Introduction to South Asia

South Asia represents a vibrant, dynamic, and fast-growing region of the world. It covers an area of 5.2 million Km2 which is around 11.7% of the Asian continent. South Asia has a population of 1.89 billion and is home to nearly a quarter of the world's population. South Asia is the most densely populated area of the world, consisting of Pakistan, India, Bangladesh Srilanka, Afghanistan, Nepal, Bhutan and Maldives. The region faces public health challenges on a demographic and geographic scale unmatched in the world. South Asia’s low life expectancy, high rates of malnutrition, maternal mortality, infant mortality, and incidence of tuberculosis are second only to those of sub-Saharan Africa. India, Pakistan, Bangladesh are burdened by the mammoth population load. The fact that the countries of the South Asia region are home to one fourth of the world’s population, living on less than $1 a day makes the matters worse and solutions more difficult to find.

The region has witnessed rapid urbanisation and a rise in non-communicable diseases, smoking, mental illnesses, and injuries. Conflicts, natural disasters, and infectious disease outbreaks periodically stall progress on health indicators, leaving the populations in this region vulnerable to their impact. The private health sector has grown rapidly while public health services remain too fragmented, under-financed, and over-burdened to meet the needs of the majority.

Genesis of SAFOG

Background

The problems and health issues related to women’s health of various countries of South Asia were common due to the shared geography, poverty and limited resources. It was noted that there was very limited or no interaction amongst the health care providers or organizations of these countries and no integrated efforts were made for the region. Till the mid nineties, there were two major associations representative of Obstetricians and Gynaecologists of the region, namely FIGO and AOFOG. Obstetrical and Gynaecological Societies of the SAARC Region are all members of the International Federation of Obstetrics and Gynaecology (FIGO) and Asia-Oceania Federation of Obstetrics and Gynaecology (AOFOG). Both these Federation have members from the Obstetrical and Gynaecological societies of a large number of countries including that of the South Asian region, with widely varying standards of women’s health care. At one end are the highly developed resource rich countries and at the other end, countries with a poor health care delivery system and service resource constraints.

So, it became apparent over the years that those big forums were not quite appropriate to focus on the women’s health problems relevant in the South Asian countries, and it was necessary to establish a fraternity of Obstetricians and Gynaecologists of this region where they can discuss their problems which are very similar, and can learn from the experiences of the other countries of the region. Moreover, such as organization will be the appropriate body to organize seminars, workshops and other educational activities in which both the experts and the aspiring young Gynaecologists can be brought together on the same platform. This would not only reduce expenditures in connection with attendance in International Conferences which are often held in faraway places and provide an opportunity to young researchers to present their work in front of a large regional group, as many of them may not have the resources to attend large international conferences.

Thus the South Asian Federation of Obstetrics & Gynaecology can trace its beginnings to the desire of the Doctors in the South Asian region who felt that they should get together and form an organization as all the countries in the region were of similar cultural back ground with similar socio economic status as well as similar problems regarding maternity services.

Born with a Bang

It was in this background that on the 7th of September 1995, during the SLCOG conference in Colombo, a meeting was convened by Dr. Lakshman Fernando, the then President of the Sri Lanka College of Obstetricians & Gynaecologists, on the suggestion of Dr.Rohan Perera, with the idea of developing an association consisting of national societies of Obstetricians and Gynaecologist of South Asia. The meeting was attended by senior OB/GYN’s of the region. They included Prof Rashid Latif Khan from Pakistan, Dr. Shrish Sheth, Prof. Kamal Buckshee, Dr. D.K.Tank from India and Prof. W.S.E. Perera, Prof. Mahasara Gunaratne, Prof Harsha Seneviratne, Dr. Lakshman Fernando, Dr. Rohan Perera & Dr. Rohana Haththotuwa from Sri Lanka.

The meeting ended by everyone agreeing to form the Federation of Obstetrical & Gynaecological Societies of the South Asian Region (FOGSAR) and deciding to speak to the members in the other SAARC countries namely, Bangladesh, Bhutan, Maldives & Nepal, and get their cooperation. A committee was also appointed to formulate the constitution. The members appointed to the committee were Dr.Lakshman Fernado, Prof. Mahasara Gunaratne, Prof. Harsha Seneviratne and Dr. Rohana Haththotuwa.

