The role of the South Asia Federation of Obstetrics and Gynaecology (SAFOG) in South Asia
Dr D Goodall, Maternal and Newborn Health Unit, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. Email firstname.lastname@example.org
Please cite this paper as: Bhuiyan A, Goodall D. The role of the South Asia Federation of Obstetrics and Gynaecology (SAFOG) in South Asia. BJOG 2011; 118 (Suppl. 2): 22–25.
The obstetric and gynaecological societies of the South Asian Association for Regional Cooperation (SAARC) are members of the International Federation of Obstetrics and Gynaecology (FIGO) and the Asia–Oceania Federation of Obstetrics and Gynaecology (AOFOG). The membership of both of these federations includes the obstetric and gynaecological societies of a large number of countries with widely varying standards of women’s healthcare, from highly developed resource-rich countries to countries with a poor healthcare delivery system and resource constraints.
It was apparent in the mid-1990s that these larger federations, such as FIGO and AOFOG, were not appropriate for focusing on the women’s health problems prevalent in South Asian countries. Therefore, it seemed essential to establish a forum for the obstetricians and gynaecologists of this region to enable them to discuss their specific problems and progress, as well as to share and learn from the experience of all the countries in the region.
In September 2005, senior obstetricians and gynaecologists from India, Pakistan and Sri Lanka met for the first time in Colombo to suggest that a regional federation be formed, which was initially named the Federation of Obstetrical and Gynaecological Societies of the South Asian Region (FOGSAR). Those present at this inaugural meeting agreed to invite members of other SAARC countries, namely Bangladesh, Bhutan, Nepal and Maldives, to participate.
In October 1996, at the 14th AOFOG Congress in Bali, it was decided that the first congress of the new federation specifically for the SAARC countries would be held in Lahore, Pakistan, later that year. The FOGSAR constitution was presented and subsequently adopted with some amendments at this conference. As there was difficulty in registering the organisation in the SAARC Secretariat, the name was changed to the South Asia Federation of Obstetrics and Gynaecology (SAFOG).
Membership and objectives
Membership of SAFOG is open to all national societies of obstetrics and gynaecology in the SAARC region. It was agreed that, where more than one society exists, the apex body of all societies in that country would represent the country.
As stated in the SAFOG Journal, the objectives of SAFOG, as set out in the constitution, were as follows:1
1 To bring together the obstetricians and gynaecologists within the region for closer cooperation and social understanding.
2 To use and develop reproductive health as an instrument towards social and health development.
3 To promote the exchange of ideas and sharing of knowledge, skills and attitudes among obstetricians and gynaecologists in the region.
4 To strengthen and produce uniformity in the postgraduate training of medical graduates in reproductive health.
5 To facilitate continuing medical education in reproductive health in the region.
6 To encourage and maintain research on reproductive health in the region relevant to the good health of the population.
7 To cooperate with other international and regional organisations concerned with reproductive health.
8 To strive to reach the goal of providing reproductive health care for all persons in the region and, in particular, the provision of safe motherhood.
9 To enhance the involvement of obstetricians and gynaecologists in the process of decision making in the health policies of the region.
In addition, it was decided that a SAFOG Congress would be held once every 2 years in association with the obstetrics and gynaecology society of the country hosting the congress.
Subsequently, a congress was held in Bangladesh in 1998, Sri Lanka in 2000, India in 2003, Nepal in 2005, Pakistan in 2007, Bangladesh in 2009 and Sri Lanka in 2011. As a result of the enthusiasm and commitment of all members, each congress has been very successful and well attended.
Presidents of SAFOG are appointed from each country in which the congress is held. Past Presidents of SAFOG include: Professor Rashid Latif Khan (Pakistan), 1996–98; Professor T.A. Chowdhury (Bangladesh), 1998–2000; Dr Lakshman Fernando (Sri Lanka), 2000–03; Dr D.K. Tank (India), 2003–05; Dr Sudha Sharma (Nepal), 2005–07; Professor Farrukh Zaman (Pakistan), 2007–09; Professor Abdul Bayes Bhuiyan (Bangladesh), 2009–11.
In addition, from the year 2000, the SAFOG Journal has been published in Delhi, quarterly, by Jaypee Brothers Medical Publishers (P) Ltd., Current Editor Dr Narendra Malhotra. In December 2008, SAFOG launched a new website to enable improved communication with members (http://www.safog.org/).
