History of the International Association for Maternal and Neonatal Health (IAMANEH)
Gerda Santschi
Gerda Santschi, Ambassador of IAMANEH
Introduction
Hubert Pierre de Watteville was born on 13 March 1907, in Bern, where he
grew up and went to elementary school; afterwards he attended the Faculty of
Medicine of the University of Bern from which he graduated in 1931. He
practiced at the University Departments of Gynecology and Obstetrics in
Bern, Zurich, Geneva, Mannedorf, Aarau, Leipzig, Basel, and Zurich. In the
year 1946 he became Head of the Maternity at the Geneva University Hospital,
Department of Gynecology and Obstetrics, and Professor at the School of
Medicine, where he remained as such until his retirement in 1976.
Professor de Watteville was an extraordinary individual who had an enormous
impact on the specialty of gynecology and obstetrics. During his life he was
a member of numerous societies, held honorary memberships, participated as
speaker at many international conferences and congresses and traveled
extensively.
FIGO
In May 1950 a few American professors organized an international congress
for gynecology and obstetrics in New York. With this they revived a
tradition which was held since the turn of the century, every four years.
Professor Hubert de Watteville participated at this meeting as a lecturer,
and the proposition was made that Switzerland should organize the next
congress in view of the fact that in 1936, in Amsterdam, Bern was proposed
for the following congress site, but could not be held because of the Second
World War. Further it was decided that at the next meeting an international
federation with a fixed constitution should be created.
Returning to Switzerland Professor de Watteville contacted the President of
the Swiss Association for Gynecology and Obstetrics informing him of the
decision taken in New York. The Committee immediately felt that this
honorable and responsible proposition should be accepted taking into
consideration that there were already several international organizations
here in Geneva. It was decided that Professor de Watteville should be the
President. In order to organize such an important, international event much
time, but also cash was needed for the preliminary organization. With the
help of colleagues and qualified and motivated staff a small secretariat was
established to manage the administration and other duties connected with the
organization of this congress.
On 25 July 1954, the International Federation of Gynecology and Obstetrics -
FIGO, was founded in Geneva, with 42 members at that time. Over 1500
gynecologists-obstetricians attended with a few hundreds family members at
this occasion. One of the difficulties was to prepare an interesting
scientific program, since there was no international committee who took care
of this part of the congress. Professor de Watteville managed to have one
main presentation every day and managed to have five well-known scientists,
two of them having received the Nobel Prize. This innovation was very much
appreciated and such a presentation was afterwards part of the program.
The next FIGO Congress took place in 1958, in Montreal, where it was decided
to shorten the time between congresses from four to three years.
According to the constitution Professor de Watteville had to lay down his
post as president of FIGO, but was elected as secretary general, a position
which he held for 18 years until the congress in the year 1976, in Mexico.
During these 18 years as secretary general of FIGO, he witnessed as the
organization developed into a world-wide one, with solid structures and many
fields of activities. Each congress was to be held on a different continent
in order to enable many gynecologists-obstetricians to participate one time
or another and the number of participants rose every time. While this was a
most enjoyable sign of the popularity of these congresses, it made the
organization more and more difficult for the organizers. Besides there was
also criticism that these events had become too large, with too many
lectures to choose from or that one could not find a friend in the crowd.
Professor de Watteville believed that such large congresses are most
valuable even if its usefulness cannot be measured. However, most important
seems to be the personal contact and exchange between colleagues from all
over this world.
The manifold functions held by Professor de Watteville within FIGO kept him
extremely busy and he worked often late into the night in order to fulfill
his duties. On the other hand he was also highly rewarded. He was able to
meet many illustrious colleagues from all over the world, not only
gynecologists-obstetricians, but also from other medical fields and was
often asked to give his opinion on various current subjects.
