Category Archives: Human Reproduction

Pascale Allotey, Director Department of Sexual and Reproductive Health and Research including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)

I was asked recently if there would be repercussions if we simply removed sexualfrom SRH and focused on reproductive health, ensuring a non-controversial agenda that targeted the proximal causes of maternal mortality. The question is indicative of the ever-present, escalating and worrisome sensitivities to sexual health and rights.

These are sensitivities that HRP has never shied away from. In fact, the question underscores the essential role of HRP, committed to generating evidence to support the health and wellbeing of all people everywhere.

There is no reproductive health without sexual health. Sexual health encompasses the promotion of bodily autonomy and agency, recognizing the importance of safe, healthy relationships throughout life. This requires access to information to enable choice. Sexual health ensures the prevention of and protection from sexually transmissible infections, unintended pregnancies and harms imposed by differential power relations. Sexual health seeks to provide high-quality screening, diagnosis and treatment for gynaecological and andrological conditions that underly infertility, sexual disorders and dysfunction and reproductive cancers. Over the life course, sexual health safeguards health and wellbeing, ensuring that we remain productive and not just reproductive.

A comprehensive approach to sexual and reproductive health is essential for gender equality. Research shows that the presence of services such as comprehensive sexuality education, contraception services, comprehensive abortion care and maternal health services all contribute to more empowered, healthier, happier communities. Critically, sexual and reproductive health are fundamental to gender equality and human rights.

In recent months, experts from WHO and HRP have been present and visible in global forums speaking to the importance of an approach to sexual and reproductive health that addresses peoples needs within and well-beyond reproduction.

In this newsletter you will find highlights from FIGO, where we launched the pivotal PPH Roadmap, as well as the World Health Summit where we launched the first Joint Statement on Selfcare with WHO, UNDP, UNFPA and the World Bank. Then there was the World Conference for Sexual Health where colleagues further emphasized the importance of sexual health and sexual pleasure as essential to wellbeing.

We have just launched a joint Call to Action on Climate Change and Maternal, Newborn and Child Health with WHO, UNICEF and UNFPA, alongside an advocacy brief by PMNCH and partners, and ahead of COP28.

The 16 Days of activism against gender-based violence commences 25 November and extends through 10 December. This year we are releasing a number of resources intended to empower health workers with the knowledge and tools they need, as sometimes the first and often the only point of contact for people experiencing violence.

Finally, as the year draws to a close, stay tuned as we focus on maternal health with an exciting Lancet Series launching on 7 December, followed by a BMJ Global Health series on the post-natal period.

Tribute to Dr Fathalla

Earlier this month thepublic health community lost one of its great champions, Dr Mahmoud Fathalla. He was a visionary of womens health who led the way on empowering women through sexual health and rights. I am proud to say his legacy carries on through today in everything we strive to do at HRP.

See more here:
Message from the Director of the Department of Sexual and ... - World Health Organization

A visionary of womens health and rights, father of the Safe Motherhood movement, and voice behind Why Did Mrs. X Die?, Dr Mahmoud Fathalla, died on 10 November 2023 at the age of 88.

Dr Fathalla assumed his role as Director of the UNs Special Programme on Human Reproduction (HRP) from 1989 to 1992, after two years as Head of Research with HRP and the World Health Organization (WHO) and years of work as a renowned doctor and Professor of Obstetrics & Gynaecology at Assiut University, Egypt.

When asked what one prescription women need most for their health, Dr Fathalla answered power. While the concept of listening to women was astoundingly provocative at the time, his commitment to equality and equity informed every aspect of his work.

Convinced from experience that maternal health was inextricably influenced by social trauma, Dr Fathallas leadership at HRP brought a seismic shift from a focus on biomedical interventions to solutions that address the very personal contexts in which women live.

In 1990, Dr Fathalla invited the International Womens Health Coalition to advise HRP on how to effectively solicit and respond to womens perspectives on fertility regulation technologies and services.

They co-convened a landmark meeting which emphasized the equal participation by womens health advocates alongside contraception specialists. The resulting report, Creating Common Ground, demonstrated the value of listening, and led to ongoing engagement of womens health and rights advocates in research, policy development and decision making.

HRP continued to conduct similar consultations throughout the 1990s, in every WHO region. This led to a series of Creating Common Ground publications, and influenced countless other epochal initiatives including the first safe abortion guidance document in 2001 and the forming of the Gender Advisory Panel (GAP) in 1995, which still reviews and provides advice on all aspects of HRPs work with attention to gender equality and considerations from a sexual and reproductive rights perspective.

Gentle, soft spoken and solitary, he was highly regarded by his colleagues who lovingly thought of him as a Sphinx. In the rare event that Dr Fathalla spoke, people listened. He often provided searing insights that cut through controversy.

When it came to the issue of abortion, he was forever motivated by his work as an obstetrician in Egypt, his own place of birth. Dr Fathalla often told the story of a woman he treated who had endured an unsafe abortion that left her uterus and intestines severely damaged.

