Executive Director, Family Planning ACT , P.O. Box 1317, Canberra ACT 2602, Australia
Telephone: +61-2-6247 3018 Fax: +61-2-6257 5710
Email: karebena@familyplanningact.org.au

Australia is a multicultural society, one in which 25% of citizens are born outside of Australia and where there is a significantly disadvantaged indigenous population. All Australians have had to grapple with the problems that difference presents; undoubtedly you will see evidence of this during your stay.

This international Congress of medical women will bring together many of the themes of women’s lives. It will show us the differences in our cultures, traditions and beliefs, but also that our issues, problems and sometimes solutions, are similar.

Current global health policy is predicated on the premise that you have to be able to make an investment in your future. Our present artificial economy has dire social consequences that leave women and children particularly vulnerable. It is horrifying to see how many of the submitted papers coming from all around the world have violence against women as their underlying theme; they are largely found in the sessions on refugees and human rights, on traditional practices, as well as those on violence in it’s various forms. The Human Immunodeficiency Virus poses particular problems for women given that a woman’s risk of infection is usually associated with her situation in life.

Mainstreamed health professionals can further compound the disadvantage experienced by marginalised individuals and groups. Women doctors face particular demands. They deal with demands from their patients, they must address the needs of the population in which they work, and must adapt to their role as determined by the society in which they live. A series of support structures are necessary to ensure optimum utilization of their medical training.

It is possible to work for the development of different performance indicators for health systems which could best reflect social justice principles and the efforts of people working to improve women’s health. Such indicators would need a strengthened commitment to reaffirming the responsibility of respectful gender relating families. They may be named: safe pregnancy and parenting, the maintenance of a multi-cultural society, active participation in a buoyant economy, and freedom from violence. This challenges the cultural context in which policies are developed and reflects the diversity in which health care is delivered.

Makerere University, Box 7072, Kampala, Uganda
Telephone: +256-41-541044, Fax: +256-41-541044
E-mail: pmusoke@mujhu.org or philippa@afsat.com

The first major breakthrough in prevention of MTCT was ACTG 076 (USA & France) in 1994, which demonstrated for the first time that the risk of passing HIV infection from mother to infant could be reduced by 66% using long course AZT. Even with shorter, less expensive, less complicated regimens with AZT showing a reduction of 30–50% in breast feeding cohorts the majority of women in the developing world do not have access to these regimens.

The use of a single dose of nevirapine (NVP) to the HIV infected woman at the onset of labor and a single dose to the infant within 72 hours after delivery reduced HIV transmission from mother to infant by 47 % as compared to AZT in a breast feeding population. HIVNET012 randomised 619 HIV infected Ugandan women to receive NVP (200mg) or intrapartum AZT (600mg at the onset of labor and 300mg Q 3 until delivery). The infants received either a single 2mg/kg dose of NVP or 4mg/kg dose of AZT twice a day for 1 week. The final HIV transmission rates in 311 infants in the NVP arm and 308 in the AZT arm were 8.1% vs 10.3% at birth, 11.8% versus 20% at 6-8 weeks (p=0.006), 13.6% versus 22.1% at 14 –16 weeks, and 25.1% versus 14.7% at 12 months of age. Serious adverse events were not significantly different between the 2 arms. This simple two dose NVP regimen at a cost of $4 per mother infant pair finally provides a cheap affordable regimen for HIV infected women in developing countries.

However, the translation of research into implementation is not easy and the costs involved go far beyond the cost of the drugs. Due to the poor health infrastructure, understaffing of health units, and limited sites where Voluntary Counseling and Testing is done, there needs to be a lot invested in the current health systems to make prevention of MTCT accessible to the many HIV infected pregnant women of resource poor countries. Furthermore, the stigmatization of HIV infected persons in the community, limited partner involvement, poor treatment options, and lack of alternatives to breastfeeding make it difficult for many pregnant women to choose testing for HIV in an effort to save the baby. The universal use of NVP in pregnancy where sero-prevalence rates are high may seem like a viable option but this takes away the opportunity for women to learn their HIV status and adjust or protect themselves accordingly.

Therefore, each country in collaboration with UN Agencies, NGO’s and other donors must start national programs for implementation of anti-retroviral treatments to prevent perinatal transmission of HIV involving commitment by national governments, community mobilization, delivery of the basic MCH services, and the training of health workers in counseling. In order to reduce transmission of HIV from mother to infant we must face the fact that the HIV pandemic is not someone else’s problem but our own. The task left before us is to make NVP accessible to the many HIV infected women in resource poor countries and by so doing improve the basic reproductive health services so that women and children all over the developing world may benefit.