IAMANEH
The creation of IAMANEH has a long history. During his presidency,
Professor A. Alvarez-Bravo from Mexico proposed to create a foundation,
whose funds would be used by FIGO for the realization of own projects in the
field of gynecological improvements. A personality intended to offer to this
foundation a large sum of money, provided that the foundation would carry
his name. For various judicious reasons this tempting plan could not be
realized. Therefore Professor Alvarez developed another project in which a
foundation with the same aims should be founded. It was intended that not
only gynecologists-obstetricians should be members, but also other persons
interested in the well-being of mothers and children and which should
through membership fees and donations support this foundation. At first the
FIGO board was skeptic, but asked Professor Alvarez and Professor de
Watteville in his capacity as secretary general of FIGO to further study
this project. The two professors worked on a constitution, but due to the
fact that both had many other commitments, the project did not make much
progress. Once Professor de Watteville had decided to step down as secretary
general of FIGO in 1976, did the planned foundation enter a critical
stadium. At the same time he retired from his position as chief of the
University Clinic in Geneva in order to put all his energy into the creation
of an international foundation for the health of mothers and their newborns.
First of all Professor de Watteville made contact with some friends from the
World Health Organization, who were very supportive to his intention and
found it most useful to create an international association. The aim of this
private association was the worldwide improvement of midwifery and infant
welfare. Professor de Watteville shared this plan with some of his wealthy
patients and a few promised their support or paid a substantial sum. With
this help he was able to organize in June 1977, in Geneva, a foundation
meeting. To his invitation about 20 colleagues from various countries
replied present. The meeting selected the logo IAMANEH, which represent the
first letter of the English version of the name of the association to be
founded: International Association for Maternal and Neonatal Health. It was
decided that the seat of the association would be Geneva.
Professor Eric Martin, the former president of the International Red Cross,
was elected as the first president of IAMANEH, Professor Hubert de
Watteville was designated as secretary general and a Geneva banker was
chosen as treasurer.
With a Geneva lawyer we had prepared a constitution in accordance to Swiss
law and after intense discussions this document was accepted.
Structure and aims of the association
The structure of IAMANEH is quite complex, because on one hand
individuals and private companies can become members and pay their
contribution or donation directly into the central account. On the other
hand IAMANEH consists of autonomous national sections.
At the foundation meeting in Geneva several of Professor de Watteville’s
colleagues were immediately ready to create such a section in their country.
Within 5 years more than 30 sections were founded.
It was easy to create such a section since they were not obliged to pay a
membership fee to the central account in Geneva. National societies who had
similar aims were encouraged to join IAMANEH. Until then it was possible to
pay the secretariat in Geneva with individual dues and donations, as well as
support from three large Swiss companies.
In the course of the last decades great progress was made in the field of
obstetrics-gynecology in industrialized countries and with complicated
technical methods extraordinary results were achieved. The number of death
in mothers during pregnancy, birth and confinement were considerably
reduced. Unfortunately this has not been the case in developing countries in
which due to deficient care more than hundredfold mothers and newborns still
loose their lives.
Over 70% of all women, who give birth, are doing so without the help of a
person with a minimum of training or medical formation. Most of the time the
women to give birth are being helped by an older women living in her
village, a so-called traditional birth attendant. The activities of a
trained midwife are often also inadequate since she does not have the
necessary instruments or medication. The same goes for the doctors, who have
to handle the more complicated cases and often the equipment in periphery
hospitals is also inadequate.
In our part of the world many people have no idea of the suffering of
mothers and newborns in many parts of the developing world. This is the
reason why many refuse any kind of help towards development projects or
relief agencies. Great progress has been made in the medical field thanks to
the insertion of complicated technical machines, which have greatly improved
the medical care in the field of gynecology and obstetrics. Only rarely a
woman dies in childbirth in industrialized countries. The same goes for
serious complications during pregnancy, birth and shortly after, as well as
for the children during their first year of life.
Unfortunately women and children in developing countries do not enjoy this
type of progress. Therefore the death rate of mothers and children is in
some countries still very high.
One of the aims of IAMANEH is to support projects which are concerned with
the basic medical provision for mothers and newborns and participate in
organizational and financial ways.
The vocational training of enough midwives is time-consuming and costly and
it might be easier to form the traditional birth attendants in courses and
provide the ones who have successfully followed the course, with a small bag
with basic necessities. Every pregnant woman should have the possibility to
have a medical check-up during her pregnancy, even if there are no signs of
illness. It has been proven that during these check-ups various
complications related to pregnancy can be detected and treated early on.