The next meeting of FOGSAR was held in Bali, Indonesia during the 14th Asia and Oceania Congress of Obstetrics and Gynaecology, on 16th October 1996, where in addition to members from India, Pakistan and Sri Lanka, members from Bangladesh and Nepal also participated. Bangladesh was represented by, Prof. Ershad Ali, Prof. T.A. Chawudhary and Prof. A.B. Bhuiyan and Nepal was represented by Dr. Sanumaiya Dali. At this meeting it was unanimously decided to have the Headquarters of the organization in Colombo and Dr. Rohana Haththotuwa was requested to look after the secretarial work. In the meeting Prof. Rashid Latif Khan volunteered to organize the First congress of the Federation in Lahore, Pakistan in 1996, and everyone agreed to it. Under the patronage of Dr. Rashid Latif, a core team consisting of Dr. Farrukh Zaman, Dr. Sohail Lodhi, Dr. Rubina Sohail and Dr. Mohammad Tayyab was formulated, for managing this significant occasion. It was also decided to have the constitution ready by the time of the first congress. The next meeting of the group was in Delhi on the occasion of another conference. Here, Dr. Rashid, invited delegates from the component countries and offered to fully sponsor travel arrangement, registration and hotel stay of ten invited speakers from each country. The offer was received with enthusiasm and was graciously accepted by the member countries. There was a lot of emphasis on the success of the first conference and it was decided to make it a mega event.

The First Congress

The first Congress was held in association with the Pakistan Society of Obstetricians and Gynecologists (SOGP) in Lahore. The conference was a tremendous success due to the untiring efforts the excellent work done by the chief organizers, Prof. Rashid Latif Khan and Prof Farrukh Zaman and their team lead by Dr Rubina Sohail. The budget of the conference was a major financial challenge because of the sponsorships offered to various countries, including delegates from the South Asian region, UK and Europe. Moreover, there was extreme difficulty in providing sponsorship especially for a conference at the regional level. After hectic efforts by Dr. Farrukh Zaman and Dr Rubina Sohail, a firm commitment for the sponsorships was managed. Finally, the organizers and the host society sponsored tickets and provided local hospitality to 40 delegates for attending the conference which was a huge feat by any standards. As things got moving and started becoming tangible, the rest of the pharmaceutical industry came forward and provided support for exhibition, hall, dinner and entertainment etc. The conference itself had more than hundred overseas delegates and around a thousand registered delegates. About one hundred and fifty scientific papers were presented during the conference. The conference provided an opportunity for interaction and exchange of ideas. It was a platform for discussing the common problems and the unique solutions each country had to offer.

The social program was instrumental in bonding at a personal level. The hospitality and warmth received from outside the conference hall was memorable, both for the conference delegates and the citizens of Lahore. The enthusiasm, love and goodwill it generated were remarkable and the conference was a roaring success. For the first time ever, the specialists of the SAARC countries converted it into a tight knit unit and friendships developed. It resulted in a flow of invitations to and from each country to conferences and initiation of writing books with contributions from authors belonging to different South Asian countries. SAFOG had born with a bang!

THE FIRST EXECUTIVE COUNCIL

First SAFOG Council Meeting The first formal council meeting was held on 29th November 1996, at Hotel Pearl Continental during the conference. All the member countries were in attendance except Bhutan and Maldives. The office bearers elected during the conference were Professor Rashid Latif as President, Dr D.K. Tank as Vice President, Dr T.A. Chowdhury as President Elect, Dr Rohana Haththotuwa as Secretary General and Dr Harsha Seneviratne as treasurer. Vice Presidents were Dr. D.K.Tank and Dr.Lakshman Fernando, Deputy Secretary General- Prof. Sanumaiya Dali. Two special posts of Secretary Research and Secretary Education were identified to promote research and academics in the region. Prof. Farrukh Zaman was Secretary Education and Prof. Alokendu Chatterjee was elected Secretary Research. Dr A.B. Bhuiyan was allocated the post of editor of Journal.