Alfred Hospital, Commercial Road, Prahran VIC 3181, Australia
Telephone: +61-3-9276 2000 Email: a.mijch@alfred.org.au

HIV infection remains predominantly a sexually transmitted disease in Australia in 2001. The risks of HIV infection and the exposure categories for women with HIV differ from those seen amongst Australian men. Women in Australia do not hear prevention messages and they are often unaware of their potential risks of exposure until diagnosis. With access to newer therapies, improved outcomes and a changed perception of disease risk many infected women are choosing motherhood. Combinations of antiviral therapy, Caesarean section and alternatives to breast feeding are available to those who are aware of their HIV infection. HIV discordant couples are seeking access to reproductive technologies. Women remain the primary carers and sources of family support for the majority of Australians with HIV, striving to assist their men often to the detriment of their own health.

7555 Morley Drive, Burnaby BC B5E 3Y2, Canada
Email: shelley.ross@usa.net

The theme of the 1998-2001 term has been “Access to Medical Care.” A questionnaire was sent to all national associations, asking for specific information that could be provided in short answer form. Comparisons were made regarding the number of practising female physicians, the training of female medical students and the funding of medical care. Waiting times for specialist consultation and time-to-surgery were noted.

Specific common women’s health problems were surveyed as to incidence, diagnosis and treatment, ranging from osteoporosis to menopause to maternity and gynaecological care. Screening mammography was visited as well as family planning and breastfeeding.

Results were compared in various ways. It was found that women’s health problems know no country boundaries and create a common bond among women wherever they live and die.

Email: mwhittaker@hssp.gov.pg

This paper used the International Conference on Population and Development (ICPD) Programme of Action definition of the right to reproductive health as the framework for its exploration into reproductive rights. Into this framework, I use the elaboration of twelve sexual and reproductive rights, based on an analysis of various UN Charters and other key documents International Planned Parenthood Federation (IPPF).

However the analysis does not focuses on the legal aspects of the rights. I analyse the present status of three of these reproductive rights: the right to equality; to privacy; and to health care and protection. I draw upon ethnographic fieldwork I undertook in 1997 in a Red River delta province In Vietnam, and qualitative work undertaken with colleagues in the same province. I use Vietnam as a case study for other development settings in order to illustrate the present realities of rights, especially from women's points of view. This case study illustrates women's perspectives: what they see as the challenges facing them in accessing quality affordable reproductive care and transforming their rights into realities. In doing so, the analysis serves to complement the policy, legal and advocacy discussions in the international arena.

In this paper I highlight some of the challenges that programme managers in many developing countries face in trying to service the reproductive rights of women. These include: inadequately trained staff; poorly motivated staff with discriminatory attitudes; inadequate supplies; inadequate information and education activities; organisational barriers to the provision of privacy and confidentiality; and disempowered clients who cannot place their demands for better quality and for their "rights".

In the conclusion I discuss how the transformation of rights into realities for many women and men needs concerted national and international efforts to advocate for reproductive rights, funding of reproductive health care services and maintaining/increasing allocations of developed countries to development assistance. The assistance should focus on the interlinked social sectors of health, education, poverty alleviation and human rights.

Addis Ababa Fistula Hospital, P.O. Box 3609, Addis Ababa, Ethiopia
Telephone: +251-1-716544 Fax: +251-1-716628,
Email: mulumuleta@hotmail.com

Introduction: Obstetric fistula is a major complication of childbirth, causing misery to a large number of young women in developing countries. This study investigates the characteristics of fistula patients, reasons for home delivery and for the delays in institutional delivery in Ethiopia.

Methodology: 213 newly admitted obstetric fistula patients between May and July 1999 to the Addis Ababa Fistula Hospital were studied in a cross-section. Trained nurses filled the questionnaire and took anthropometric measurements.

Results: Ninety-four percent of fistula patients were married and 84% developed fistula before the age of 20. The mean ages at first marriage and at delivery were 14.7 and 17.8 years respectively. Patients’ mean height was 14.9cms, 95% were farmers, who needed to travel on average 5 hours on foot and 6 hours by bus to reach the nearby hospital with operation facilities. 93% were illiterate, 62% owned nothing valuable, 44% delivered at home and labour lasted for 3.8 days on average. Distance, lack of financial resources and lack of awareness were frequently mentioned as main reasons for delayed decisions to seek medical help.

