of Gynecology& Obstetrics in Cape Town,South Africa in 2009. Theinitiative recognises theenormous potential of nationalprofessional organisations ofobstetrics and gynaecology tocontribute to the achievementof the United NationsMillennium DevelopmentalGoals 4, to reduce childmortality, and 5, to improvereproductive and maternalhealth.

The goal and objectives of theFIGO “LOGIC” Initiative are asfollows:

GoalTo improve Maternal andNewborn Health (“MNH”) policyand practice by strengtheningFIGO Member Associations(“MAs”) and using their positionand knowledge to facilitate andcontribute to theseimprovements, leading to betterMNH for under-servedpopulations in low- and middle-resource countries.

Objective OneEvidence informed policy,strategy and action plans onMNH influenced and supportedthrough MAs advocating to raiseand maintain awareness of andinvestment in MNH and engagingin dialogue with health sectorstakeholders (Policy Influence).

Objective TwoProgress made in deliveringevidence informed policy,strategic objectives andoperational/annual plans withMAs’ active role inimplementation, monitoring andevaluation (PractiseImprovement).

Objective ThreeNational and sub-national MAorganisation strengthened toenable effective participation innational and sub-nationalstrategic and operational forarelated to MNH (CapacityBuilding).

Objective FourFIGO’s facilitative role with MAsstrengthened.

Objective FiveDissemination PhaseThe eight participatingprofessional associations are:SOGOB, Burkina Faso; SOGOC,Cameroon; ESOG, Ethiopia;FOGSI, India; AMOG,Mozambique; NESOG, Nepal;SOGON, Nigeria and AOGU,Uganda. The project is supportedby a Technical Advisory Groupcomposed of internationalexperts from differingbackgrounds, including advocacy,gynaecology and obstetrics,midwifery, neonatology, maternaldeath reviews, and organisationalcapacity development.

Objective One(Policy Influence)Raising awareness of thetragedy of maternal andnewborn mortality andmorbidity is pivotal toachieving increased investmentin the relevant health,education and transportservices. The FIGO “LOGIC”

Initiative has provided MAswith training in advocacy andcommunication, so that theyare better able to influenceMinistries andParliamentarians, but alsoincrease demand throughworking with the media andcivil society, particularlywomen’s groups. Trainingpartners have included INTRAC(International Training andResearch Centre for NGOs), theWhite Ribbon Alliance and thePatricia Galvao Institute, Brazil.An example of a success inthis area is that AOGU,together with partners such asthe White Ribbon Alliance, hasinfluenced the Ugandangovernment to take out a loanof $131 million, with $31 millionring fenced for maternityservices.

Objective Two(PractiseImprovement)The FIGO “LOGIC” Initiativehas focused on using twoinstruments for improving MNHi.e. evidence based guidelinesand maternal death and “nearmiss” reviews. Guidelines forthe treatment of severe pre-eclampsia/eclampsia and theprevention and treatment ofpost-partum haemorrhage havebeen developed, where theydid not exist, and are now inthe process of beingimplemented. Several MAshave also been instrumental inresearch, piloting and scalingup of new treatmentapproaches such asmisoprostol for post-partumhaemorrhage and magnesiumsulphate for (pre-) eclampsia.

A major success has been thedevelopment of facility based

P A G E 5 3

maternal death and “near miss”reviews. A faculty of internationalexperts has been recruited and isdirectly supporting the MAs intheir endeavours in this domain.These include Alberta Bacci(Italy), Carine Ronsmans andVeronique Filippe (School ofHygiene & Tropical Medicine,London, United Kingdom),Vincent de Brouwere and ThereseDelvaux (Institute of TropicalMedicine, Antwerp, Belgium) andGwyneth Lewis, (UniversityCollege London, UnitedKingdom). Overcoming localdeficits in resources, such asambulances, staff, equipment,blood, laboratory reagents anddrugs, and improved professionalpractise, such as note keeping,use of partograms, and improvedreferral and care pathways, arealready being witnessed. Thesesuccessful review processes haveresulted in three professionalorganisations, AOGU, ESOG andSOGOB, being approached bytheir Ministries of Health to leadnational programmes of maternaldeath reviews.

Objective Three(Capacity Building)The FIGO “LOGIC” Initiativehas provided support to MAsthrough site missions, personalcoaching and theme-specificcapacity building workshops.Pivotally, the initiative hasprovided capacity improvementthrough the Society ofObstetricians & Gynaecologistsof Canada (“SOGC”) and itsorganisational capacityimprovement framework, whichdevelops organisationalstructures. The framework hasfour main elements, whichhave been applied to the eightparticipating MAs:

• Capacity Assessment. Thiswas a two day process,whereby the organisationassessed its own strengthsand weaknesses in fivedomains – culture, operationalcapacity, performance, externalrelations and how it isperceived.

• Data Analysis. An analysis ofthe capacity assessmentidentified areas for capacityimprovement and established abaseline, from which progressis measured during and afterthe FIGO-LOGIC Initiative.

• Capacity Improvement Plan.Action plans were developedto address the weak domainsof the organisation.

• Implementation andProgress Measurement. Thistracks the progress of thecapacity improvement plan bya time line and outcomeindicators in annual workplans.

As a result of the FIGO “LOGIC”Initiative, all MAs now have fullyequipped offices with telephones,computers, internet, websitesand administrative staff. Theircapacity has been improved inevery aspect of their workincluding mission, strategy,governance, leadership,administration of humanresources, financial managementand legal framework, programmedevelopment and implementation,fund raising and incomegeneration, diversity,partnerships, advocacy andpolicy change, marketing,positioning and planning.

