Women’s health—what’s new worldwide


International guidelines/reports

Trends in maternal mortality: 1990–2010

This report, published by the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the World Bank, sets out comprehensive global, regional and country level maternal mortality estimates for 2010 and highlights trends from 1990 to 2010. The report was prepared by the Maternal Mortality Estimation Inter-Agency Group (MMEIG).

The report states that by 2010 there had been a 47% global decrease in maternal deaths from levels recorded for 1990. Factors that could account for this decrease include improvements to health systems, increased access to health services and increased levels of education within the female population. In 2010 two countries, India at 19% and Nigeria at 14%, accounted for a third of all maternal deaths worldwide. By 2010 ten countries had already achieved Millennium Development Goal (MDG) 5 (which aims to reduce the maternal mortality ratio by 75%): Estonia; Maldives; Belarus; Romania; Bhutan; Equatorial Guinea; Iran; Lithuania; Nepal; Vietnam. In May 2011, the Commission on Information and Accountability for Women’s and Children’s Health recommended that all countries should establish a comprehensive civil registration system to record births and deaths (including a specific cause of death) and implement efficient health information systems. If achieved, this would ensure greater accuracy in preparing maternal mortality estimates and would allow for better monitoring of progress towards MDG 5. At present, however, only one-third of countries are reported as having accomplished this.


Tools for change: applying United Nations standards to secure women’s housing, land and property rights in the context of HIV

This multi-stakeholder manual has been produced specifically for use by anyone pursuing claims to land, housing or property rights for women affected by HIV, including women themselves or professionals or service providers working on their behalf. The manual clearly sets out international human rights principles and the United Nations Standards, and the importance of these to women with HIV. Brief overviews of women’s rights in various countries are provided including Uganda, Canada, Malawi, India, Kenya, Nepal and South Africa. Chapter three focuses on enforcement and highlights that in signing up to the MDGs all United Nations member states have undertaken to uphold women’s rights within their own countries. Enforcing those rights, however, remains a challenge. The manual provides examples of ways in which women have become involved in promoting women’s rights in their country within the context of HIV including: participating in constitutional development in Uganda; Huairou Commission and GROOTS Home Based Care Alliance; raising the Voices of Women Affected by HIV in Kenya; and the South African National AIDS Council Women’s Sector. The manual provides eight advocacy strategies for people to use as a tool for change: fact-finding and documentation; human rights training and capacity building; strategic organising; strategic litigation; petitioning national human rights commissions; law reform; media campaigns; international advocacy.


I had to run away: the imprisonment of women and girls for moral crimes in Afghanistan

This report, published by Human Rights Watch, highlights the issue of the imprisonment of women and girls in Afghanistan for what are termed ‘moral crimes’. These include ‘running away’ and zina (sexual intercourse between two individuals who are not married to each other). The 2009 Elimination of Violence against Women Law banned forced marriage, forced prostitution, domestic violence, rape and other abuses against women but this law is reported to be inconsistently enforced. No official law governing ‘running away’ from an abusive family or relationship exists in the Afghan Penal code but it is reported that women who do run away receive no support from the police, judiciary or government officials and many are actually charged with the crime of ‘running away’ and face a lengthy punishment. The report discusses women’s rights since the end of Taliban rule, including violence against women and girls, the prevalence of forced and underage marriage and traditional practices of Baad and Baadal (exchange marriages). The report is based on in-depth interviews with 58 Afghan women and girls who are being held in prison and juvenile rehabilitation centres, and with prison wardens, government officials and advisors and women’s rights activists and experts.


Priority life-saving medicines for women and children 2012

Published by the WHO, this list updates the 2011 version entitled ‘Priority medicines for mothers and children’. The 2012 list was drawn up following the 18th Expert Committee Meeting on Selection and Use of Medicines, the release of relevant new treatment guidelines and consultation and feedback from key partners. The medicines included in the 2012 list take into account the global burden of disease and were chosen as a result of their efficacy and safety in preventing or treating major causes of ill-health including sexual and reproductive health, maternal and newborn health and child and adolescent health. Additions to the 2012 list include: misoprostol for the prevention of postpartum haemorrhage; hydralazine and methyldopa for the treatment of severe pregnancy-induced hypertension; misoprostol and mifepristone for termination of pregnancy; tetanus vaccine for the prevention of tetanus in both mothers and children; and various family planning methods. Medicines removed from the updated list include: 2 ml vial of magnesium sulphate; procaine benzylpenicillin; and higher dosage forms for treating neonatal sepsis.


Clinical trial recruitment

Clinicians keen to keep up-to-date regarding clinical trials that are currently recruiting may find the following informative.

Randomised study of letrozole and trilostane for medical abortion


This randomised pilot study aims to determine whether, in women undergoing termination of pregnancy, the addition of letrozole or trilostane (which target estrogen levels) to the standard regimen of mifepristone and misoprostol leads to more effective shedding of the endometrial lining.

Inclusion criteria: Healthy women aged 18–45 years without any contraindication for treatment of any of the drugs involved in the study.

Primary outcome measure: Efficacy.

Secondary outcome measure: Acceptability.

Study site: Stockholm, Sweden.

Anticipated study end date: October 2013.

Fitness improvement in obese, pregnant women: an intervention trial (InterGOFIT)


This randomised study aims to assess the effects of a supervised moderate intensity physical conditioning programme (consisting of up to three 1-hour weekly sessions for 12 weeks) on obese pregnant women during the second trimester in terms of whether the programme encourages the women to maintain higher levels of physical activity until the end of their pregnancy. The investigators also wish to assess the effects of the programme on maternal fitness and neonatal anthropometry.