In a speech on abortion he said, A woman can claim as her own her head, her hair, her hands, her arms, her upper body, her legs and her feet. She cannot claim the same right to the remaining area of her body, which appears to belong more to certain males of the species, moralists, politicians, lawyers, and others, all of whom claim to decide how this area is best utilized. Within this disputed territory the fetus happens to lie. Basically, the opposition to abortion was part of the wider spectrum of reproductive subordination of women. Men in the patriarchal societies have always reasoned that if women had control over their reproduction, they would also have the unthinkable: control over their own sexuality

The depth of Dr Fathallas commitment to building community, his passion for sexual and reproductive health and his humble, inexhaustible optimism in spite of many challenges is conveyed in his final thoughts and hopes for the future:

My very dear friends,

I asked my son Dr Mohamed to e-mail this message to you when I leave the stage of this present world. In saying farewell, I want to express my sincere appreciation and gratitude for our long association and friendship, and for our comradeship in serving noble causes. I consider myself fortunate and privileged to have known you and worked with you for a noble mission. We all can look back with satisfaction as we see a brilliant new generation moving forward with the torch. I wish you all many happy healthy productive years ahead, until we meet again in what I hope will be a better world and a rewarding life hereafter.

Warmest regards.

Yours sincerely,

Mahmoud

Originally posted here:
Tribute to Dr Mahmoud Fathalla - World Health Organization

Our reproductive lives are considerably different from those of our ancestors, thanks in part to health innovations that have taken place over the past few decades. Practices such as IVF, donor eggs and sperm, womb transplants, surrogacy and egg freezing, mean that for many, theres now more choice than ever before over whether, when and how to reproduce.

Yet, despite these advances, one aspect of reproduction has remained constant: the need to gestate (grow) foetuses in the womb. But what would happen to our notions of parenthood if technology made it possible to grow a foetus outside the human body?

Until recently, the idea of ectogenesis growing a foetus outside the body has been science fiction. But teams in the US, Australia and Japan have begun developing artificial wombs. Its hoped that this technology will someday save the lives of very premature infants.

Should I have children? The pieces in this series will help you answer this tough question exploring fertility, climate change, the cost of living and social pressure.

Trials have already been performed on animals with researchers reporting success in gestating lamb foetuses.

Meanwhile, a team in the Netherlands is developing a similar system using simulation technology. This approach mimics the birth of extremely premature infants using a manikin equipped with advanced monitoring and computer modelling. This allows the researchers to understand how an infant may develop in an environment that simulates the wombs conditions.

Although this may be many decades away, and is not the intended endpoint of current research, artificial womb technologies could eventually lead to full ectogenesis growing a foetus from conception to birth wholly outside the human body.

One barrier to research into full ectogenesis is current legislation worldwide, which either bans embryo research altogether or forbids growing human embryos for research beyond 14 days.

Legislation would therefore need to change for this kind of research to happen. Theres an increasing appetite for this among the international scientific community, but whether such a change would have public support is not known.

Full ectogenesis also raises important ethical, legal and social questions, which would need to be answered before it can be used.

In the UK, the person who gives birth is the childs legal mother regardless of genetics or intention. Growing a foetus in an artificial womb could however sever this link between gestation and motherhood.

Surrogacy has, to some extent, already challenged our legal and social conceptions of motherhood. The surrogate is the childs legal mother at birth, but parenthood can then be transferred to the intended parents via a parental order or adoption.

But artificial wombs could disrupt long-established norms in more profound ways, as there would no longer be a birth mother at all. The law would need to define who the legal mother is in such circumstances, and whether that definition applies to all mothers or only when artificial womb technologies are used.

The impact of artificial wombs on legal definitions of fatherhood may be less significant.

In the UK, the person who provides the sperm is normally the legal father of the child unless the child is born using sperm donated in a licensed clinic. In that case, the donor is not the legal father of any resulting child.

But fatherhood (or parenthood for same-sex couples) can also legally be attributed to someone via the Human Fertilisation and Embryology Act 2008. This allows someone not genetically related to the child to be recognised as their legal father or other parent. The provisions in this Act would apply to full ectogenesis because this will require IVF to create the embryo.

Full ectogenesis may result in more radical changes to the way we view legal parenthood. It may cause us not only to rethink our ideas of mother and father, but also the language used. Would it be more appropriate, for example, to always use the word parent, instead?

Artificial womb technology would also influence the personal decisions that people make about reproduction. It could drastically change the way the decision to become a parent fits into many peoples lives.

Like egg freezing and IVF, artificial wombs would make it possible for women in particular to have children later in life. It could also allow people to gestate multiple foetuses at once making it possible for them to complete their families within a far shorter time period than has previously been possible.

Artificial womb technology technology would make it easier for more people to have their own biological children including single men, same sex couples and women unable to become pregnant for health reasons. It would also mean that women would no longer have to undergo the significant risks and burdens associated with pregnancy and childbirth in order to have children.

In science fiction, artificial wombs are often a symbol of dystopia of technological incursion into natural processes and a means of government control (as in The Matrix or Brave New World). But artificial womb technology might instead add to the reproductive choices currently available making it possible for more people to become parents if they want to.

Full ectogenesis is still a long way off, but its important to discuss it now so that we can have a more informed view of the issues it raises. As with many aspects of human reproduction, artificial womb technology may be divisive.

Some will see it as a way to increase reproductive autonomy and equity, others as dangerous or even a threat to traditional family structures and values. More still will probably see its potential for both. Whatever your position, this technology could be on the horizon and its implications for society and our concept of parenthood merit careful consideration.

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Artificial wombs could someday be a reality here's how they may ... - The Conversation