Dorothy Shaw

Women in high resource nations are increasingly delaying childbearing until their thirties. Delayed childbearing poses challenges for the spacing of a woman’s pregnancies. Inter-pregnancy intervals <12 months are associated with risk for adverse pregnancy outcome, yet increased maternal age at delivery is linked with increased risk. The optimal inter-pregnancy interval for older mothers is uncertain. This systematic review will aim to assess the relation between inter-pregnancy interval and perinatal and maternal health outcomes in women who delay childbearing to age 30 and older. We will search MEDLINE, CINAHL, and EMBASE databases for peer-reviewed articles on the effects of inter-pregnancy interval on perinatal and maternal health outcomes among women over 29 years at the time of first birth, in high-income countries. To assess the quality of studies, the Cochrane’s Collaboration tool for assessing risk of bias will be used for randomized controlled trials, and the Newcastle-Ottawa tool to assess quality of case control and cross-sectional studies. The quality of the findings on each outcome will be assessed across studies, using the GRADE approach. The decision to conduct meta-analyses will be based on the concordance in definitions used for inter-pregnancy intervals, age groups studied, or outcomes measured among selected studies. We will report odds ratios and/or relative risks and/or risk differences for different inter-pregnancy intervals and perinatal and maternal outcomes as well as pregnancy complications. This systematic review will summarize existing data on the relation between inter-pregnancy interval and perinatal and maternal health outcomes among women who delay childbearing to age 30 and older. Findings will inform clinical best practices to assist mothers over age 30 to space their pregnancies appropriately. Prospero CRD42015019057

The FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health was developed on the premise that organizational capacity strengthening in eight low‐ and middle‐income countries would result in improved ability of member associations to take a leadership role in engaging a range of stakeholders in the health sector to discuss evidence and facilitate policy change and clinical practice in maternal and newborn health. Definitions of relevant terms, principles, and a framework for an advocacy plan are presented. The term advocacy is typically not well understood by health professionals, nor generally thought to be part of their role as a clinician, researcher, or educator. “Influence” based on expertise is often more consonant with a clinician's reality, especially where advocacy is perceived as a more political process that may present a barrier in some countries. The organizational capacity development of the FIGO member associations was integral to their ability to exert influence based on evidence, both internally in their associations and with other stakeholders, including the Ministry of Health. Examples of advocacy from each of the eight LOGIC countries are provided, noting that evaluation of impact can be challenging.

The origins of the International Federation of Gynecology and Obstetrics (FIGO) Initiative for the Prevention of Unsafe Abortion and its Consequences began in 1969 when a young British medical student encountered a young woman in Canada with complications of unsafe abortion. Through evolving understanding of the context of women's lives, including the role of family planning and access to safe abortion globally in preventing the deaths and imprisonment of women, I was able to contribute to FIGO's advocacy through a collaborative initiative with country‐led action plans based on a situational analysis. Forty‐six member associations rapidly agreed to participate with results of situational analyses—an unprecedented result in FIGO's history. Professor Anibal Faúndes’ role has been pivotal to the success of this initiative, including the establishment of a working group of regional coordinators and collaborating agencies to oversee the implementation of action plans involving in‐country partners and the Ministry of Health. Deaths from unsafe abortion and its complications are preventable.

Universal access to reproductive health is a target of Millennium Development Goal (MDG) 5B, and along with MDG 5A to reduce maternal mortality by three‐quarters, progress is currently too slow for most countries to achieve these targets by 2015. Critical to success are increased and sustainable numbers of skilled healthcare workers and financing of essential medicines by governments, who have made political commitments in United Nations forums to renew their efforts to reduce maternal mortality. National essential medicine lists are not reflective of medicines available free or at cost in facilities or in the community. The WHO Essential Medicines List indicates medicines required for maternal and newborn health including the full range of contraceptives and emergency contraception, but there is no consistent monitoring of implementation of national lists through procurement and supply even for basic essential drugs. Health advocates are using human rights mechanisms to ensure governments honor their legal commitments to ensure access to services essential for reproductive health. Maternal mortality is recognized as a human rights violation by the United Nations and constitutional and human rights are being used, and could be used more effectively, to improve maternity services and to ensure access to drugs essential for reproductive health.