Objective Four (FIGOFacilitating Role)The FIGO-LOGIC team hasprovided continuous supportfor the MAs through regular

communication, conferencecalls, field visits, coaching,thematic workshops (eg projectmanagement, financialmanagement, advocacy andcommunication, maternaldeath reviews, verbal autopsy),identification andimplementation of expertsupport, annual reviewmeetings and technicaladvisory group meetings.

Objective Five(Documentation andDissemination)As the project nears its end(October 2013), a focusedeffort is being made todocument the lessons learned,successes and challenges,with an aim to extend theimpact of the FIGO “LOGIC”Initiative beyond the currentMAs and to inform a wideraudience of decision makersand donors.

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FIGO Saving Mothersand NewbornsInitiative 2006–2011Globally, over 500,000 womendie each year fromcomplications of pregnancyand childbirth. Approximately90% of these deaths occur insub-Saharan Africa and Asia,making maternal mortality thehealth statistic with the largestdiscrepancy between high andlow resource countries. Indeed,of all the indicators monitoredby the World HealthOrganization (WHO), maternalmortality ratios demonstratethe largest gap betweendeveloped and developingcountries. More than 70% of allmaternal deaths are due to fivemajor complications that arelargely preventable andtreatable using evidence-basedand cost-effectiveinterventions: haemorrhage,sepsis, unsafe abortion,

hypertensive disorder ofpregnancy and obstructedlabour/uterine rupture. Forevery woman who dies from apregnancy-related cause,another 20 suffer from seriousbut non-fatal health problemsand long term disabilities suchas: uterine rupture, vaginaltearing, severe anaemiaresulting from haemorrhage,and obstetric fistulae.

The economic and social impactof these deaths and disabilitieson families, communities andnations is quite enormous,encompassing the cost of caringfor disabled or sick women andchildren; lost earnings; and anon-going cycle of poverty anddeprivation for poor families andsocieties.

While effective knowledge andnew technologies exist to reducematernal mortality and newborndeaths, to make a real difference,they must be made available in

the areas where the majority of

deaths occur – largely the

community. In simple terms, to

decrease maternal and newborn

mortality and morbidity, women

must have access to skilled care

during pregnancy and birth,

providing safe and clean delivery

and care of the newborn at birth

and access to emergency care

when and where needed.

Professional associations have a

leadership role in promoting and

advocating for actions related to

the reduction of maternal and

newborn mortality and morbidity

worldwide. Ob/gyn and midwives,

as the specialties directly involved

with sexual and reproductive

health in general, and specifically

pregnancy and childbirth, have an

important role to play with regard

to:

• The development of national

policies, strategies and action

plans related to sexual and

reproductive health;

P A G E 5 5

• The strengthening of healthsystems and health teams;

• The development andimplementation of standardsand protocols of care;

• The monitoring and evaluationof quality services;

• The investigation of causes ofmaternal deaths, and theidentification of problems andstrategies to address these;

• The development andimplementation of educationalservices or CME programmesfor health professionalsinvolved in sexual andreproductive health;

• The identification of social andcultural barriers affectingwomen’s use of health servicesand further, the implementationof actions to reduce thesebarriers; and

• Discussions and actions onissues of controversy such asthe elimination of harmfulpractices, access to servicesindependent of age, race orlack of money, post abortionservices, etc.

Since 2006, FIGO has beenoverseeing a project known asthe “FIGO Saving Mothers andNewborns” initiative. The overallgoal of the project is to contributeto the reduction of maternal andneonatal mortality in 10 low- tomid-resource countries.

The Saving Mothers andNewborns Project employs atwinning mechanism wherebylow- and middle-resourceprofessional associations arepaired with professionalassociations from higher resourcesettings. The twinnedassociations work together toobtain the project’s objectives.

The project’s secondaryobjectives include:• Strengthening the capacity of

national professional societiesto engage in maternal-newborn health through thedesign and implementation ofmaternal and neonatal healthprojects;

• Strengthening cooperationbetween FIGO and nationalsocieties, and also betweensocieties in regions of differenteconomic levels;

• Strengthening cooperationbetween national societies andnational stakeholders involvedin safe motherhood andnewborn health;

• Increasing the credibility ofnational societies locally toprovide technical support toMinistries of Health andnational professional councils.

Funding for nine of the projects isprovided by the SwedishInternational DevelopmentCooperation Agency (Sida) andFIGO. The Ukraine initiative wassupported by the CapacityProject (a USAID fundedconsortium) for phase one of theproject and then by FIGO’sPresident Fund, along with theSociety of Obstetricians andGynaecologists of Canada, forphase two of the project.

The national societies from eachcountry are responsible formanaging and reporting to FIGOon project activities and funds.FIGO has the overall responsibilityfor guidance and supervision, aswell as for financial accountabilityto donors. Each professionalassociation provides in-kindcontribution to the project in theform of volunteering theirpersonal time to the activities ofthe project.

Country InterventionsThe initiatives included within thisproject were developed in

keeping with the respectivecountries’ national policies andwith the aim of being sustainable.Each project integrates at thepractice level evidence-based,low-cost technologies whichoften do not get down to theservice delivery level, outside pilotinitiatives.

Each country project aims:• To develop, execute andevaluate a project to improveaccess to new and well-knownaffordable technologies,interventions, audits, andskilled attendants;

• To strengthen the capacity andcredibility of nationalprofessional societiescommitted to maternal-newborn health (nurses,midwives, obstetricians);

• To strengthen the cooperationbetween national societies andnational stakeholders (women’shealth groups, governments,etc.) by institutionalisingconfidential inquiries intomaternal deaths and ensuringthe long-term sustainability ofinterventions to reduce it;

• To strengthen the engagementof women’s groups and civilsociety as well as of mothersand their families on initiativesto reduce maternal mortalityand improve care of newborns.