Four members from each member country were nominated as council members. The elected council members were Dr. Dr Shala Khatun, Dr Syeda Firoza Begum, Dr Syed Ershad Ali, Dr A. I. M. Anowar-ulAzim from Bangladesh, Dr Sohail Khurshid Lodhi, Dr Sadiqua Jafarey, Dr Mohammad Saeed, Dr Muhammad Tayyab, Dr Rubina Hussain and Dr Shahnaz Naseer Baloch from Pakistan, Dr Sanumaya Dali from Nepal and Dr J.N. Rodrigo, Dr Mahsara Guneratne, Dr W. S. E. Perera, Dr Asoka Gunesekera from Sri Lanka.

Key points raised of the meeting

• Members from Sri Lanka worked diligently to put forward an interim constitution, which was approved and a committee was formulated for preparing and proposing the final constitution. One of the important meetings for the development of the final constitution was held at the house of Dr. J.N. Rodrigo, whose son being a lawyer helped in fine-tuning the constitution. The final constitution was presented, subsequently approved and adopted by the council after some amendments.
• It was decided that a SAFOG Congress would be held once every 2 years in association with the Obstetrics and Gynaecology society of the country hosting the congress. The conference would rotate amongst India, Pakistan, Bangladesh, Sri Lanka and Nepal every two years. Bangladesh was offered to host the next conference in 1998.
• There had been some difficulty in the registration of this newborn organization under the existing name. Therefore, the name was changed to SAFOG (South Asian Federation of Obstetrics & Gynecology) after approval of the other constituent members. The logo of SAFOG, designed initially by the local artists, was later modified by Prof. Alokendu Chatterjee and was approved by the Council at Dhaka.
• Sri Lanka College of Obstetrics and Gynecology (SLCOG) graciously offered to provide space and maintain the headquarters of this emerging organization. This offer was accepted and thus, Colombo became the headquarters of this emerging association. It was also decided to open an account in Colombo, which was to be operated by the treasurer of SAFOG.
• To generate some finances, all countries societies agreed to make annual subscription to SAFOG.

Membership

Membership of SAFOG is open to all national societies of Obstetrics and Gynaecology in the SAARC region. It was agreed that, the Obstetric and Gynaecological Societies of the South Asian Association for Regional Cooperation (SAARC) are members of the International Federation of Obstetrics and Gynaecology (FIGO) and the Asia–Oceania Federation of Obstetrics and Gynaecology (AOFOG). The membership of both of these federations includes the Obstetric and Gynaecological societies of a large number of countries with widely varying standards of women’s healthcare, from highly developed resource rich countries to countries with a poor healthcare delivery system and resource constraints.

Change of Name

Initially named the Federation of Obstetrical and Gynaecological Societies of the South Asian Region (FOGSAR), the name was soon changed to “Federation of Obstetrics and Gynaecology of SAARC Countries.” However, there were difficulties in registration of the organization, due to the use of the term “SAARC”. Hence, the name was changed again to its final name – SAFOG - South Asia Federation of Obstetrics and Gynaecology (SAFOG).

Progress over the years

The first three presidents of SAFOG, Dr. Rashid Latif Khan, Dr. TA Chaudhry and the late Dr Lakshman Fernando, ensured that the SAFOG concept would be established, and the member national societies would get familiarized with each other and interact professionally.

The tenure of Dr DK Tank saw the initiation of advocacy with government and a path developed for partnership between the national societies and the state organization particularly in India. The presidency of Dr Sudha Sharma saw a serious attempt being made to develop an effective network between SAFOG, the UN agencies and other stakeholders involved in provision for the health of the mother and newborn.

This collaboration with developmental partners continued during tenure of Dr Farrukh Zaman. SAFOG planned to work in close corporation with the fellow federations in the region, supplementing and not duplicating their work. Dr Farrukh Zaman took the initiative to have a meeting with the Asia Oceania Federation of Obstetrics & Gynaecology. Dr. Rohana Haththotuwa was able to organize the first meeting between the representatives of the executive council of the AOFOG and council members of the SAFOG in June 2007, during the SAFOG conference in Lahore, Pakistan. There it was agreed by everybody to work jointly so that both Federations will benefit from each other.