Inclusion criteria: Pregnant women 18 years or older; single pregnancy; delivery at Centre Hospitalier Universitaire de Québec; prepregnancy body mass index ≥ 30 kg/m2.

Primary outcome measure: Weekly time spent at physical activity of moderate intensity and above.

Secondary outcome measures: Gestational weight gain; muscular fitness; cardiorespiratory fitness; energy expenditure; neonatal anthropometry; fetal growth.

Study site: Quebec, Canada.

Anticipated study end date: January 2014.

Mirena and estrogen for control of perimenopause symptoms and ovulation suppression


This randomised, double-blind study aims to determine whether low-dose estrogen therapy in combination with circulating low doses of levonorgestrel, as a result of use of the Mirena intrauterine system (IUS), can suppress ovulation in perimenopausal women. The study will also investigate the ovulation rates and symptom control of the Mirena IUS used alone and will assess the tolerability of the combined treatment of perimenopausal symptoms with the Mirena IUS and the combined estrogen therapy.

Inclusion criteria: Age 40–52 years; history of regular menstrual cycles every 20–35 days in mid-reproductive life (20–35 years of age); at least one period within the past 3 months; body mass index < 35 kg/m2; presence of at least one perimenopausal symptom (hot flushes (vasomotor symptoms), cyclical headache, bloating or adverse mood, self-reported poor quality of sleep).

Primary outcome measure: Ovulation suppression.

Secondary outcome measures: Suppression of ovulation in older reproductive aged women; relief of perimenopausal symptoms.

Study site: Colorado, USA.

Anticipated study end date: June 2013.

Surgery or chemotherapy in recurrent ovarian cancer (SOC 1 Trial)?


This phase III randomised trial aims to investigate the role of secondary cytoreductive surgery followed by chemotherapy versus chemotherapy alone in women with platinum-sensitive recurrent ovarian cancer. Validation of a risk model for patient selection criteria for surgery will also be undertaken.

Inclusion criteria: Age at recurrence 18 years and older; women with platinum-sensitive, first relapsed epithelial ovarian, primary peritoneal, or fallopian tube cancer which is defined as those with treatment-free interval of 6 months or more; a complete secondary cytoreduction predicting score, iMODEL≤ 4.7, including FIGO stage (0 or 0.8), residual disease after primary surgery (0 or 1.5), progression-free interval (0 or 2.4), PS ECOG (0 or 2.4), Ca125 (0 or 1.8), and ascites at recurrence (0 or 3.0); assessed by experienced surgeons, complete resection of all recurrent disease is possible; women who have given their signed and written informed consent.

Primary outcome measure: Overall survival.

Secondary outcome measures: Progression-free survival; quality of life; complication incidence.

Study site: Shanghai, China.

Anticipated study end date: December 2017.

Patent news

Granted patents

US 8173592 Method for a programmed controlled ovarian stimulation protocol.  This US granted patent outlines a method of controlled ovarian stimulation to allow oocyte pick-up and fertilisation procedures to take place during Mondays to Fridays. Specifically, this invention involves the administration of luteinising hormone-releasing hormone antagonists (selected from cetrorelix, teverelix, ganirelix, antide or abarelix) during the luteal phase in a dosage of 0.5 mg to 10 mg to prevent premature ovulation.

Engel, J., Riethmuller-Winzen, H. Method for a programmed controlled ovarian stimulation protocol. 8 May 2012.


US 8168198 Therapeutic agent for polycystic ovary syndrome (PCOS).  This US granted patent relates to a therapy for treating polycystic ovary syndrome. Specifically, this therapy consists of an extract of mushrooms preferably from one of the following: Grifola frondosa, Lentinus edodes, Agaricus blazei Murill, Ganoderma lucidum and Pleurotus ostreatus. The treatment is said to have few side-effects and is effective in inducing ovulation.

Tominaga, K., Anzai, H., Zhuang, C. Therapeutic agent for polycystic ovary syndrome (PCOS). 1 May 2012.


Patent applications

WO 2012/055840 A1 Composition and preparation for treatment of dysmenorrhea and menstrual pain and use of a hormonal agent and a zinc salt for treatment of menstrual disorders.  This world patent application outlines a pharmaceutical composition and regimen for the treatment or prevention of dysmenorrhoea and menstrual pain. Specifically, the invention proposes a preparation comprising a progestin or an agent that has progestogenic activity and a biocompatible zinc salt. The patent also outlines a pharmaceutical composition, containing zinc salt, that can be taken 1–4 days before the onset of menstruation. Additionally, the authors propose that zinc administered concomitantly over the complete menstrual cycle (a lower dose in the early phase and an increased dose in the late phase) is also beneficial.

Lezzaiq, S., Schneeweis, A., Patched, V. Composition and preparation for treatment of dysmenorrhea and menstrual pain and use of a hormonal agent and a zinc salt for treatment of menstrual disorders. 3 May 2012.


Legal matters

Making abortion services accessible in the wake of legal reforms: a framework and six case studies

This report provides comprehensive information for six countries or states (South Africa, Nepal, Mexico City, Cambodia, Ethiopia and Colombia) regarding the implementation and impact of the passing of revised termination of pregnancy (TOP) laws. The report discusses the country or state setting, the legal grounds for seeking a TOP under the newly introduced laws, new guidelines for TOP and their dissemination, the establishment, availability and uptake of safe TOP services and the impact of the revised laws. Recommendations are provided for policy makers, programme managers and health service providers in countries undergoing reform of TOP laws.



  1. Shona Kirtley, Research Information Specialist, Centre for Statistics in Medicine, University of Oxford, UK and John Thorp, North Carolina Center for Women’s Health Research, USA.