The project themes range inscope from facilitating theprovision of basic emergencyobstetric care in underservedcommunities to theimplementation of clinical auditsfor improving quality of care, tothe development of new maternaland newborn health protocols toaddressing unsafe abortion. Table1 provides a summary of thecountries involved and thematernal and newborn healthactivities being conducted.

P A G E 5 6

Table 1: Saving Mothers and Newborns Project Summary

*The ALARM International Program is a five day training course in emergency obstetric care that also aims to address the reproductive and sexual rights of women.It is produced by the Society of Obstetricians and Gynaecologists of Canada.

Expansion of the district health centre to ensure 24-houremergency obstetric care by providing midwifery services,equipment, supplies and referral for complicated cases.Promotion of active management of the third stage of labour.

Strengthening the HealthCentre of Croix Des Bouquets

Haiti

Training of multidisciplinary team in four health facilities to usetools to collect baseline data and to perform clinical audits toevaluate and improve quality of care.

Improving the quality ofantenatal, delivery andpostnatal care through clinicalaudits

Kenya

Train obstetric staff in three health facilities and developnational protocols regarding maternal and newborn care usingthe ALARM International Program.*

Reducing maternal andnewborn mortality in Gjakova,Gjilan and Pristina, Kosovo

Kosovo

Provision of training seminars for multidisciplinary health staffto perform perinatal death audits to identify problems andcauses of deaths in term newborns of normal weight in orderto improve the capacity of the health system.

Implementing new approachesfor reviewing maternal andperinatal deaths in the Republicof Moldova

Moldova

Collection and analysis of hospital data to determine the casefatality rates and causes of maternal deaths in three statehospitals. This data is used for advocacy purposes and toevaluate the impact of an emergency obstetric trainingprogram of health care providers in these hospitals.

Improving emergency obstetriccare in Edo, Amambra andKaduna States, Nigeria

Nigeria

Provision of 24-hour emergency obstetric and neonatal care byupgrading facilities, ensuring staff presence and improvingreferral in two sub-districts of rural Sindh.

Reducing maternal andperinatal mortality andmorbidity in Thatta District

Pakistan

Evaluation of maternal and perinatal health care usingcommunity surveys to identify barriers in accessing care.Training of health care providers and community educationregarding maternity care. Development and implementation ofstandards of care.

Improving access to maternaland newborn care in Peru

Peru

Training in emergency obstetric skills and provision of on-sitecontinuing medical education and supervision in twounderserved districts. Provision of delivery kits and supplies toensure BEOC or CEOC in six health facilities. Communityeducation regarding emergency preparedness and dangersigns during the childbearing year.

Capacity building by providingemergency obstetric andessential newborn care inKiboga and Kibaale districts

Uganda

Expanding coverage of the ALARM International Program*,evaluating behavioural change of health care staff, monitoringspecific maternal health indicators at health facilities andimproving skills of national instructors in delivering the course.

Improving emergency obstetriccare in Ukraine: applying theALARM international program

Ukraine

Aims to reduce unsafe abortion by providing pre and postabortion counselling services for women with unwantedpregnancies in six health centres. Community education aboutavailable counselling service and sensitisation of healthprofessionals to provide confidential and non-judgementalservices.

Protecting women’s health andlives by reducing unsafeabortion

Uruguay

Country Project title Key Activity


All country interventions arecommitted to the achievement ofthe Millennium DevelopmentGoals (MDGs), especially thoserelated to child and maternalhealth. It directly supports theglobal strategy for safemotherhood and newborn healthwhich advocates for skilledattendance at birth, emergencyobstetrical care and strengtheningof emergency referral/transportsystems as a means by which toreduce maternal morbidity andmortality. The results of theseprojects will be channelled intotheir national public health policyprocesses.

Advocacy, to place safemotherhood as high priority inpolicy formulation and to ensureadequate budgetary allocationsfor maternal health, hasintensified in these countries. It isexpected that the proposedinitiatives will contribute tonational efforts to scale upresources, strategies and politicalcommitments to ensure that allwomen have a right to health and

safe pregnancies and childbirthand deliver a healthy child.

Role of FIGOFIGO monitors the projectthrough the constitution of aFIGO Project Advisory Committeeunder the umbrella of the FIGOCommittee for Safe Motherhood& Newborn Health. Each countryhas incorporated a monitoringand evaluation component in thedesign of their project andmeasures their achievements ofthe objectives.

To ensure an objective evaluation,FIGO engaged an independentexternal evaluator, called Options.Options has completed a reviewof the ten funded projects.Evaluation focused on:• Programme achievements andchallenges;

• Programme management interms of the local teamrelationships and composition;

• Relationship between theprogramme teams and FIGO;and

• Relationship between the

twinning society and theprogramme teams.

The baseline evaluation occurredbetween 2007 and 2008 andconfirmed collaboration atinternational and local levels andnorth to south partnerships. Thefinal evaluation of all of the projectwas performed in the second halfof 2011. The final evaluationdescribed the successes andchallenges of the projects andprovided FIGO and countryrecommendations.

Finally, strategies are integratedinto the project to ensure thesustainability of the projects andincorporate the results intonational policies and practice.The projects ended betweenJune and November 2011; eachcountry expects the results of theproject to be disseminated to allhealth institutions in the projectcountries.

