Promoting Evidence-based Reproductive Health

Over the past decade there has been a growing swell of demand for "evidence-based" health care. This is not to suggest that modern medical care was not based on evidence but, rather, that there is now much more evidence available and there is much more opportunity to review it so that it can be taken into account in evaluating the effectiveness of interventions.

For example, large trials have been conducted which show that routine episiotomy is not beneficial. Also, routine electronic fetal monitoring during labour, and routine ultrasound assessment during pregnancy, have not been shown to decrease morbidity and mortality. Yet these two practices are used widely in some countries. A more effective resource allocation, complemented by efforts to implement only those practices that are effective should be a priority in order to improve reproductive health services.

A prerequisite for evidence-based allocation of resources and appropriate health care practices is access to scientifically solid and up-to-date information. As this issue of Progress explains, evidence-based health care involves iosystematic, scientific and explicit use of current best evidence in making decisionsli. But what does that mean in practice?

In order to practice evidence-based health care, providers must be able to access the evidence. However, this can be difficult, particularly for providers in developing countries where resources may be limited and access to up-to-date information very limited. This issue of Progress describes the efforts of the WHO Department of Reproductive Health and Research to enable health care providers to overcome this lack of access to evidence.

One of the key elements of an evidence-based approach to health care is the use of systematic reviews of evidence - reviews that set out to find evidence from a range of scientific studies and to appraise and synthesize this evidence. As part of its effort to map the best reproductive health practices, the Department currently not only carries out such reviews itself but also commissions others to do them.

The Cochrane Collaboration, for instance, was established to help clinicians and consumers access the best available evidence about medical practice. Volunteer physicians and other around the world are attempting to find and synthesize randomized controlled trials in many areas of medicine. Cochrane reviews relevant to reproductive health are now being distributed worldwide through The WHO Reproductive Health Library (RHL). In addition to Cochrane reviews, RHL includes expert commentaries on the reviews and other useful information. It is published in electronic format, thus making large amounts of information easily accessible at low cost. 

Instead of relying on expensive subscriptions to traditional journals, the delivery of which is often erratic in many parts of the world, health care providers and libraries can now receive most of the needed information via RHL. In fact, many physicians and other health workers around the world are often unable to interpret from research data what the findings imply for their practice. The expert commentaries and other sections in RHL are designed to overcome this problem.

RHL, now in its third issue, is updated annually, and its usefulness continues to grow as the number of completed reviews increases.

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