During this period (2007-2009), SAFOG initiated collaboration with the Royal College of Obstetricians and Gynaecologists (RCOG), UK. Under the Chairmanship of Dr Alokendu Chatterjee, the then Chairman of AICC RCOG the 1st RCOG-SAFOG Conference, was held at Kolkata in 2007. At the conference, Prof. Arulkumaran, then a Vice President of RCOG represented the college. RCOG than provided a breakthrough for SAFOG by jointly hosting the “The South Asia Day” at RCOG, London, on fourth July 2009. This event was the outcome of the efforts of Dr Alokendu Chatterjee. It was a joint RCOG and SAFOG activity aimed at collaboration and to promote the discussions on how to achieve MDGs 4 and 5 in the region. The presentations at the conference highlighted the success and failures in current strategies to achieve the targets for MDGs 4 and 5 in Nepal, Bangladesh, India, Pakistan and Sri Lanka. The South Asia Day proved to be instrumental in achieving recognition for SAFOG at an international level.

At the SAFOG council meeting held on 10th March 2007 in Lahore, it was decided to review and replace the original SAFOG charter signed on 29th November 1996 in Lahore. Suggestions and comments were requested from SAFOG council members. The constitution was discussed and amended during subsequent SAFOG council meetings held from 2007 – 2008. Dr. Malik Goonewardene and Dr. Rohana Haththotuwa worked meticulously on the constitution and proposed the final draft. The current SAFOG constitution was signed on 28th June 2008 in Colombo. n December 2008, SAFOG launched a new web site to enable improved communication with members (www.safog.org). During the presidency of Professor A.B. Bhuiyan, in 2009, the SAFOG journal was launched and has been published quarterly on a regular basis in Delhi under the able guidance of the chief editor, Dr Narendra Malhotra. The editorial board of the first Journal comprised of Alokendu Chatterjee, Jaydeep Mukherjee, Rubina Sohail, Pankaj D Desai, Malik Goonewardane, Sudha Sharma, Ferdousi begum, Pushpa Chaudhry, PK Shah, Jaideep Malhotra, Rashid Latif Khan, Rohana Haththotuwa, Laila Arjuman Banu, TA Chowdhry, Ashma Rana and Chanda Karki. It is now obligatory on all the regional professionals to help keep it a regular feature. During the same period at the SAFOG conference in March 2009, out of the various presentations, interactions and sharing of experiences came the “Dhaka Declaration”, which was the brainchild of Professor A.B. Bhuiyan. This was a consensus statement of the South Asian Region on the issues of maternal and neonatal health.

The years 2009 – 2011, have proven to be eventful and under the presidency of Professor Harshalal Seneviratne. During the last two years, SAFOG has been effective in establishing links with other professional organizations mainly, the International Federation of Obstetrics and Gynaecology (FIGO). The year 2012 was symbolic for SAFOG as it was the first time since inception of SAFOG (1996) in its fifteen years of existence, that, SAFOG managed to have a dedicated SAFOG session in the XX FIGO World Congress, Rome, Italy, held on October 2012. The session was on the important issue of “Maternal Health Economics in the South Asian Region.” The concept of SAFOG session at FIGO was proposed by Dr. Rubina Sohail and taken forward by Dr. Harsha Seneviratne. SAFOG has continued to interact effectively with the UN agencies in enhancing reproductive health care in South Asia, in general, and the millennium development goals 4 and 5 in particular. In 2012, SAFOG conducted a joint workshop with WHO and UNFPA – APRO on “Quality Enhancement to Achieve MDG Five” in Colombo. This workshop had participants from Bangladesh, Sri Lanka, Nepal, Pakistan and India.

