Most pregnancy related mortality and complications are preventable through increased contraceptive use-Dr. Attiya Inayatullah

Print

 International Conference of Obstetrics & Gynaecology

Most pregnancy related mortality and
complications are preventable through
increased contraceptive use-Dr. Attiya Inayatullah

Interventions that prevent maternal mortality also prevent
still births and neonatal mortality-Prof. Goldenberg

KARACHI: Dr.Attiya Inayatullah was one of the invited keynote speakers at the recently concluded international conference organized by Society of Obstetricians & Gynecologists of Paksitan here from February 23-25th 2018. In her address she referred to the recent 2017 census which shows Pakistan’s population growth rate of 2.4%. This, she said, has put the country’s family planning intervention in the spotlight.

Three critical indicators i.e CPR, TFR, Unmet Family Planning need, tell us that fertility decline is practically static & if this issue is not addressed immediately, it will play havoc with the country. The result of unplanned pregnancies is that six thousand abortions occur daily, 38-40 mothers die daily from preventable causes; Neo-natal mortality is 55 per 1000 live births; 4 million unwanted children are born each year; Pakistan’s pre-term births of 15.8 for every 100 births places it 8thin the top 10 countries; Pakistan is amongst countries with the highest rate of child malnutrition. Approximately 60% of the population is food insecure and more than 35 million of Pakistan’s school going age children (5-10 yrs) is out of school. These, she said, were not just statistics, each number has a women or child’s life behind it.


Prof. Farid Al-Zafar President of Society of Obstetricians & Gynecologists of Pakistan along with
Prof. Rashid Latif Khan and Prof. Farrukh Zaman chairing a session during the recent
international conference organized by SOGP at Karachi during February 2018.

Continuing she further stated that our maternal deaths every hour are the equivalent of one Boeing super jet crash with no survivors, but this never makes the headlines in the media. To bluntly summarize, these demographics tell us that Pakistan’s 2.4% population growth rate (PGR) is collective suicide. We need to address pregnancy related mortality and complications which are preventable and whose solution lies in increased contraceptive use. The colossal shame of 9 million women with an unmet need for contraception should be immediately addressed by closing the gap between demand & accessible quality services.


The Social Marketing of Contraception, Dr. Attiya Inayatullah further stated must be revived to its robust past so that the culture of self procurement is inbuilt. The LHWs original calling of devotion 25% of time to family planning should be reinstituted. Post 18th Amendment the Provinces should fast track FP programs, provide adequate budgetary allocation, meet the CPR through CIP’s and align provincial health and population programmes with national goals. Doctors, particularly gynecologists, she opined can play a crucial role. Each doctor participating in this Conference can today make a commitment to give dedicated time to family planning. The Year 2017 has given us a wakeup call. Pakistan’s Population time bomb is ticking. Without universal access to family planning the SDG interactions will cost more & take longer to achieve. In short investing in family planning is a development best buy and fundamental for human well being and socio-economic development, she concluded.


On left Sindh Chief Minister Syed Murad Ali Shah presenting a memento to Dr. Sadiah Ahsan Pal, while
in the Centre Prof Rashid Latif Khan presenting memento to one of the speakers and on extreme
right Dr. Attiya Inayatullah presenting memento to Prof. Sadiqa Jafary at the SOGP conference.

Prof. R Goldenberg from USA in his Keynote address highlighted that Pakistan has one of the highest maternal & newborn mortality rates in the world, as well as the highest stillbirth rate. This is preventable by good antenatal and childbirth care as other developed countries have done. Unfortunately Pakistan is lagging far behind. Most of the conditions that cause maternal mortality in low income countries like Pakistan, he said, also cause stillbirth and neonatal mortality, and most of the interventions that prevent maternal mortality also prevent stillbirth and neonatal mortality. Individual interventions aimed at maternal, fetal or neonatal mortality rarely improve outcomes. Instead, sequences of interventions aimed at improving care within the health system have the greatest potential impact on outcome. Programs should focus on improving all pregnancy outcomes, not just the individual components of maternal, fetal and neonatal mortality.