By relying on the professionalexpertise and knowledge of theirmembers, the project developedthe capacity, technical skills andexperience of professionalassociations to not only act astechnical experts on issuesrelated to safe motherhood andnewborn health, but also to makeuse of their political and socialclout to advocate for increasedcommitments and investment inthe field.

The efficiency of the initiative thuslies in developing nationalcapacity with regard to safemotherhood and newborn healthinstead of relying on internationalcapacity. Active and effectiveprofessional associations will inthe long-run be efficient as theywill ensure access to nationalexperts in the field which willcontribute to efforts to scale upsafe motherhood programmes. P A G E 5 7

The FIGO Saving Mothers andNewborns Initiative project2006–2011 was the first FIGOlong-term project involving apartnership between countriesand within countries to reducematernal mortality and morbidity.

The final report and evaluation areavailable from the FIGO websiteat http://www.figo.org/projects/newborns

P A G E 5 8

Country Project Twinned Country

Haiti: Canada:Dr Lauré Adrien Dr René Laliberté, Ms Charlotte Landry RM

Kenya: United Kingdom:Dr Omondi Ogutu, Dr Edwin Were, Dr Tony Falconer, Prof Will StonesDr Patrick Ndavi

Kosovo: Canada:Dr Shefqet Lulaj, Dr Albert Lila Dr Ferd Pauls, Ms Cathy Ellis RM

Moldova: United Kingdom:Dr Stratulat Petru, Dr Ala Curteanu, Prof Jason GardosiProf Stelian Hodorogea

Nigeria: Denmark:Dr James Akuse, Dr Hadiza Galadanci Dr Prof Staffan Bergström (from Sweden)

Pakistan: Sweden:Dr Shershah Syed, Dr Razia Korejo, Dr Bo Möller, Ms Charlotta Grunewald RMDr Habib Ur Rehman Soomro

Peru: Spain:Dr Juan Trelles, Dr Eduardo Maradiegue, Prof Luis Cabero RouraDr Miguel Gutierrez Ramos,Ms Tania Salazar RM

Uganda: Canada:Dr Frank Kaharuza, Dr Othman Kakaire, Dr Jean Chamberlain, Ms Ann Lovold RMDr Dan Zaake, Ms Enid Mwebaza RM

Ukraine: Canada:Dr Iryna Imogilevkina, Dr Vyta Senikas, Dr Eileen Hutton RMDr Viachexlav Kaminsky

Uruguay: Canada:Dr Leonel Briozzo, Ms Ana Labandera RM, Dr André Lalonde, Ms Sandra Gervais RMDr Veronica Fiol

People involved in the FIGO-SMNH Initiative


FIGO Misoprostol forPost-PartumHaemorrhage in LowResource SettingsInitiativeThe number of women dying asa result of complicationsrelated to pregnancy andchildbirth remainsunacceptably high. This isespecially true in low resourcecountries across sub-SaharanAfrica and South Asia wherealmost all these deaths occurand where a high percentageof women deliver at home oroutside a health facility withoutimmediate recourse toemergency obstetric care or askilled birth attendant.

Post-partum haemorrhage (PPH)is the most significant directcause of maternal mortality in lowresource countries, accounting

for approximately 30% of

maternal deaths worldwide, and

is one of the most preventable.

The most common cause of PPH

is uterine atony, a failure of the

uterus to contract adequately

after delivery of the newborn. A

key aspect in PPH prevention

and treatment is uterotonic

therapy and the most widely

recommended agent is injectable

oxytocin. Certain factors can

hinder its use in low resource

settings. Oxytocin requires

parenteral administration, and,

therefore, skills to give injections

as well as sterile equipment, and

refrigeration.

In settings where injectable

uterotonics are neither available

nor feasible, misoprostol, a

synthetic E1 prostaglandin

analogue, has increasingly been

adopted as an alternative

intervention strategy for PPH care

– one endorsed by FIGO and

other international bodies.

Misoprostol is available in tablet

form, relatively inexpensive, stable

at room temperature, well

absorbed orally and sublingually,

and requires few skills to

administer.

Recent research points to

misoprostol’s potential in settings

without access to oxytocin. A

large scale trial, involving 1,119

home births attended by trained

traditional birth attendants in

Pakistan, for example, showed

that compared with placebo,

600mcg oral misoprostol

significantly reduced the rate of

PPH (500 mL) (16.5% versus

21.9%, RR 0.76, 95% CI

0.59–0.97) and incidence of post-

partum declines in haemoglobin >

3 g/dl [Mobeen 2010]. A

randomised controlled trial,

assessing the effectiveness of P A G E 5 9

800 mcg sublingual misoprostol

to 40 IU IV oxytocin for treatment

of PPH in women not exposed to

oxytocin prophylaxis, showed that

oxytocin was more effective at

controlling active bleeding within

20 minutes (96% vs. 90% of

women) and preventing additional

blood loss of 300 mL or more

(17% vs. 30%) but that sublingual

misoprostol could be an effective

first-line alternative when oxytocin

is not available, providing many

women from low resource

countries who deliver at home or

at low level facilities with the

potential for immediate treatment

of PPH [Winikoff, 2010].The

results of a second trial involving

women diagnosed with PPH, all

of whom were given oxytocin

prophylaxis, indicated that

misoprostol was non-inferior to

oxytocin at controlling active

bleeding within 20 minutes (90

per cent versus 89 per cent) and

preventing additional blood loss

of 300 mL or more (31% versus

34%) [Blum, 2010].

In 2012, FIGO published

guidelines on the Prevention and

Treatment of PPH with

Misoprostol which reflect the

current best available evidence1.