In 2014, with the joint efforts of Dr Alokendu Chatterjee and Dr Rohana Haththotuwa, FIGO & SAFOG held a joint conference in collaboration with the SLCOG in Colombo, from 30th October to 2nd November. The theme of the conference was “Unmet Need in Women’s Health” – an area which needed much attention, particularly in this part of the world. This congress addressed these issues on a global scale in order to foster positive growth and development in future.

In 2015, the prestigious “SAFOG Distinguished Services Award” was initiated. The first award was given to Prof Sir Sabaratnum Arulkumaran for his distinguished service to SAFOG over the years. This was followed by the award being given to Prof. Rashid Latif Khan the founding father of SAFOG in 2017.

In 2017, SAFOG president Dr Rubina Sohail was invited by Director, Women and Health Initiative (The Maternal Health Task Force at EngenderHealth) to participate in the technical consultation: “Ensuring Cesarean Section Safety and Quality in Low Resource Settings” at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts. This was an important step forward for SAFOG in gaining international attention. This technical consultation was organized in response to growing evidence suggesting that important safety and quality issues have arisen as Cesarean section access and volume have expanded in low- and middle-income countries (LMIC).

On July 6th 2018, Prof. Rubina Sohail, than the president of SAFOG organized the South Asia Day at the Royal College of Obstetricians & Gynaecologists. The theme of South Asia day was “Joining hands to achieve SDG 3 & 5”. Prof Lesley Regan, President RCOG, played a pivotal role in this regard. It was very successful endeavor and gave opportunity to SAFOG to showcase the issues of the region by holding panel discussions on patient safety, menopause, violence against women, Gynaecological cancer and rising rate of caesarean section. This was attended by significant number of participants of South Asian origin. The evening was made colourful by the South Asian talent residing at home and in UK.

In 2018, it was decided to initiate the “SAFOG Young Gynaecologist Award” (SYGA) which was happily approved by the council. The first SYGA was to be sponsored by Prof. Rubina Sohail, followed with two SYGA at every SAFOG conference. The first SYGA was given on the 12th SAFOG conference being held at Dhaka, Bangladesh to five recipients from South Asia. During the NESOG conference in Kathmandu, Dr Rubina Sohail and Dr Kusum Thappa discussed high maternal mortality in South Asia due to PPH and the possibility of PPH bundle approach initiative for the South Asian region specially Bangladesh and Pakistan. This led to the development of concept note by Dr Kusum Thappa and it was her hard work, experience and coordination which resulted in the first SAFOG FIGO project for PPH Bundle Approach. The work is ongoing on the project. In addition to issues of maternal and neonatal mortality, SAFOG is very sensitive to sexual and reproductive rights of women and gender-based violence. Keeping these in mind, many sessions & workshops were held on “Integration of sexual and reproductive rights in the practice of physicians” and “violence against women” during 2017 & 2018. SAFOG launched the book on “Sexual & Reproductive Rights in South Asia - A Critical Review” at the 12th SAFOG congress in Dhaka, on the 4th of April, 2019 and is the combined effort of many eminent Gynaecologists from the region. Dr Rubina Sohail and Dr Narendra Malhotra are the editors of the book.

In 2021, due to the changing needs of the present time, it was decided to review and make amendments to the constitution. For this a committee was constituted, with Prof Farrukh Zaman as chair of the committee and Dr Malik Goonawardene and Dr Shyam Desai as its members. The committee revised the constitution and made amendments. The committee expanded the council to include Afghanistan, increased the number of committees, created the post of third vice presidents, created the office of director international relations and allowed for creating an executive board. This was presented and approved at the virtual council meeting held on 7th August 2021 under president Dr. Ferdousi begum. COVID saw a surge of activity in SAFOG and the leadership of SAFOG under the able guidance of Dr Ferdousi Begum responded to the challenge by organizing activities within countries and series of webinars which have become a part and parcel of SAFOG. From 2020 to 2021 thirteen webinar were conducted by various committees of SAFOG including webinars in collaborations with FIGO and AOFOG. These webinars were very popular and well attended. Dr. Ferdousi Begum very ably involved in the past president of SAFOG and Prof. Sir Sabaratnum Arul Kumaran involved in the webinars to mainly use of their wisdom and experience.