Gynecol Obstet Invest 2012;74:187–189 DOI: 10.1159/000343054
Published online: November 7, 2012
Interview with Prof. Dr. Marleen Temmerman, New Director of the WHO Department of Reproductive Health and Research, Assuming Office on October 15, 2012
We have to meet the unmet need, and increase the demand.
I had the opportunity to do this interview in the plush environment of the Belgian Senate, on a sunny June afternoon, where Senator and Prof. Marleen Temmerman had lunch with a delegation of the Kenyan Parliament interested in the Belgian political model. The reason for this interview was the appointment of Marleen Temmer© 2012 S. Karger AG, Basel 0378–7346/12/0743–0187$38.00/0 Fax +41 61 306 12 34 E-Mail
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man as the next director of the Department of Reproductive Health and Research (RHR) and of the UNDP/ UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), both based at the WHO headquarters in Geneva, Switzerland. Q: The WHO RHR Department has established over the years a whole network of WHO collaborating centers, like the International Center of Reproductive Health (Belgium, Kenya, and Mozambique), chaired by you, and the Institute of Primate Research, Nairobi, Kenya, where I am involved as a research associate and chair of the International Advisory Board to promote its development into an African Center of Excellence in Preclinical Biomedical Research in Reproduction. These WHO collaborating centers have a lot of potential. Do you have plans to work with these centers when you assume office? A: I feel that the existing WHO collaborating centers represent a unique resource of human resources, brains, and goodwill to work closely with the WHO, and that their utilization should be maximized. Therefore, I want to make an inventory and identify their stakeholders according to the different WHO RHR/HRP programs (fetomaternal and neonatal health care, family planning, infertility, prevention of unsafe abortion, sexually transmitted diseases, sexual health). Next, I would like to enDownloaded by: KU Leuven University Library 134.58.179.36 - 2/4/2015 4:17:15 PM
Abstract In this interview with the editor of Gynecologic and Obstetric Investigation, Prof. Dr. Marleen Temmerman, the new director of the WHO Department of Reproductive Health and Research (October 15, 2012), presents her vision on the role of WHO collaborating centers; the relationship between scientific research, guideline development, implementation, and policy; the need to prioritize family planning, and the need to improve perinatal and maternal health but also to address other global reproductive health problems like infertility, pelvic pain, dysfunctional bleeding, and sexually transmitted diseases, which deserve more attention from the WHO. She also addresses the challenge to increase funding for WHO sexual and reproductive health research.
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highly visible in its efforts to do research, produce guidelines, and give family planning tools to governments. In fact, WHO RHR HRP needs to create the same ‘sense of urgency’ regarding family planning as UNAIDS did for the HIV problem in the nineties. In order to meet this unmet need for family planning services, it is important not only to improve access to these services but also to create the demand. I mean, if these services exist, if they are well known and are perceived to function well, there will be increased demand to use them. Such a situation will greatly assist governments to provide incentives to their citizens to have families with limited numbers of children, for instance by considerable financial support, which could be much less from the third or fourth child onwards. Family planning has to be made feasible and attractive! Q: Some people have the perception that WHO RHR HRP has focused much on the improvement of antenatal, perinatal, postpartum, and newborn care over the last years, with excellent results. Nevertheless, other relevant areas like family planning, infertility, sexual health, and sexually transmitted infections have received less attention. The important problem of pelvic pain, which may lead to infertility and reduced sexual health, and which is often caused by benign gynecological problems like endometriosis and pelvic adhesions, has not been addressed at all. Sexually transmitted infections and their consequences (reproductive tract adhesions and/or obstruction in both female and male reproductive tracts) contribute enormously to global infertility problems. Another example is dysfunctional bleeding, often caused by uterine fibroids or endometrial polyps. How will you address these issues? A: As I said before, family planning will be my main priority. I agree that the problems of infertility, pelvic pain, dysfunctional bleeding, and sexually transmitted diseases are very important as well and deserve more attention. For instance, the human drama of infertility is probably more fundamental in the southern part of this world than in the north. In fact, the number one reason why health professionals consult the WHO RHR/HRP website is to find guidance for the management of infertility, including the WHO manual for sperm analysis. Prevention of infertility and affordable early treatment should be on the WHO RHR HRP agenda. Obviously, prevention and early treatment of sexually transmitted diseases would be very important in that respect and could be integrated in the WHO RHR agenda for family planning. Global problems like pelvic pain and dysfunctional bleeding and their causes also need to be adInterview with Prof. Dr. Marleen Temmerman
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courage them to create program-related networks, with the aim to establish North-South global collaborations. These networks would then have sufficient manpower and academic and clinical experience to start multicenter studies centrally coordinated by the WHO that can address the currently important questions in reproductive and sexual health. A nice example of this format is the recent Kesho Bora study showing that the incidence of neonatal HIV infection could be reduced by the use of antiretroviral medication during breast feeding. This study not only yielded relevant scientific publications but also led to new guidelines that are already implemented by national governments. Q: So your point is that, as much as possible, research in human reproduction should be clinically relevant and lead to guideline development and to local implementation worldwide? A: Exactly. It is sometimes a pity how scientific insight is not translated into daily clinical practice. For instance, in Belgium, the knowledge that screening for cervical cancer can be done by cytological analysis of a cervical smear every 3–5 years did not significantly change the routine clinical practice offering an annual cervical smear to every woman, until Belgian legislation limited the reimbursement to once every 2 years. In my opinion, WHO RHR/HRP should not only be active in research and in the development of international guidelines but also promote their translation into national and clinical guidelines and, if needed, national legislation. Next, we need to study how these guidelines can be implemented locally, based both on the provision of national health services and on social, cultural, and psychological factors affecting access to health care. For example, in rural areas in Mozambique, a woman is considered to be ‘strong’ if she delivers a child at home and ‘weak’ if she delivers in a professional medical environment. Q: The WHO RHR/HRP activities and programs are very diverse and open to lobbying from various stakeholders. How will you prioritize them? A: Indeed. We need to study if all of them are equally important in view of the WHO RHR/HRP mandate, and also in relation to the activities of other UN agencies, NGOs, and other international funding bodies. In my opinion, there is one area which deserves definitely more attention, and that is family planning. Access to safe family planning is a human right for both women and men, starting from their adolescent years. Furthermore, the impact of the population explosion on economic and ecological resources is enormous. WHO RHR HRP has to be
A: I believe that it is important to approach this problem not only financially but also from a human rights point of view. In my opinion, it is a human right that women should not risk their life during child birth. WHO RHR HRP should make significant efforts to promote this human right. In terms of funding, it is clear that WHO RHR HRP is underfunded. In order to have better financial support, we need to work together with more governments, NGOs, donors like the Gates Foundation, and with industrial partners in our research programs. However, this will remain a delicate exercise, as many of our programs are related to ethically sensitive issues. Prof. Thomas M. D’Hooghe, Leuven
Interview with Prof. Dr. Marleen Temmerman
Gynecol Obstet Invest 2012;74:187–189
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dressed. For global reproductive health problems like infertility, pelvic pain, dysfunctional bleeding, and sexually transmitted diseases, I plan to organize a ‘State of the Art’ meeting at the WHO headquarters, involve all stakeholders, identify the unmet needs in these areas, develop guidelines, set up research programs, and seek funding. Q: Traditionally, it has been more difficult for research in reproduction to attract funds when compared to, for instance, research in oncology or cardiovascular disease. Due to the current economic crisis, funding for reproductive biomedical research has become even more difficult, which has also affected the WHO RHR HRP programs. How are you planning to handle this situation?