For PPH prevention, FIGO

recommends a single dose of

600 mcg misoprostol

administered orally immediately

after delivery of the newborn and

after it is established that there

are no additional babies in utero.

For PPH treatment, FIGO

recommends a single dose of

800 mcg misoprostol,

administered sublingually

immediately after PPH is

diagnosed and if 40 IU IV

oxytocin is not immediately

available (irrespective of theprophylactic measures).

The FIGO Initiative(2010–2014)The FIGO Initiative, funded by agrant to Gynuity Health Projectsfrom The Bill & Melinda GatesFoundation, advocates for anddisseminates evidence-basedinformation on misoprostol forPPH, aimed at healthcareproviders and clinicalpolicymakers. It is part of a globalproject that is looking at ways totranslate scientific and operationalresearch on misoprostol for PPHinto effective policies,programmes and practice.

In collaboration with FIGO’sCommittee for Safe Motherhoodand Newborn Health, professionalassociations and others, FIGO’sactivities include:

• Conducting expert panelsessions at global obstetricand gynaecologic meetings topresent current evidence andto discuss programmaticimplications.

• Publishing scientific articles,editorials and communicationsin FIGO’s official journal, theInternational Journal ofGynecology & Obstetrics(IJGO).

• Producing an IJGOsupplement on Misoprostol forPPH.

• Conducting expert panelsessions at the FIGO WorldCongress of Gynecology &Obstetrics in Rome.

• Developing guidelines,protocols and other trainingmaterials.

• Conducting nationalworkshops.

P A G E 6 0 1 For a comprehensive overview of a combination of best practice approaches and life-saving interventions along a continuum of care from community to hospital,readers are referred to FIGO’s Guidelines on the Prevention and Treatment of Postpartum Haemorrhage in Low-Resource Settings (2012).

Project Team

Project Director Hamid Rushwan (FIGO Chief Executive)

Project Manager Clare Waite

Financial Administrator Raj Waghela


“The CuttingTradition”One of the highlights of the2009 FIGO World Congress ofGynecology & Obstetrics inCape Town, South Africa wasthe official launch of adocumentary film funded byFIGO – “The Cutting Tradition:insights into Female GenitalMutilation” – produced anddirected by filmmaker NancyDurrell McKenna of SafeHands

for Mothers, with award-

winning actress Meryl Streep

as narrator.

The film aims to educate health

professionals and members of

the public worldwide on the

issues surrounding this highly

controversial subject. The film

was subsequently screened at

several international film festivals

around the world including the

Strasbourg International Film

Festival and festivals in Florida,

USA and the London incarnation

of the Raindance Film Festival.

It was awarded the “Best

Documentary” prize at the

Victoria Independent Film Festival

in Australia and received

recognition in the “Best Direction”

category by the Jury of the

Philadelphia Documentary &

Fiction Festival. It was also

broadcast nationally in Denmark

as part of the state broadcaster’s

principal documentary strand. P A G E 6 1

P A G E 6 2


FIGO Fellowshipsand AwardsAs part of its on-going missionto improve the practice ofobstetrics and gynaecology,FIGO makes a number offellowships available, each ofwhich is designed to enhancethe level of knowledge of eitheran individual or a group ofpractitioners.

FIGO/Chien-Tien HsuFellowshipThe FIGO Chien-Tien Hsufellowships were established in1993 in honour of ProfessorChien-Tien Hsu, who wasprofessor of obstetrics,gynaecology and biochemistry atthe Taipei Medical College and,subsequently, professor of

obstetrics and gynaecology at the

National Yang-Ming Medical

College, both in Taipei, Taiwan.

Professor Hsu developed an

international reputation in

gynaecologic oncology, especially

in relation to radical surgery for

cervical cancer.

The objective of the fellowship is

to enable trainees/fellows who

are beginning a career in

gynaecologic oncology to attend

the FIGO World Congress of

Gynecology & Obstetrics and to

visit a gynaecologic oncology

centre in the country where a

FIGO World Congress of

Gynecology & Obstetrics is being

held.

• To be eligible for the

FIGO/Chien-Tien Hsu

Fellowship, applicants mustbe:

• 40 years old or younger• Able to communicate fluently inEnglish

• Holder of a postgraduatedegree in obstetrics andgynaecology

• Engaged in a research projectin oncology

• Able to present an oralcommunication or poster atthe FIGO World Congress ofGynecology & Obstetrics

In 2009, Fellowships wereawarded to Dr Imran OludareMorhason-Bello from Nigeria andDr Spela Smrkolj from Slovenia

In 2012, Fellowships wereawarded to Dr Eun Ji Nam fromKorea and Dr Samir Hidar fromTunisia.


FIGO WorldCongress ofGynecology &ObstetricsEvery three years since FIGOwas founded in 1954,thousands of gynaecologistsand obstetricians gather in onecity to spend a week not onlyanalysing and discussing newmedical discoveries but alsolooking at problems and issuesthat can be addressed by theapplication of low costtechniques. The site for theFIGO World Congress ofGynecology & Obstetricsrotates between the Africa-Eastern Mediterranean,Asia-Oceania, Europe, LatinAmerica and North Americaregions of FIGO. The site isselected six years in advanceby a majority vote at theGeneral Assembly.

FIGO CongressOrganising CommitteeThe FIGO Congress OrganisingCommittee is responsible for allaspects of the organisation of theFIGO World Congress ofGynecology & Obstetrics and inaddition has a brief to investigatethe feasibility of intermediateregional meetings, seminars orworkshops according toperceived needs.

Planning of the scientificprogramme for the FIGO WorldCongress of Gynecology &Obstetrics is delegated to adedicated Scientific ProgrammeCommittee.