SAFOG congress themes and outputs
The theme for the congress in Mumbai, India, in 2003, was ‘The Adolescent Girl and her Problems’. A consultation meeting of SAFOG with the United Nations Population Fund (UNFPA), World Health Organization (WHO), United Nations Children’s Fund (UNICEF), Averting Maternal Death and Disability Program (AMDD) and the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO now rebranded as Jhpiego) was held in April 2004 and consensus was reached on planning human resource development, emergency obstetric care, skilled birth attendants at delivery and the prevention of postpartum haemorrhage.
The theme for the SAFOG Conference held in March 2005 in Kathmandu, Nepal, was ‘Challenges for Community Obstetrics in South Asia’, following which steps were taken to bring about closer collaboration between SAFOG and UNICEF in the areas previously agreed in April 2004.
More than 90 million terminations of pregnancy and 198 000 maternal deaths as a result of termination of pregnancy were estimated to have occurred in the 25 countries of AOFOG between 1995 and 2000.2 In 2008, there were an estimated 17 000 deaths caused by unsafe termination of pregnancy in Asia (12% of all maternal deaths in this region). This accounts for 36% of deaths caused by unsafe termination of pregnancy globally.3 To achieve Millennium Development Goal (MDG) 5, the issue of unsafe terminations of pregnancy must be addressed. The law in all AOFOG countries permits termination of pregnancy on some grounds—whether to save a woman’s life, preserve her physical and mental state, in cases of rape and incest, for socio-economic reasons or on request.4
In the realisation and recognition of the size of the problem, a consensus statement on unsafe termination of pregnancy was drafted at the 6th SAFOG Conference (themed ‘Shaping the Future’) in 2007, held in Lahore, Pakistan. This was subsequently released as ‘The Tokyo Declaration: Position Statement on Preventing Unsafe Abortions’ and adopted at the 20th Asia and Oceania Congress of Obstetrics and Gynaecology (AOCOG) in Tokyo in September 2007. To achieve the stated objectives, a series of recommended actions for individual obstetricians and gynaecologists, and obstetrics and gynaecological associations, was drafted (Table 1).
Table 1. Recommended actions to prevent unsafe terminations of pregnancy
| 1||Establish a Working Group on Sexual and Reproductive Rights in each obstetrics and gynaecology society or federation with the participation of professionals from other disciplines in order to promote these rights and these recommendations|
| 2||Sponsor/support comprehensive family planning programmes for all women and men of reproductive age and dispel myths about temporary, permanent and emergency methods of contraception|
| 3||Take a leadership role in promoting official government interventions at all levels to promote access to safe termination of pregnancy services for all legal indications and to control mortality caused by unsafe termination of pregnancy|
| 4||Work with government health authorities to prepare and implement norms and guidelines that define the minimal level of quality in termination of pregnancy care, the steps to ensure sufficient public sector services, and the staffing and supplies needed for the promotion and protection of sexual and reproductive rights, including access to safe termination of pregnancy services for all legal indications. The use of WHO-endorsed technologies should be recommended and added to essential drugs and equipment lists|
| 5||Promote continuing education of health professionals in the area of women’s reproductive and sexual rights in each country, and stimulate medical professionals to promote interdisciplinary debates on termination of pregnancy care, including the fields of epidemiology, nursing, psychology, social work and other disciplines which could have a bearing on unwanted pregnancy and termination of pregnancy|
| 6||Serve as a source of information to the media in order to disseminate correct information related to women’s sexual and reproductive rights, including termination of pregnancy and the dangers of unsafe termination of pregnancy|
| 7||Support efforts to prevent sex-selective termination of pregnancy by addressing the underlying causes that perpetuate discrimination against women and girls, including discriminatory laws, patriarchal structures, unfair dowry systems, etc. No physician should perform a sex-selective termination of pregnancy on social grounds|
| 8||Give special attention to adolescents seeking care for unwanted pregnancy or termination of pregnancy|
| 9||Establish alliances with public and private institutions and with national and international nongovernmental organisations concerned with these issues, including women’s groups, in order to strengthen mutual efforts|
|10 ||Study, analyse and understand national laws and policies in order to encourage the provision of termination of pregnancy services to the fullest extent permissible|
|11 ||Advocate for laws which recognise the rights of women to obtain a safe termination of pregnancy|
|12 ||Advise service providers to honour the code of professional ethics which safeguards confidentiality, whilst working within the laws of the country|
|13 ||Question laws and regulations which require physicians to report women suspected of obtaining termination of pregnancy services or require police presence in obstetric clinics and emergency services|
The 7th SAFOG Conference held in Dhaka, Bangladesh, in March 2009, was themed ‘Professionals can Make a Difference in Maternal Health’. It affirmed SAFOG’s main objective to drive progress towards the achievement of MDGs 4 and 5. The Postpartum Haemorrhage Initiative from the Sri Lanka College of Obstetricians and Gynaecologists was considered to be the highlight of this congress.
