The UNDP/UNFPA/WHO Special Programme of Research, Development and
Research Training in which WHO plays the key research and coordinating
role was established more than 30 years ago, primarily in response to
international concerns about unwanted fertility and the impact of rapid
population growth. While improvements in contraceptive acceptability,
safety and choice and in the quality of care still play an important
role in its research agenda, the scope of work has expanded to
emphasize newly salient issues such as adolescent sexual behavior,
gender inequalities and violence against women, the prevention and
management of sexually transmitted infections including HIV/AIDS, the
development of safe and effective methods for the early termination of
unwanted pregnancies and the management of complications of unsafe
procedures, and improvements in pregnancy, delivery and postpartum care
in resource-poor settings. The Special Programme has built up an
international network of more than 120 research institutions in
developed and developing countries that is engaged in social science
and biomedical research aimed at strengthening the evidence base for
improved policies, programs and practices in sexual and reproductive
health for women, men and young people throughout the world.
WHO Overviews and Periodic Reports on Sexual and Reproductive Health
Research and Data
WHO's Department of Reproductive Health & Research (RHR) produces a biennial report on Research on Reproductive Health at WHO based on the collaborative work of the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. This is an excellent overview of WHO's biomedical and behavioral research in family planning, safe pregnancy, STI/RTI prevention and management, adolescent sexual and reproductive health and the prevention of unsafe abortion. The report describes WHO's regional and in-country programs and identifies cooperating research centers and RHR staff.
RHR also produces an Annual Technical Report that describes new and ongoing research projects, identifies the scientists and institutes involved, and lists resulting publications in each area. Topics include all areas of sexual and reproductive health plus gender and reproductive rights, implementing best practices, monitoring and evaluation, communication and dissemination of information, technical cooperation, and policy and program issues in countries and regions. Activity reports from the WHO Regions of Africa, the Eastern Mediterranean, the Americas, South-East Asia and the Western Pacific, and Europe are included.
Guidelines for Providers
WHO's tools and guidelines embody international standards for sexual and reproductive health care. Within each of these areas, evidence-based best (and worst) health care practices are collected in the Reproductive Health Library (RHL) on CD-ROM. Currently in its sixth edition (2003), the RHL is distributed to almost 12,000 subscribers worldwide and is free to individuals in low- and middle-income countries (see Annex for ordering information). It is the major tool of WHO's Programme to Map Best Reproductive Health Practices for disseminating information to researchers, medical and public health faculty, program managers and health care practitioners.
Focusing on evidence-based solutions to reproductive health problems, the annually updated Reproductive Health Library presents systematic reviews of scientific studies of the effectiveness of specific health interventions in STIs/RTIs and HIV/AIDS, pregnancy and childbirth, neonatal disorders, fertility regulation, gynecology, and the treatment of infertility. The RHL is organized in four sections:
Reproductive Health in Developing Countries describes the methodology of the systematic reviews based on randomized controlled trials ("Cochrane reviews") and on "meta-analyses" of results from different studies, plus editorials written by library staff and subscribers.
Effectiveness Summaries for Decision-Making evaluates dozens of specific interventions (e.g., routine examinations, drug treatments, laboratory tests, counseling) in sexual and reproductive health care. These are classified as beneficial forms of care; forms of care likely to be beneficial; forms of care of unknown effectiveness, forms of care likely to be ineffective; and forms of care likely to be harmful. Each conclusion is based on an annotated review of the evidence that is included in the RHL. The individual research articles on which conclusions are based can also be accessed on the CD-ROM.
The Reproductive Health Database contains more than 200 Cochrane reviews, meta-analyses, RHL commentaries and practical guidelines on fertility regulation, infertility, gynecology and cervical cancers, STIs/RTIs and HIV/AIDS, pregnancy and childbirth, and neonatal disorders.
Policies and Strategic Plans
WHO has produced a series of reports over the past decade affirming its commitment to implementing the global sexual and reproductive health and rights agenda. The most recent of these is a strategic plan, Reproductive Health: Strategy to Accelerate Progress Towards the Attainment of International Development Goals and Targets (2003), which was requested by the World Health Assembly in 2002 and adopted by the Assembly in May 2004.
Opening with the comprehensive definition of reproductive and sexual health and rights from the Programme of Action of ICPD, the plan is aimed at speeding up the achievement of global reproductive and sexual health goals set by ICPD, its five-year follow up meeting, and the U.N. Millennium Development Project. The report emphasizes the pervasive gap between global and regional goals and realities with respect to pregnancy, childbirth and newborn health; family planning; unsafe abortion; and STIs/RTIs (including HIV) and identifies key barriers to progress such as inequities related to gender, to poverty, and to adolescents' exposure to risks and restricted access to services. The strategy to accelerate progress is based on the guiding principle of human rights and addresses core aspects of comprehensive reproductive and sexual health services. Recommended actions include strengthening health systems capacity and quality of care, improving information for priority setting, mobilizing political will, creating supportive regulatory frameworks and improving methods of monitoring, evaluation and accountability.
Regional strategy papers prepared by the WHO offices for the South-East Asia Region, Africa, Europe (including Russia and the former Soviet republics) and the Americas are also available from the Department of Reproductive Health & Research. These provide useful guides to regional and country priorities in sexual and reproductive health, including goals and targets.