Scientific ProgrammeThe Scientific Programme is oneof the most important elements ofany FIGO World Congress ofGynecology & Obstetrics andconsists of seminars, “meet the

experts” sessions, debates,plenary sessions, discussions onnew technology, newdevelopments, updates andinteractive sessions. Theprogramme invariably includesfree oral communication sessionsand sponsored symposia.

XIX FIGO World Congressof Gynecology &Obstetrics – Cape Town,South Africa 2009The host society for the 2009FIGO World Congress ofGynecology & Obstetrics was TheSouth African Society ofObstetricans and Gynaecologists(SASOG). The Congress wasattended by 6,395 delegates and838 accompanying persons from155 countries/territories. The finalprogramme involved 351 invitedspeakers and 668 invited andspecial presentations, FIGOreceived 2,270 abstracts, ofwhich 2,248 were ultimatelyaccepted.

The Exhibition attracted over 100organisations from around theworld.

XX FIGO World Congressof Gynecology &Obstetrics – Rome, Italy2012The XX FIGO World Congress ofGynecology & Obstetrics takesplace in Rome, Italy from 7th to12th October 2012.

An outstanding scientific andcultural programme has been puttogether which it is hoped willmore than satisfy the interests ofall participants. The scientific andindustrial exhibits will present thelatest information and will prepareattendees for the on-goingchanges in women’s health care.The FIGO World Congress ofGynecology & Obstetrics is built

around science and itsadvancement, and a varied,interesting and informativescience-based programme isbeing developed by ProfessorWilliam Dunlop from the UnitedKingdom that not only presentsthe latest science and practicebut also seeks to address themany issues that affect women’shealth world-wide. EachCongress day will include plenarysessions, keynote lectures,concurrent and freecommunications sessions. Youngscientists will be encouraged topresent their work and posterpresentations will be featuredheavily.

The XX FIGO World Congress ofGynecology & Obstetrics is beingundertaken with the assistance ofSocietà Italiana di Ginecologia eOstetricia (SIGO).

FIGO/IFFS De WattevilleLectureEver since 1991 the De WattevilleLecture has been organisedjointly by FIGO and theInternational Federation of FertilitySocieties (IFFS) in memory ofProfessor Hubert de Watteville,the founding father of bothorganisations.

The De Watteville Lectureoccupies a prominent placeamong the special lectures thattake place at each triennial FIGOWorld Congress of Gynecology &Obstetrics. The De WattevilleLecture in 2012 will be given byProfessor Bruno Lunenfeld at theXX FIGO World Congress ofGynecology & Obstetrics inRome, Italy.

P A G E 6 3

P A G E 6 4


Honorary Treasurer’sReportThe organisational structure of

FIGO has changed

substantially in recent years.

On 1st January 2008, virtually

all of the assets of the Swiss

Federation established in 1954

were transferred, following a

decision taken by the General

Assembly, to a new United

Kingdom Registered Charity.

All financial transactions since

1st January 2008 have

therefore been handled through

the United Kingdom Registered

Charity or its trading subsidiary

“FIGO Trading Limited”.

As a United Kingdom RegisteredCharity, the organisation mustcomply with United Kingdomlegislation and adhere to therequirements of the UnitedKingdom Charity Commissioner.FIGO remains a benevolent, non-profit organisation, with theaffiliation of 124 societiesworldwide.

As at 31st December 2011,FIGO’s combined net worthassets (total assets less currentliabilities) was £4,525,252compared with £4,894,974 as at31 December 2008. The lastthree years have seen continuedincome streams from the FIGOWorld Congress of Gynecology &Obstetrics and grants received,but the latter fall primarily under acategory of “restricted funds” thatcan only be expended for theexplicit purpose of that specificgrant and – with the exception ofagreed funds within projectbudgets to cover overheads – notfor the general running of theorganisation or other charitableactivities. The FIGOadministration continues to worktowards making FIGO financially

stable but this must be an on-going effort and one that mustalways remain in focus. FIGOmust continue to seek morefunds and find new partners forits projects whilst continuallyrestricting internal expenditures toa minimum.

United KingdomRegistered CharityA separate United KingdomRegistered Charity wasestablished in 2005 both in orderto facilitate the solicitation ofdonations from United Kingdomresidents and to formalise thestatus of the organisation withinthe United Kingdom. Taking thisinto account, it was agreed at theFIGO General Assembly in 2006that, whilst the Swiss entity wouldremain in existence, to all intentsand purposes the “business ofFIGO” would be undertakenthrough the United KingdomRegistered Charity and its tradingsubsidiary, with the assets of theSwiss entity being transferred tothe United Kingdom Charity.

This move was designed to putFIGO on a more stable footing forthe future and to regularise theFederation’s tax and legal status.To facilitate this, the assets ofFIGO were transferred into thenew United Kingdom Charity andit was agreed that any incomeaccruing to the Swiss entity frommembership fees and othersources should in the future bepaid directly to the new UnitedKingdom entity.

As a consequence of this, it wassubsequently agreed by theExecutive Board that, when theUK Registered charity becamefully operational on 1st January2008, the base currency of FIGOshould be Pounds Sterling ratherthan United States Dollars. All

financial statements issued by theorganisation are now, as aconsequence, stated in PoundsSterling.

Society ContributionsFIGO currently charges eachaffiliated society an annualsubscription of £3.50 for each ofthe affiliate’s declared individualmembers. This will increase to£4.15 for each of the affiliate’sdeclared individual members from2013.

