Eastern Europe Annual Technical Report 1997

8th Postgraduate Course for Training in Reproductive Medicine and Reproductive Biology

J. Kasonde and H. Honkanen
HRP - UNDP/UNFPA/WHO/World Bank Special Programme

REGIONAL STRATEGY

The gravity of the health problems, particularly reproductive health problems, resulting from the political and socioeconomic upheavals in eastern Europe in the late 1980s was recognized by the Programme in 1990. In that year, an initiative was taken to bring together scientists from WHO Collaborating Centres in the region to assess the research and service needs in reproductive health. Areas requiring priority research were later identified and documented at a special meeting in Szeged, Hungary in 1993.

Considering that the infrastructure for research already existed to a large extent in the region, the strategy adopted by the Programme was to promote the design and conduct of research, with a small investment (not exceeding 20 per cent of available resources) in research training, mainly related to the proposed research projects. The bulk of funding for the implementation of research projects was to be sought from multilateral and bilateral donors.

In January 1994, a Scientific Working Group (SWG) on Reproductive Health Research in Eastern Europe was established to promote and coordinate research and training in the region. The Group first met in Geneva in 1994. The first six research proposals were developed in that year but funding has subsequently proved difficult as donor support was not forthcoming.

RESEARCH PROJECTS

Three research areas were selected for initial studies, based on the priorities of the region: family planning, abortion and perinatal care.

Family planning

The prevalence of modern contraceptive use remains low in most countries of eastern and central Europe, making abortion a major method of fertility regulation. Three projects were designed to increase understanding of this problem and suggest solutions.

The first project concerns the determinants of the choice and use of fertility regulation methods in the region. It aims to explain why modern contraceptive prevalence remains low despite the existence of contraceptive services. The project was ongoing in 1997. The second study is a randomized, comparative clinical trial of once-a-month and three-monthly injectable contraceptives. It aims to examine the acceptability (as well as safety and efficacy) of long-acting injectable methods which are currently not included in most of the family planning programmes of the region. The third study in this area is on the acceptance and follow-up of different contraceptive methods in parous women. The latter two projects could not start in 1997 due to unresolved methodological and financial issues.

Abortion

The impact on service delivery of introducing mifepristone and misoprostol for early termination of pregnancy is the subject of one study in this field. The proposal was undergoing scientific and ethical review in 1997.

Another proposal, on mortality and morbidity related to induced abortion, was also at various stages of review and modification in the course of the year.

Perinatal care

Countries of eastern Europe have perinatal mortality rates two to four times higher than those in western Europe in spite of health care services with full coverage. To understand the reasons for this difference a structured perinatal audit was adapted from previous studies in Denmark and Sweden. Latvia, Lithuania, and Russia are participating in this study which was ongoing through 1997.

Other studies

Due to financial difficulties it was not possible to initiate other studies in the year. But the Programme’s protocol on the standardized management of infertility was adapted in Yerevan, Armenia, in a study to evaluate the causes of infertility in the country.

Publications

A special session at the XV World Congress of the International Federation of Gynecology and Obstetrics (FIGO) in August 1997 in Copenhagen, Denmark was devoted to reproductive health in eastern Europe. The eight papers presented will be published in 1998.

RESEARCH TRAINING

The Programme contributed financially and technically to the annual Postgraduate Course for Training in Reproductive Medicine and Reproductive Biology hosted by the University of Geneva, Switzerland. Several candidates from eastern Europe participated in the course.

A Scientific and Technical Advisory Group on Training in Reproductive Health was established by the WHO Regional Office for Europe to coordinate training relevant to eastern Europe. This Group and the Programme’s SWG are exploring ways of working together.

FUTURE PLANS

The limited research programme in eastern Europe has been slow to start but is now well under way. In the immediate future, the implementation of already developed projects is a priority. In the long-term, the building-up of capacity in social science research should receive urgent attention. There has been a slight increase in funding to the region from the Programme. This should ensure implementation of approved research projects. Funding from sources other than the Programme will continue to be sought.

The involvement of scientists from the central Asian Republics still needs to be increased. A setback in this direction was the withdrawal of the only scientist from the subregion who served on the SWG due to his transfer to other duties in his home country. New initiatives will need to be taken in the next year.

Mechanisms for collaboration between the SWG and the Advisory Group set up at the WHO Regional Office in Copenhagen will be a subject for discussion in 1998.

Annex 1

SCIENTIFIC WORKING GROUP ON REPRODUCTIVE HEALTH RESEARCH IN EASTERN EUROPE IN 1997

Members

S. Alexaniants, (Chairman) Armenian Research Centre of Maternal and Child Health Protection, Yerevan, Armenia
A. Campana, Clinic for Infertility and Gynaecological Endocrinology, Geneva, Switzerland
M. Horga, Institute of Public Health and Medical Research, Targu-Mures, Romania
L. Kovacs, Albert Szent-Györgyi Medical University, Szeged, Hungary
*G. Lindmark, University Hospital, Uppsala, Sweden
P. Velebil, Institute for Maternal and Child Care, Prague, Czech Republic
*E. Vikhlyaeva, Research Centre of Obstetrics, Gynaecology and Perinatology, Moscow, the Russian Federation

*Denotes woman