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Stanford Program for International Reproductive Education and Services (SPIRES)- Building Capacity in Developing Countries

June 03, 2012
Paul D. Blumenthal

A woman dies of cervical cancer every two minutes worldwide, claiming nearly a quarter of a million women every year. The disease affects an estimated 500,000 women annually. Eighty percent of the cases occur in developing countries where women have limited access to cervical cancer screening and ob-gyn treatment services.

The Stanford Program for International Reproductive Education and Services (SPIRES) aims to advance women’s health in developing countries. The program focuses on building medical capacity by providing technical expertise and training for international non-governmental organizations (NGOs). For example, it provides clinical training for inserting intrauterine devices (IUD)and conducts cervical cancer screenings. It also has worked with the World Health Organization (WHO) to design safe abortion guidelines and standards for cervical cancer prevention programs. The Office of International Affairs interviewed Dr. Paul D. Blumenthal, Director of SPIRES, to learn more about the program’s approach and achievements. 

Q. Why is providing technical training critical to improving medical conditions in developing countries?

PB: There are many NGOs working in developing countries with relatively little in-house capacity for technical direction and expertise in family planning and reproductive health. Since they are not clinically focused organizations, but rather NGOs with a more programmatic perspective, they can benefit from the training and clinical expertise of a program like SPIRES. Our collaboration provides them with technical advice and guidance. However, our training of NGO staff to conduct clinical tests and treatments on the ground is not limited to educating the clinicians themselves. Delivering a consistent quality of medical services, and monitoring and evaluating the services are all closely related. By contracting with SPIRES, they know what to do, how to evaluate the services and how care could be improved. Thus, standardized training and protocols provided by SPIRES can improve the overall quality of technical assistance.

Q. What are the most serious issues in women’s health in developing countries and what is SPIRES’ approach to improving these issues?

PB: One of the biggest issues is hemorrhage after delivery, which accounts for 30% of maternal mortality in developing countries. Cervical cancer is another leading cause of death in these areas. Relevant family planning interventions also are critical in developing countries where both unsafe abortion and unmet needs for contraception are prevalent.

It is particularly unfortunate that so many women die from these causes because relatively simple interventions can prevent a woman from dying of hemorrhage after delivery or from cervical cancer. In order to solve these issues, our training focuses on screening cervical cancer, inserting an IUD, and providing accessible and effective family planning in more than 20 different countries in Africa and Asia. We also conduct research in African countries regarding the impact of their IUD programs and learning curves.

"We need a focused and large-scale approach to meet the demand and get to the point where the opportunistic approaches are manageable."

Q. What are some of the challenges SPIRES has dealt with?

PB: Every year, millions of women die of cervical cancer and complications from unsafe abortion. It is very frustrating that we often have a hard time finding financial resources to test and develop innovative ways to prevent women dying of these diseases. Another interesting aspect of collaborating with various international NGOs is that each organization has its own culture and institutional history. It often takes some time to figure out the best way to work with a given group. Some NGOs are highly centralized and others are not. It is very important to understand each NGO’s operating style and culture in order to collaborate effectively with them.

Q. What is your view of the field of women’s health in developing countries for the next decade?

PB: Prolonged and sustained support from both government and established foundations and donors is really important. Continuous support on a large scale enables both consistency and constancy. It enables a program like SPIRES (or any NGO) to be successful.   “Sustainability” is a watchword among funders these days, but it may take a long time, sometimes a generation, for any new initiative aimed at the population level to achieve real sustainability.

Think about a successful public health program such as small pox eradication. There were hundreds of thousands of people who had not been vaccinated when the government started its programs. It had to achieve a high level of vaccination throughout the population to eradicate the disease. Eventually, it developed a surveillance containment system to effectively vaccinate the necessary numbers of people around the country. Organizers of family planning programs can learn a lesson from the small pox eradication campaign, not necessarily in a medical sense, but from an operational perspective.

We currently have significant unmet needs in developing countries when it comes to women’s health issues. There are massive numbers of women who don’t have access to contraceptive methods or who can’t afford family planning in these areas. For example, it is said that approximately one thousand girls in Kenya enter reproductive age everyday. Unless we provide these thousands of young women with a contraceptive daily, we cannot keep pace with the need. That is because the demand created by the number of people entering reproductive age is much greater than the supply of available contraceptives.

We need a focused and large-scale approach to meet the demand and get to the point where the opportunistic approaches are manageable. This is why the community of governments and donors has recognized the importance of true long-term planning for at least two decades. Without significantly shifting the proportion of unmet needs, we cannot truly discuss the sustainability of a program designed by an individual university or a group of researchers such as SPIRES.

Q. Is there a patient you remember and if so, why?

PB: There was an African woman who had been offered a cervical cancer screening. After the test, she showed sincere and profound appreciation to our team. Many women in African countries, including her, have friends or family members who died of cervical cancer, so the medical services introduced by SPIRES not only provides personal relief but actually can save a sister’s, daughter’s and mother’s life.