FIGO’s audited accounts for 2011reveal that the amount ofsubscriptions due in that yearwas £288,129. This figure is,however, the sum that FIGOwould receive if all societies paidtheir membership fees in full. Infact, the income actually receivedfrom this source was less thanthis figure (£232,395). It is,however, not unusual in “non-Congress” years for such asituation to arise and manysocieties remedy their arrearsprior to the FIGO GeneralAssembly (which takes placeduring the FIGO World Congressof Gynecology & Obstetrics) inorder to enable them to voteduring this event. FIGO’s auditorsadopt a policy of providing forbad debts and in 2011 the totalallocated for bad debts in respectof errant member societies was£6,850.

As at 30th June 2012, 57 ofFIGO’s 124 member societies(46%) were technically in arrears,having not paid their fees for2012. Strenuous efforts are madeby the Secretariat to recoverthese amounts and a number ofsocieties have brought theirsubscriptions up to datesubsequently.

InvestmentsAt its meeting in June 2006, the

P A G E 6 5

FIGO Executive Board agreedthat, in order to support a seriesof safe motherhood projectsbeing co-ordinated by the FIGOCommittee for Safe Motherhood& Newborn Health in countriesaround the world, up to theequivalent of US$1,000,000 ofthe investments held by FIGOcould be liquidated in case ofneed over the four-year periodfrom 2006–2010. Due to prudentfinancial management, however, itdid not prove necessary to datefor the organisation to liquidateany investments to fund thiscommitment.

After suffering from a markeddownfall in 2009 and 2010 in linewith the worldwide economicdownturn, FIGO’s portfoliogradually began to recover andthe value of the organisation’sinvestment portfolio hasincreased from £968,886 as at31st December 2008 (excludingDeposits & Cash) to acomparable figure of £1,105,378as at 31st December 2011. In aneffort to try and improve theperformance of the investmentportfolio further, the managementof the assets by FIGO’sinvestment bankers is nowundertaken on a “discretionary”rather than “advisory” basisallowing greater investmentflexibility within definedparameters.

Congress incomeFIGO is heavily reliant on incomefrom its triennial World Congressof Gynecology & Obstetrics tosupport its on-going activities andthe administration of theorganisation. As a result ofhistorical difficulties regarding thefinancial management of theFIGO World Congress ofGynecology & Obstetrics,contractual arrangements were

put in place for the 2006 FIGOWorld Congress of Gynecology &Obstetrics that guaranteed aspecified level of income to FIGO.

FIGO has now taken over fullresponsibility for the organisationand management of its ownCongresses, only outsourcingitems that cannot be centrallymanaged. The 2009 FIGO WorldCongress of Gynecology &Obstetrics was the first eventarranged on such a basis and, asa result, the Congress generatedincome of 2,683,747 for FIGO.

Because of the specificpeculiarities of organising aCongress in Italy, a decision wastaken to revert to the earliermodel for the 2012 FIGO WorldCongress of Gynecology &Obstetrics with a local Congressorganiser (supervised by theFIGO Events and MeetingsManager) undertaking to pay toFIGO a guaranteed sum subject

to certain specified levels ofdelegates and sponsors beingachieved; it is nevertheless hopedthat the net profit to FIGO will besufficient to allow funds to bechannelled into the organisation’scharitable activities.

Funding from otherorganisationsDespite the economic downturn,FIGO has continued to attractsubstantial funds from a numberof NGOs, the pharmaceuticalindustry and other donors tofurther its activities in areas suchas the prevention and treatmentof fistula, guidelines on preventionof cervical cancer, safemotherhood and newborn health,capacity building of memberassociations, and the preventionof unsafe abortion. A number oforganisations donated sums ofmoney for specific purposes,including (but not limited to) thefollowing:

FIGO’s overall fundraising has

been enhanced since 2008 by

the recruitment of a Chief

Executive, one of whose main

priorities has been securing

additional funding for charitable

activities.

FIGO would like to acknowledge

with thanks all of its donors

(including those listed above) that

have contributed to the success

of the organisation’s activities.

ExpensesDespite undertaking new

projects, and consequently a

significant increase in its

workforce, the Administration and

Management expenses of FIGO

have been kept to a minimum by

maintaining a slim and efficient

workforce. The costs of salaries

for staff engaged in specific

project work are generally

sourced from the grants provided

by donors to support the specific

activities.

Salaries and wages were

£572,273 for the year to 31st

December 2009, £674,383 for

2010 and £743,130 for 2011.

The average salary increase in

Pounds Sterling for 2009–11 did

not exceed an average of 5.5%

per annum.

Funding for the purchase of a

FIGO headquarters building in

2004 was obtained partly from a

bank loan of US$735,962

(approximately £375,874) and

partly from FIGO’s own liquid

resources. As at the time of

writing, through prudent financial

management, FIGO has not had

to liquidate any of its other

investments to finance the

property purchase.

The bank loan relating to the

property purchase will be repaid

by March 2019, whereupon the

organisation will face no more

rental or loan repayments.

