Dr. Anibal Faúndes and the FIGO Working Group for the Prevention of Unsafe Abortion
Wednesday, September 12, 2012
When the second edition of the World Health Organization’s Safe abortion: technical and policy guidance for health systems was released earlier this year, Dr. Anibal Faúndes quickly started getting the word out. As chair of the International Federation of Gynecology and Obstetrics (FIGO) Working Group for the Prevention of Unsafe Abortion, he immediately asked his regional coordinators to disseminate information about the new Guidance to focal points and other key contacts in their countries.
His quick action and keen interest come as no surprise. A provider, professor, author and advocate of women’s sexual and reproductive health and rights, Dr. Faúndes is a strong bridge between the women’s and medical communities and was among those consulted by WHO as the new Guidance was being developed.
Established in 2007, FIGO invited all its member societies to participate; currently, there are projects in 43 countries. In each country, a situation analysis was conducted that informed a plan of action to reduce unsafe abortion in coordination with government leaders, health-care officials and local and international partner organizations such as Ipas. Intervention is aimed at four primary objectives: preventing unintended pregnancies; improving access to safe, legal abortion services; increasing the quality of postabortion care; and preventing repeat abortions through postabortion contraceptive counseling and service provision.
Dr. Faúndes, who is professor of obstetrics at the State University of Campinas, São Paulo, Brazil, says the new Guidance “should be in the hands of every provider.” Some of the clinical updates reflect practices already in place in many countries, such as the recommendation that sharp curettage should be replaced by vacuum aspiration to improve safety and quality of care. (FIGO made that recommendation in a consensus statement on uterine evacuation issued in 2011.) He says, however, that their inclusion in the WHO Guidance gives them added weight and will emphasize, especially for providers in developing countries, their importance.
Throughout his career, Dr. Faúndes, a native of Chile, has been guided by the belief that ob-gyns have a crucial role to play in influencing governments and provider attitudes. As a mentor to thousands of medical students, he has helped mobilize the voice of ob-gyns on the issues of women’s reproductive health and rights. He is particularly encouraged that Chapter 4 of the new Guidance contains a strong and clear call for the removal of regulatory and policy barriers that hinder access to and timely provision of safe abortion care. It states that “policies should be geared to respecting, protecting and fulfilling the human rights of women.”
Removing barriers to access—especially barriers created by the attitudes of health-care providers themselves—is of great concern to Dr. Faúndes. He cites the findings of a study that Dr. Sosthene Mayi-Tsonga conducted with his collaboration at the principal maternity hospital of Gabon between January 2005 and December 2007. It looked at the delay in provision of care for women who died from abortion-related complications, compared to the delay in provision of care for women who died from eclampsia and post-partum haemorrhage. The mean time between diagnosis and initiation of treatment was 1.2 hours for women with eclampsia and post-partum haemorrhage, compared to 23.7 hours for women with abortion-related complications. “An important determinant of the delay in initiating care may be discrimination against women who have had an abortion,” the study concluded. These results caused a movement by local partners to improve services.
As those findings illustrate, Dr. Faúndes says, providers themselves need support and values clarification training to help them understand and overcome the stigma that surrounds abortion--and he has hope that the strong policy and legal recommendations in the new Guidance will encourage governments and providers alike to value and respect women’s human rights, including the right to safe abortion care.
Dr. Faúndes and the working group’s regional coordinators are reaching out to ob-gyn societies in the group’s 43-country coverage area to help ensure that the new Guidance is widely disseminated. He and his FIGO colleagues also will be working with Ipas and other reproductive rights organizations to organize trainings, workshops and other activities to ensure that the Guidance is implemented to the fullest extent possible.
With respect to the new Guidance, he says it brings to mind the words of former FIGO President Mahmoud Fathalla: “Obstetricians and gynaecologists are moving from being part of the problem to becoming part of the solution." The new Guidance, Faúndes says, gives ob-gyns around the world a new and clear opportunity to continue on that path.