Miserable environmental conditions and ignorance lead to an unhygienic
conduct of the pregnant women and therefore contribute to the high illness
and death rate.
Since many years the World Health Organization - WHO - and many
international, official organizations and governments have started a
campaign, with the provision of important funds to improve the care in
gynecology and neonatology.
However the task is great and small private organizations, with relative
limited funds can help with small projects to save the lives of mothers and
children.
The set-up of centers for the health of mothers and children, where pregnant
women would be able to get a regular check-up and the newborns would also be
checked. Such centers would allow getting to know complications during
pregnancy in time and therefore could be treated.
IAMANEH and its national sections were active in the prevention of tetanus
amongst the newborn, since this infection is the cause for many deaths in
developing countries. The infection can be prevented in a simply way by
vaccination of two doses during pregnancy. In this way the newborn is
protected during the first few months.
With this only a few important illnesses of gravity, which is of special
interest to IAMANEH are mentioned. Over and over it was criticized that
IAMANEH is trying to keep more children alive and therefore contributes to a
catastrophic overpopulation. This reproach is not justified, because since
quite some time it has been proven that programs for family planning can be
best realized within the framework of an action for mothers and children.
Many women are only willing to wait with another pregnancy if they can be
sure that their last child will stay alive. Therefore the reduction of
neonatal mortality is one of the provisions that the women and her family
will accept some form of birth control. For the population it is important
to know that the risk for the mother to die in childbirth is higher after
the fourth child. Further the intellectual development is in danger if the
interval is less than 18 months. Nobody is in a better position to convince
these women of the importance of family planning than the persons which are
taking care of her during her pregnancy, birth and shortly afterwards.
Therefore all persons who are concerned with the care of mothers and
newborns should get also training in family planning.
The aim of IAMANEH is to realize this basic principle and has for this
reason in every training program for doctors, nurses and midwives special
time devoted to family planning. The same goes for the basic training of
traditional birth attendants.
IAMANEH is asking its national sections in industrialized countries, besides
the projects which they run in their countries regarding the health of
mothers and newborns to support and finance other projects in developing
countries. The health of mothers and newborns does not only depend on
gynecologists, but also neonatologists, midwives, nurses, social workers and
persons related to family planning.
IAMANEH is trying to cooperate and coordinate between the national sections
and representatives in this field and makes it a condition that their
projects are only implemented if they have the approval of the national
health authorities.
For the evaluation of such projects a scientific panel was named. Besides
representatives of large, international, official and private organizations
in the field of mothers and children a number of prominent personalities
were named.
At regular meetings the opportunity should be given to the National Sections
to exchange the experiences from various countries in the field of mother
and newborn care and the public worldwide should be made aware of the
distressed condition in large parts of the world.
IAMANEH should be able to give the well-to-do population an opportunity in
all countries to help their suffering fellow-man by financially supporting
its projects.
During the time Professor de Watteville was secretary general of IAMANEH he
devoted all his time for the advancement of the Association. To gain the
friendship of some important persons, who shared his views and supported his
endeavors, gave him the hope that IAMANEH has a future and its activities
will help to save the lives of many mothers and children.
The Association consists of individual members, national sections, a
scientific council, and an administrative committee, who was to help the
secretary general with special duties.
Individual members
After the foundation meeting Professor de Watteville started a promotion campaign with all his energy amongst his friends, acquaintances and patients, which was quite successful. This was the same with the other foundation meeting participants, who were as well busy contacting their friends and private businesses in order to incite them to become a member of IAMANEH. All these persons paid their membership fee into the IAMANEH account in Geneva and thanks to these contributions it was possible to set up a small secretariat. The larger part of these funds remained untouched so that in due time a special program for the improvement of health of mothers and newborns could be financed.
National sections
Already at the start for the foundation of the Association it was clear
that a central secretariat in Geneva would not be able to recruit members on
a worldwide basis, considering the different languages, aims and needs
amongst the populations and make them known the purpose of IAMANEH within
the local population and recruit members amongst them. This task should be
taken over by the national affiliates. Each section should develop and
implement projects which are adapted to the needs of the country and
especially the basic health of mothers and newborns should be taken into
consideration.