Conclusion: There are often affordable ways to tackle these obstacles including such methods as the establishment of maternity waiting areas, organisation of community funds, and community education.

Medical Officer, Royal Flying Doctor Service, South Eastern Section, Broken Hill NSW 2880, Australia
Telephone: +61-8-8080 1777 Fax: +61-8-8080 1741
Email: kathyrbr@ozemail.com.au

The Royal Flying Doctor Service is an aeromedical organization that has become one of Australia’s icons. In this presentation I will explain some of the history of the organization; who John Flynn was and what his vision for a “mantle of safety” entailed.

The current structure serves 90% of Australia. I will give details regarding the activity of the South Eastern Section, both the Dubbo and Broken Hill bases in New South Wales, and outline the way in which we cover an area the size of Western Europe. We provide both an emergency/evacuation and remote consultation service and general practice type clinics in small isolated communities and bush properties.

I will explain a few details regarding our planes and staff requirements as well as our funding arrangements and how this impacts on my ability to spend time with my patients in a unique Australian practice.

I will give a few examples of some of the types of incidents we have been involved in and some of the difficulties encountered due to the distances we deal with. We are also involved in the provision of medical care to a large number of indigenous people who have their own problems in accessing appropriate medical care.

The benefits/disadvantaged of being a …the… only female flying doctor in the section will be highlighted.

President, Institute for Research on Women’s Health
Email: jbraak@valstar.net

Well over half a century ago, the United Nations came into being and codified at the international level major principles of international relations. The preamble to the UN Charter reaffirms “...faith in fundamental human rights, in the dignity and worth of the human person, and in the equal rights of men and women...” This equality of dignity, worth and rights for men and women still has not happened. UN World Conferences and UN official documents have increasingly concerned themselves with the health and welfare of women. The most directly relevant UN Economic and Social Council (ECOSOC) bodies are the Commissions on the Status of Women, on Population and Development, on Human Rights and the World Health Organization.

In 1995 the Beijing Platform for Action (BPFA) addressed explicit objectives for the health of women, and recommended concrete actions to implement these objectives. This document recognizes, “Women’s right to the enjoyment of the highest standard of health must be secured throughout the whole life cycle in equality with men.” (para 92) MWIA has also recognized this specific right of women to health. However, the BPFA also recognized that, “Women’s health... is determined by the social, political, and economic context of their lives, as well as by biology.” (para 89) This embodies a holistic concept of women as the human persons who are the subjects of health discourse, a radical departure from the traditional objectification of women as instruments of purposes and goals of others (the “breeder/feeder concept”), rather than agents of their own lives and health.

So where is women’s health in the UN perspective today? The UN General Assembly Special Session of June 2000 exposed an ominous emerging political trend. A small group of member states and a small, but aggressively vocal and busy, group of NGOs actively opposed the rights-based approach to women’s health. Women’s health and women’s human rights have become controversial topics. Unopposed, this trend could lead to the reversal of the gains made in women’s health, women’s rights and the status of women.

In 2001, now, the WHO agenda of work will focus on two topics: HIV/AIDS, and mental health. These are women’s health issues. The global crisis of the HIV pandemic threatens every sphere of human society, intrudes into every area of international responsibility. And it threatens girls and women most. Health has become a cross-cutting issue, and is at the core of development discourses. Health, and particularly women’s health, no longer fits in a biomedical box, but is central to social, political, economic, and security concerns. The logic of a gender analysis of all social institutions, and scientific research IS a social institution, and all budgets have become obvious as never before.

The HIV epidemic has explosively increased behind the expedient screen of social and political silence and is now seen as a serious destabilizing force and threat to security. It is the first health issue to be addressed by the Security Council of the UN. This global change, its sheer scale, is terrifying, but it also forces open doors of opportunity for significant changes, creative new directions and ideas.

At this point in time, MWIA can take a leadership role in shaping the future of women’s health and women’s worth. Women physicians, having succeeded in a male-dominated profession, have earned an enhanced credibility, as have men of science, and can influence health policies directly.

We must be willing to step out on an international stage, speak with a stronger voice and see advocacy for women’s right to health as an ethical obligation at every level of our function. It is a challenge, but each of us has faced challenges before, and surmounted them successfully, often against discriminatory opposition. We have the background of education and expertise, and the vision born of our own experience living as women. The future asks women physicians to become health leaders.