FIGO CharitableFoundationIn 2002, FIGO established a

separate “US 501 (c) (3)”

Foundation in the USA in order to

allow United States resident

individuals and corporations to

donate to FIGO activities on a

tax-deductible basis. Grants

provided by some donors shown

in the list of “Restricted Funds”

were made through the FIGO

Charitable Foundation. Separate

accounts are prepared for the

Foundation by FIGO’sP A G E 6 6

Contributor/Purpose Period Amount (£)

Bill and Melinda Gates Foundation – Organisational Capacity Building 10.11 2008–2011 4,607,612

Chien-Tien Hsu Research Foundation – Fellowship 2009 6,024

EngenderHealth – Fistula activities 2011 85,552

GSK Biomedicals – HPV 2011 1,642

GSK Biomedicals – Guidelines on prevention of Cervical Cancer 2010 46,732

Gynuity Health Projects – Prevention & Treatment of Postpartum Haemorrhage with Misoprostol 2010–2011 110,005

Gynuity Health Projects – World Report 2011 5,217

IBSA And Merck Serono – Committee for Reproductive Medicine Support Grant 2009–2011 84,649

Ipas – World Report on Women’s Health 2011 6,385

Johnson & Johnson – Fistula activities Fellowship program 2011 25,950

Johnson & Johnson – Obstetrics and Neonatal care 2010 85,888

Open Society Institute – FIGO Congress discussion panel 2009 4,924

PATH – Guidelines on prevention of Cervical Cancer 2009–2010 109,644

PMNCH Latin America – Maternal & New-born Health 2009–2010 49,185

POPPHI – Prevention of Postpartum Haemorrhage 2009–2010 45,608

SIDA – Saving Mothers & Newborns Initiative 2006–2009 1,159,769

SOGC – Saving Mothers & Newborns Initiative 2009 6,868

Tolkien Trust – Fistula Activities 2010 10,025

UNFPA – Fistula 2010 4,905

UNFPA – Adolescent Sexual & Reproductive Health 2008–2011 366,247

US Donor – Prevention of Unsafe Abortion 10.11 2007–2011 2,957,108

World Diabetes Foundation – World Report 2011 59,973

Various Donations – Fistula 11 2009–2011 32,353

Various Donations – Flood Disaster of Pakistan 2010 1,867

NB: Because of a change in accounting procedures during the period in question, some sums shown include items of interest received on sums donated.


independent auditors forsubmission to the US regulatoryauthorities. All sums donated tothe Charitable Foundation aretransferred to the main UKRegistered Charity.

Financial auditFIGO´s accounts are auditedannually by a professionalauditing company, Shipley’s. Thevirtually “clean” audit report in2012 (for the year to 31stDecember 2011) reflects the factthat FIGO’s accounts andfinancial transactions are in goodorder, and that internal controlsand transparency have beendeveloped gradually to respondto the needs of a growingorganisation with a diverseproject portfolio.

Copies of the audited accountsmay be obtained upon requestfrom the FIGO Secretariat.

ConclusionOverall, whilst the value of theorganisation’s investments hasfluctuated over the last threeyears in line with generally poormarket performance, FIGO’sfinancial status is relativelyhealthy. The organisation’sofficials will continue to strive tomaintain this standard, focusingon satisfying the financialdemands of existing and futurecharitable activities, whilst alsoservicing the core administrativeneeds of the organisation.

P A G E 6 7

P A G E 6 8


Summary Consolidated Balance Sheet for the three years ended31st December 2011

All figures in Pounds Sterling

2009 2010 2011

FIXED ASSETSFurniture and equipment 798,125 794,840 794,840

Investments 1,076,707 1,221,306 1,105,378

1,874,832 2,020,945 1,900,218

CURRENT ASSETSDebtors 694,245 689,934 501,689

Bank balances 3,728,550 2,341,342 2,782,447

4,422,795 3,031,276 3,284,145

CREDITORS AMOUNTSFALLING DUE WITHIN 1 YEAR (578,898) (457,592) (434,216)

NET CURRENT ASSETS 3,843,897 2,573,684 2,849,929

TOTAL ASSETS LESSCURRENT LIABILITIES 5,718,729 4,594,629 4,750,147

CREDITORS AMOUNTS FALLINGDUE AFTER MORE THAN 1 YEAR (291,805) (261,648) (224,895)

NET ASSETS 5,426,924 4,332,981 4,525,252

RESERVESUnrestricted funds 2,646,021 2,563,067 2,166,271

Restricted funds 2,780,903 1,769,914 2,358,981

5,426,924 4,332,981 4,525,252

P A G E 6 9

Summary Statement of Financial Activities for the three yearsended 31st December 2011

All figures in Pounds Sterling

2009 2010 2011

INCOMING RESOURCESGrants received 1,860,681 1,350,923 2,956,388

Congress income 2,683,747 – –

Contribution income 162,678 286,189 288,129

Investment income 39,088 38,528 33,356

Other income 226,943 242,043 284,238

Currency gains 84,055 135,204 50,163

TOTAL INCOMING RESOURCES 5,057,192 2,052,887 3,612,274

RESOURCES EXPENDEDCosts of charitable activities 2,142,110 2,505,565 2,541,350

Governance costs 711,882 755,882 831,693

Congress expenditure 1,740,001 – –

TOTAL RESOURCES EXPENDED 4,593,993 3,261,447 3,373,043

NET INCOMING/(OUTGOING)RESOURCES 463,169 (1,208,560) 239,231

Gain/(loss) on investment (3,056) 49,039 13,500

Increase/(decrease) investments 71,837 65,578 (60,460)

NET MOVEMENT OF FUNDS 531,950 (1,093,943) 192,271

RESERVES BROUGHT FORWARDAS AT 1 JANUARY 4,894,974 5,426,924 4,332,981

RESERVES CARRIED FORWARDAT 31 DECEMBER 5,426,924 4,332,981 4,525,252


International Federation of Gynecology and ObstetricsFIGO Secretariat

FIGO House, Waterloo Court, Suite 310 Theed Street, London SE1 8ST

United KingdomTel: + 44 20 7928 1166Fax: + 44 20 7928 7099Email: [email protected]

Registered UK Charity No 1113263UK Company No 5498067

© International Federation of Gynecology and Obstetrics 2012

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International Federation of Gynecology and Obstetrics