What brought improved outcome in the United States, he said was increasing access to prenatal care: preeclampsia screening with blood pressure and urine protein determination, increasing use of hospitalization for Pre eclampsia & Induction of labor (and CS) for worsening maternal or fetal status. Almost all the reduction in maternal mortality in USA occurred prior to the use of MgSO4. A Caesarean section rate of 5 – 10% is thought to be optimal for reducing stillbirths.


Group photograph taken during the SOGP international conference held at Karachi shows
Prof. Rashid Latif Khan, Prof. Farrukh Zaman alongwith other national and
international delegates attending the conference.

Many low income countries have cesarean section rates <5% and some have cesarean section rates of <1%. Worldwide, each year more than 8 million fetuses and newborns and 300,000 of their mothers die before or just after birth. We know what interventions work to improve perinatal outcomes. We just don’t know how to make these interventions available and sustain their use in low-income country settings, he remarked.

Post Pregnancy Contraception

Sir Sabaratnam Arulkumaran from UK spoke at the Green Star- SOGP session on Post Pregnancy Contraception- the Way Forward. He presented the FIGO initiative in Post Partum IUCD insertion in South Asian Countries. Data was also shared by the NCMNH PPIUCD institutionalization intervention in Pakistan by Dr Azra Ahsan which has successfully shown its safety and efficacy. Dr. Shahida Zaidi shared the successful AMAN- Rotary Intervention results for post partum and Post miscarriage IUCD intervention in Karachi. Sir Sabaratnam Arulkumaran also presented the landmark Woman Trial for post partum haemorrhage management along with leading Pakistan centers. Prof. Tobie De Villiers from South Africa highlighted the health needs of menopausal women and clarified the controversies around prescribing Hormone therapy. He emphasized that the benefits outweigh the risks associated with it, in current evidence and treatment has to be individualized according to the health needs of the woman. Prof Linda Cardozo (UK) gave an evidence based update on female urinary Incontinence and Cosmetic genital surgery. Prof Lubna Pal (USA) gave evidence based guidelines on polycystic ovaries, improving success in infertility treatment and decreased ovarian reserve.

President’s Session

In this session, Prof Rashid Latif Khan who set up the first IVF Center in Pakistan spoke on the history of gynaecology in Pakistan. Prof. Sadiqua N Jafarey (President NCMNH) spoke on the Sustainable Development Goals (SDGs). She pointed out that Pakistan is lagging behind in these goals, as it did in the Millennium Development Goals (MDGs). Prof Lubna Hassan spoke on preventing death and disability, through maintaining Maternal Death Surveillance Registry (MDSR) throughout Pakistan as an initial step. Dr. Shahida Zaidi shared the successful AMAN- Rotary Intervention results for post partum and Post miscarriage IUCD intervention in Karachi.


Prof. Sadiqa Jafari, Dr. Sadiah Ahsan Pal and Dr. Attiya Inayatullah chairing one of the
sessions during the SOGP conference held at Karachi.

Prof. Tobie De Villiers from South Africa highlighted the health needs of menopausal women and clarified the controversies around prescribing Hormone therapy. He emphasized that the benefits outweigh the risks associated with it, in current evidence and treatment has to be individualized according to the health needs of the woman. Prof. Linda Cardozo (UK) gave an evidence based update on female urinary Incontinence and Cosmetic genital surgery. Prof Lubna Pal (USA) gave evidence based guidelines on polycystic ovaries, improving success in infertility treatment and decreased ovarian reserve.

Aman Foundation & Aman Health held a session on Achieving SDGs and FP 2020 Goals in which Dr Talib Lashari presented the Sindh Government’s CIP and its progress, Dr Harris Ahmed presented the Sukh Imitative of Aman Health, and Prof Rubina Sohail presented the progress towards SDG 3 in Punjab.

IPAS & FIGO held a joint session with a focus on post pregnancy contraception, and post abortion care in Pakistan. Special sessions were also devoted to Endoscopic Surgery, Prenatal Diagnosis, Infertility, Menopause, Ultrasound and Imaging, Uro Gynaecology, Perinatal & Antenatal Care, Oncology & Contraception.

