Professor Marleen Temmerman, Director, WHO, Department of Reproductive Health and Research
International Innovation – Research Media Ltd
Professor Marleen Temmerman is the Director of WHO’s Department of Reproductive Health and Research – a centre dedicated to the investigation of all areas of sexual and reproductive health
Could you begin by briefly introducing the International Centre for Reproductive Health (ICRH), which you set up in 1994?
When I returned from working in developing countries as an HIV researcher and gynaecologist, I created ICRH, a multidisciplinary centre based at Ghent University. ICRH started as a very small centre, but we now work with a large network, with partners based in Kenya and Mozambique. We collaborate with research groups at other universities, NGOs and governments in all areas of sexual and reproductive health. ICRH brings together medical doctors, public and reproductive health experts, social scientists, people with a human rights background, civil society and stakeholders, which is an effective approach. I am still an advisor and honorary member, but left the organisation to work for the World Health Organization (WHO).
Can you outline some of the experiences you have brought to your current role at WHO? What led you to take up the position?
Up until last year, I was a Senator in the Belgian Government as well as a clinician and scientist, managing to combine these two jobs with the help of my fantastic colleagues. In 2006, I was invited by my party – the Flemish Socialist Party – to run for the elections, and was elected directly in 2007 as a Senator in the Federal parliament. My motivation for running was to help bridge the gap between research and policy. I enjoyed my busy schedule because it was fulfilling to serve in all these interesting and challenging environments.
After careful consideration, I made the decision to work for WHO in 2012, not because I was tired of working in Belgium, but because WHO was looking for a Director of the Department of Reproductive Health and Research (RHR). I chose to take up the position because I have been working in sexual health and patient rights for 35 years. In the past 40 years, there has been little progress in improving access to family planning for women and girls in terms of political priorities and financial investment. Last year, however, there was a global effort led by the UK Government and the Bill and Melinda Gates Foundation which called upon governments, NGOs and industry to invest in family planning. I strongly believe that access to family planning is not only a human right and beneficial to the health of women and children, but is also crucial to economic development. In 1970, the Indian politician and philosopher Karan Singh said that development will lead to contraceptives. In 1994 he said the opposite: that contraceptives will lead to development. I think that is true – if you give women access to contraceptives it is not only good for their rights, but also for the economy.
How can culturally sensitive issues such as female genital mutilation (FGM) be tackled?
Changes can be made largely through education. FGM can be tackled by thinking globally and acting locally – there is not just one simple solution, and I strongly believe in action at different levels. This can involve changing laws to make it clear that FGM is illegal and engaging with cultural and religious leaders. Communities must be involved and feel empowered.
A successful example of this is the work of Bogaletch Gebre, who recently won the King Baudouin African Development Prize in Belgium. Gebre was cut as a child, and came from a poor village where this was very much entrenched within the culture. She got a scholarship and went to the US before deciding to go back and do something for her country. Gebre started working at both the policy and community levels, with religious leaders and women’s groups explaining that cutting does not provide health benefits. The area she has worked in has now ended FGM. Change has to come from within the culture, and Gebre knew how to make changes within her culture.
Influential personalities need to be called upon, and in many countries first ladies are campaigning for change. Concerted action involving governments, religious leaders and women’s groups is needed. It is going slowly, but there is some progress. We need to learn from success stories and try to apply this to different contexts. I am pleased to see that the Department for International Development in the UK wants to eradicate FGM, and is taking a leadership role and dedicating a lot of funding to this issue
What do you see as the biggest challenge to women’s reproductive health?
Education of girls and boys is key! As far as the reproductive health sector is concerned, access, to family planning is the number one challenge. Effective adolescent sexual reproductive health education and interventions are also needed. As programme leaders, we talk about our target population when we should be talking with them to ensure that initiatives resonate with young people. Maternal health is another big challenge, as is violence.
How are you focusing on sexual behaviour and contraceptive use amongst young people?
We try to work with youths in schools, providing sexual education and ensuring that they have access to family planning. We should get rid of the term ‘family planning’ and use ‘contraceptives’ instead. I have spent my whole life wondering why cultures and religions are so focused on sexuality; if you educate your children to lead healthy lifestyles, why can’t you teach them about contraception?
In all of your current and previous roles, what would you cite as your main achievements?
I think that the creation of ICRH was a major accomplishment – I set this up with the vision to invest in sexual health and reproduction research, training and service delivery. ICRH is now a very active network, and I am very proud of the role I played in its establishment.
I have written books in Flemish based on true stories from my 25 years’ experience as a gynaecologist. I have always been very much engaged with my patients and have taken notes on rare or commonplace cases. Although anyone can access a vast amount of information via the internet, I decided to work on a book because there is still so much ignorance. People are often very keen to distance themselves from sensitive topics such as abortion, so I wanted the books to deal with ethics and norms in an anecdotal way.
Although the tools to promote maternal health are available, complications and deaths are still occurring. Why do you think that this is happening, and how can this be changed?
First of all, we need to put this silent tragedy of maternal mortality high on the political agenda. We know what has to be done to save women’s lives, so why don’t we do it? Governments have to be held accountable for the high maternal mortality rates in their country and act. The situation can be improved by focusing on the health system, and not assuming that if drugs are available that they will be used correctly. There are several reasons why women still die. A lot of women are coming late into the system, or were coming in early but there was a delay in recognising the problem and subsequent referral. It is not enough to deliver an innovative discovery or drug; it is also a matter of training and supervising the health systems.
Here is one example from my Belgian practice illustrating the importance of good guidelines and supervision: in pregnancy, it is important that women are tested for hepatitis B because there is a chance that they will infect their babies at birth, but cheaply vaccinating the baby will reduce the chance of this happening. I have always insisted that all women who deliver in my hospital should be tested for hepatitis B. This improved from 60 to 80 per cent, but despite all efforts this is still not done routinely. How can we ensure that this is implemented? It needs to become part of the structure, which requires training and supervision.
Could you elaborate on the physical health implications of violence against women and girls?
Women who are victims of violence lose their self-esteem, are anxious and more depressed, and tend to carry a burden for many years before regaining their confidence. There is often a sense of guilt, and a fear that it is somehow their fault. In pregnant women, we see more miscarriages and complications, which are a real health hazard.
I am worried that public health and, within that, reproductive health and rights are being pushed to the side as ‘women’s issues’, as with the advent of Horizon 2020, we see a lot of emphasis on ‘European diseases’. We need to ensure that we keep a balanced agenda in Europe, and that these matters are kept on the table.