If a national association with similar aims already exists in a given
country, it can be affiliated directly to IAMANEH and there is no need to
create a new society.
Scientific council
Already at the foundation meeting several experts, with special
experience in the field of mother and child health, were selected. Their
duty was to evaluate projects of IAMANEH or one of its national sections and
help with the implementation. Thanks to their notoriety and technical
knowledge they should also help to raise funds for these projects.
In this Council many well-known scientists were represented. The members of
this Council were invited to participate in all IAMANEH meetings and were
regularly informed about its activities. With this system it was possible to
remain in constant contact with many important international organizations.
Aims of IAMANEH
The aims of IAMANEH are to promote the health and welfare of mothers and
children, particularly in developing countries, as part of the overall goal
to improve the health of all people. The health of mothers, newborns and
children does not only depend on the gynecologists - obstetricians, but also
the neonatologists, midwives and nurses. IAMANEH should therefore aim for a
closer working relationship between these categories. At regular meetings
like general assembly and executive board meetings these persons should have
a possibility for mutual exchange of experiences.
The projects elaborated and financed by IAMANEH are especially destined for
the basic care of the pregnant mothers and their newborns. Therefore these
projects should be destined for developing countries. National sections in
industrialized countries should collect funds and support projects in a
developing country.
Thanks to the use of complicated, technical methods in the field of
gynecology and neonatology during the last decades, extraordinary results
were obtained. Only in rare cases a pregnancy results in death in
industrialized countries and the number of child death and illness has been
greatly reduced. This is unfortunately still not the case in developing
countries, were more than a hundredfold of mothers and newborns loose their
lives due to the fact that there is no adequate care. Therefore there is
still a need for an Association like IAMANEH.
Conclusion
IAMANEH has remained a relatively small organization, with great
ambition: to make a significant contribution towards the improvement of the
health of women and their newborn children in the developing world. Many
countries have achieved great progress in their efforts to reduce fertility
in order to counterbalance the most welcome decrease in mortality which they
have accomplished. However the number of poor people in the world continues
to rapidly increase, as illustrated by the mark of 6 billion people on our
small planet.
The activities of the various IAMANEH sections show similarities, but also
big differences. Most sections are engaged in training and upgrading of
knowledge and skills, as well as executing projects directly aimed at
reducing maternal and infant mortality. On-going projects have been
highlighted within the context of the overall activities of each national
section in the Annual Reports of IAMANEH.
Many of the projects - implemented over the years - have received financial
support from a national section in an industrialized country, while earlier
support was also obtained from UNFPA and the World Bank or the Swiss Agency
for Development and Cooperation.
However in recent years it has become more and more difficult to raise
funds, reason for which in 1987, at the general assembly, in
Lahore/Pakistan, it was decided that the IAMANEH sections should pay some
membership fee, a decision which has not proved very popular. First of all,
most IAMANEH members are in very poor countries and the ones in developed
countries finance in one way or the other already projects in developing
nations.
It also should be mentioned that money received by IAMANEH from
international agencies, which was destined for projects, were always
entirely given to the project in question and no overhead expenses were
taken by the secretariat.
Many times we had a member from the Scientific Council visiting and
overseeing the project, with little or no expenses to IAMANEH.
One important initiative of IAMANEH over the past years has been the
provision of scholarships for the Postgraduate Course for Training in
Reproductive Health Research, carried out by Professor Aldo Campana,
Secretary General of the Association, the Geneva Foundation for Medical
Education and Research, and the UNDP/UNFPA/WHO/World Bank Special Programme
for Research in Human Reproduction, WHO Department of Reproductive Health
and Research, in collaboration with the Department of Health of the Canton
of Geneva, the Faculty of Medicine, Geneva University, and the Geneva
Medical Association, which provides instruction by some of the best experts
in the area. The course has also facilitated a close communication between
students and the WHO coordinators of research in different areas of human
reproduction.
On the occasion of the 25th anniversary of IAMANEH the Executive Board
decided to give a Hubert de Watteville Prize, consisting of 5 scholarships
for the above course. Ever since IAMANEH has given a total of 74
scholarships to promising doctors in developing countries to participate in
this course.
Edited by Aldo Campana,