Regional and international partnerships
The Sri Lanka College of Obstetrics and Gynaecology, in collaboration with SAFOG, held its annual scientific session at Colombo, Sri Lanka, in November 2007, under the theme ‘New Frontiers in Obstetrics and Gynaecology and their Practices in the Region’.
SAFOG initiated a collaboration with the Royal College of Obstetricians and Gynaecologists (RCOG), UK, and a joint conference of RCOG and SAFOG on ‘Improving Women’s Health in South Asia’ was held in Kolkata, India, in December 2007. The South Asia Day Conference held at RCOG, London, in July 2009, was a joint RCOG/SAFOG/All India Co-ordinating Committee (AICC) activity to further the discussions on how to achieve MDGs 4 and 5 in the region. The presentations highlighted the success and failures in current strategies to achieve the targets for MDGs 4 and 5 in Bangladesh, India, Pakistan, Nepal and Sri Lanka. These are summarised in this supplement.
Sharing lessons learned
It is apparent that Sri Lanka has shown leadership in South Asia by making impressive reductions in maternal mortality, improvements which have come about as a result of changes both within and outside the health sector. The increased availability of free services, both in the community and the health units, has led to the increased use of antenatal and intrapartum services, chiefly provided by trained midwifes.5 In the 2008 WHO update,6 it was reported that, in Sri Lanka, 96.6% of births are attended by trained health personnel, which is much higher than in India (46.6%), Bangladesh (20.1%), Pakistan (54.0%) and Nepal (18.7%) (data from 2000 to 2007).
This has been followed by improvements in the availability of specialised and emergency obstetric care and the integration of family planning services. Outside the health sector, the emphasis on female education and literacy is recognised to have also made an important contribution, and is supported by evidence in some of the states in India, such as Kerala.
We are of the view that SAFOG is best placed to endorse to all of its members the two international strategies for reducing maternal mortality,7–9 namely:
1 Providing a skilled birth attendant for all pregnant women.
2 Providing access to emergency obstetric care to women with recognised problems.
We can expect that SAFOG will continue to inspire enthusiasm and commitment amongst those member countries doing less well as they see and understand the success of others around them, share lessons learned and respond to the challenges in the region. Recent developments, such as the provision of financial incentives from the government of India to women to support institutional delivery and the increased use of facilities for both deliveries and maternal complications in Bangladesh, are examples of real progress towards MDGs 4 and 5.10,11
The 8th SAFOG Conference recently held in Colombo, Sri Lanka, in April 2011, under the theme ‘New Horizons for Reproductive Health in South Asia’, has noted once again the successful achievements in Sri Lanka and some significant progress in Bangladesh and India, although problems remain in both countries, as well as in Nepal and Pakistan. The new President, Professor Harshalal R. Seneviratne of Sri Lanka, challenged the conference delegates and all SAFOG members to strive harder to achieve the goals of MDGs 4 and 5:
1 By increasing advocacy with its governments at all levels.
2 To further human resource development by providing protocols and guidelines and ensuring quality assurance.
3 To enhance the operational activities of services by addressing issues such as the management of postpartum haemorrhage and the provision of anaesthesia.
4 And, finally, to promote capacity building in the individual societies and enhance research programmes.
SAFOG as an organisation has undoubtedly grown and developed, and there is a definite commitment to fulfilling its original objectives. It has the expertise and experience to communicate and coordinate, so that more strenuous efforts can be made to achieve progress towards MDGs 4 and 5 in South Asia.
Disclosure of interests
No conflict of interests to disclose.