A guide to improving women’s health

Obstetrics and gynecology in low-resource settings: a practical guide. Nour NM, editor. Harvard University Press; 2016 ($25.00; 376 pp). ISBN 9780674731240

For any clinician from a resource-rich country, the fact that 99% of over 250 000 maternal deaths worldwide each year occur in resource-poor settings is a stark reminder that we have, at the very least, a duty to be aware and informed of the challenges outlined in this multi-author text.

It is tempting for the reader to go immediately to one of the excellent subject chapters. However, Chapter 1, “Preparing for global women’s health work”, by editor Nawal Nour, is essential reading for clinicians at any career stage who are considering a contribution to global health in reproductive medicine. Clinicians of all levels of experience must avoid the trap of trying to impose an external solution in a resource-poor setting rather than working with local experts (who can always increase our knowledge and skills) to facilitate lasting improvements, however small they may appear at the outset. The introductory chapter is an excellent resource to inform and facilitate this.

The multi-author format works well for readers who either seek specific knowledge on a topic (eg, obstetrics, infectious diseases, surgical challenges, etc) or for those who want a broader overview of the subject. Health professionals who contemplate making a contribution to global health care will also find useful information in this text. The subject matter supports the idea that global health and the interactions between resource-rich and resource-poor economies should be a mandated unit in all medical curricula.

Some chapters (eg, Chapter 4, “Obstetric fistula”) contain excellent technical detail on surgical techniques, and while of interest to the gynaecologist planning this type of care, it should not be taken as a substitute for practical and closely supervised mentorship in this most challenging surgical subspecialty.

While the subject matter in most chapters focuses on the North African and Asian settings, the material will be relevant and helpful to those working in the Asia–Oceania regions, where resource challenges equal, and in some areas exceed, those of the above countries.

Interestingly, as a clinician who works in a relatively well resourced metropolitan hospital with a large and diverse migrant and refugee population, I found several chapters of this text (eg, “HIV in pregnancy” and “Female genital cutting”) very useful for appreciating and managing problems from the low-resource setting which had accompanied the patient to our health care system.

Nawal Nour — who is Director of the African Women’s Health Center and Director of the Division of Global Obstetrics and Gynecological Health at Brigham and Women’s Hospital, and Associate Professor at Harvard Medical School, in the United States — has successfully brought together an excellent group of authors, and Obstetrics and gynecology in low-resource settings: a practical guide will find a useful place in the library of any doctor, nurse, midwife or student with an interest in, and a commitment to, improving global women’s health. This should of course, be all health care professionals.