In pursuit of better reproductive healthcare
Dina Ezzat, Sunday 5 May 2019
A host of national and international medical experts discussed new and old problems of women’s reproductive health in a two-day conference in Cairo


Helping women over 42 to get pregnant and women in their 20s to have safer and more reliable contraceptives were two leading issues medical doctors examined in Cairo over two days of the annual Ain Shams University Conference for Obstetrics and Gynecologists, which opened in Cairo 24 April.

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“The conference essentially looked at some of the traditional issues related to women’s reproductive health, including those of fertility problems. But it also approached some of the issues that are now becoming more pressing for women in Egypt, including the pursuit of natural or assisted pregnancy for women over 42,” said Ahmed Rashed, a leading obstetrician-gynecologist.

Whether in public or private clinics, Rashed, former chair of the Ain Shams Gynecology-Obstetrics Department, said he is now seeing more women getting married at an age that would be "considered late from a medical point of view" for starting a process of getting pregnant.

According to Rashed, already applied treatments have been successful in helping some women over 40 to get pregnant – either through assisted natural conception or through IVF.

However, he added, the focus of discussion of the two-day conference related to developing a treatment approach that would be specifically designed to help women in the last segment of their reproductive phase.

“I cannot say that we are there yet, but we are seeing more attention and more ideas coming up in this direction,” Rashed said.

Meanwhile, according to Khaled ElHoudaiby, another prominent gynecologist-obstetrician, part of the debate in the conference related to giving younger women better decision-making over their pregnancy choices.

According to ElHoudaiby, offering women in earlier segments of their reproductive phase safe and dependable contraceptives is essential in this regard.

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“We are now talking about new birth control pills that would have higher reliability and much less side effects for women who wish to have family planning options,” he said.

ElHoudabiy acknowledged that IUDs (intrauterine devices) are still the "generally preferred contraception of choice for many women given that it relieves them of the burden of worrying about the possible consequences of missing a pill or two.”

This said, he acknowledges there is a growing trend among women to fully take reproductive choices into their own hands.

“With the IUD, a woman needs a doctor to have it fitted, and a doctor to have it removed. But with the pill, it is an every night decision that a woman makes about wanting or not wanting to get pregnant. Clearly this gives women a lot more space to change their mind about what they want,” he said.

He added that the two-day conference allowed participants who come from a diverse range of practicing experience and access to get continued education and become better informed about new types of birth control pills with higher efficiency, less side effects and more tolerability.

“It is important to make sure that new treatments and techniques are available to women all over the country, and the way to do this is to make sure that doctors are informed and trained about what is there to offer,” he said.

According to ElHoudaiby, planning pregnancies is crucial for Egyptian women of “almost all brackets."

A founding member and former chair of the Ain Shams University IVF Unit and a practicing doctor for over 40 years, ElHoudaiby argued that over the years the ability of treatments to attend to the concerns of women have “improved significantly.”

“Of course, there is a lot more to be done and learned, but it is gratifying for us as doctors to be able to help a lot more women that we did before. And it is really getting better every year,” he argued.

Reducing maternal mortality rates is another area of success that the conference examined, Rashed said.

“We have made much progress since the launch of the national campaign to reduce maternal mortality rates, from 1988 to 1995. We went down from 84 per 100,000 pregnant woman to 32 per 100,000 pregnant women,” Rashed said.

He added that the commitment to pursue better training for doctors and higher awareness for the public is essential to serve the objective of taking this figure further down to developed countries' rate of under 20 per 100,000 pregnant women.

Chairman of the conference Khaled Saiid Moussa argued that by allowing younger and less exposed doctors from all over the country to take part in this annual conference, the medical community in Egypt manages to pass on experience that is “essential in helping doctors who might have to attend to emergency cases in less privileged clinics to save lives of pregnant women and to help them through safe delivery.”

Managing and spacing the number of pregnancies for women is an essential element in reducing the rates of maternal mortality, especially for women who start getting pregnant in their teens, Moussa said. “And this is something for the national awareness campaigns to attend to, not just for doctors’ skills and advice,” he added.

Attending to the side effects of repeated pregnancies with very short intervals is not as pressing a concern for the conference as it used to be over a decade or two ago, Moussa said.

According to Moussa, this might be a function of higher levels of education and better awareness of the hazards of excessive repeated pregnancies or a function of economic concerns that prompt couples to be serious about family planning.

However, Rashed said that with a society that still has a segment of women who go through repeated pregnancies, “willingly or unwillingly," the conference is still concerned with handling the side effects in question.

This year, he said, the focus was on examining effective treatments to the impact of excessive repeated pregnancies on the control of bladder function, especially among women above 50.

The impact of changing lifestyles among women on their reproductive health is a matter the conference examined in detail this year, said Moussa.

“Whether we are talking about delayed pregnancies, or safe natural delivery, or cutting down on increasing rates of caesarean sections, we are talking about matters related to managing a lack of physical fitness, unhealthy eating habits and harmful habits and practices,” he said.

Also on the agenda of this year’s conference, ElHoudaiby said, were issues related to treatment of fibroids and medical pregnancy care for mother and child.

http://english.ahram.org.eg/News/331087.aspx