Child Sexual Abuse and Rape

FIGO and SOGP also organized a joint session on Child Sexual Abuse & Rape which was open to the public. Speakers included Prof. Rubina Sohail and Prof. Shehla Baqai who highlighted the problem in Pakistan, highlighted the lack of training of Doctors and Health care professionals in the management of this issue. This session was moderated by Prof. Sadiah Ahsan Pal and the panelists included Dr. Attiya Inayatullah (SPARC), Prof. Shershah Syed, Prof. Aisha Mehnaz (Konpal, PPA) Ms Sarah Zaman (Shirkatgah), Dr. Azra Ahsan (AMAN), Dr Noreen Zafar (GWHI). The panelists were of the view that healthcare professionals were guilty of maintaining silence on the issue. The solution lies in Life skills and sex education in schools and educational institutions of Pakistan, as well as education of Parents.

The Global Network of Women and Child Health Research & the CHS Dept of AKUH also held a session on the concluding day and shared key findings of their research related to maternal and child health in Pakistan. The speakers included Prof. Sarah Saleem, Dr Talib Lashari, Prof Goldenberg and Dr. Elizabeth McClure.

Asia Oceania Federation of Obstetricians & Gynecologists (AOFOG) held a session on reducing Caesarean Section rates. Prof Ravi Chandran (President AOFOG, Malaysia), Prof Rohana Haththouwa (SriLanka), Prof. Thaneemalai Jeganathan (President OGSM Malaysia) and Prof U.D. P Ratnasiri( Sri Lanka) conducted the session. South Asian Federation of Obstetricians and Gynecologists (SAFOG) held a session on Cancer prevention.

Inaugural Session

The Conference was inaugurated by Chief Minister Sindh, Mr. Syed Murad Ali Shah. He congratulated the SOGP on holding the conference and said that Sindh Government was already taking steps to improve women’s health, by introducing legislation on a minimum age for marriage, increasing access to contraception and public private partnerships to improve health facilities throughout the province.

President SOGP Prof. Sardar Al Fareed Zafar highlighted the high maternal mortality in Pakistan and the urgent need to address it.Prof. Rakhshanda Rehman in her keynote speech pointed out that the health and progress of our nation depends on improved healthcare of our women.


Some of the delegates attending the 17th Biennial international conference of
SOGP photographed during the conference held at Karachi.

The conference attracted a large number of eminent obstetricians & gynecologists from many countries of the world who contributed a great deal to the scientific programme. Some of the eminent personalities which graced the occasion included key opinion leaders in this field like Sir Sabaratnam Arulkumaran (Ex President FIGO) from UK, Prof. R Goldenberg from USA, Prof Tobias De Villiers (South Africa) , Prof Linda Cardozo (UK), Prof Lubna Pal from USA and Dr Elizabeth McClure also from United States. Eminent speakers from Pakistan included Prof. Sadiqua Jafarey, Prof. Rashid Latif Khan, Prof. Aftab Munir, Prof.Farrukh Zaman, Dr. Shershah Syed, Prof. Lubna Hassan, Prof.Tasneem Ashraf, and current President Prof Sardar Al Fareed Zafar. The scientific programme consisted of State of the Art lectures, workshops and panel discussions with latest research and evidence based practices.

Post Conference Workshops

Over 100 Pre and Post conference workshops were held all over Pakistan in the month Preceding the Conference, by Senior Gynecologists addressing key areas for developmental change like post-pregnancy contraception, safe childbirth, emergency obstetrics & newborn care, research, MVA, Communication Skills, Management of the rape victim and newborn resuscitation and endoscopic surgery. The UK team which held workshops and lectures included Dr. Naila Siddiqui from Imperial College London, Dr. Farah Saeed, Dr. Umar Hussain, Dr. Ayesha Bati-Paracha, Dr. Mehreen Mirza and Dr. Sana Usman

Those who were actively involved in the organization of the conference included Prof. Sadiah Ahsan Pal, Prof. Nusrat Shah & Prof Sonia Naqvi, besides Prof Fareed Zafar President of SOGP.

Note: Report prepared by Shaukat Ali Jawaid with input from Dr.Saira Ahsan Pal.

© Professional Medical Publications. All rights reserved.