José Belizán is Editor-in-Chief of Reproductive Health, a journal dedicated to research into the reproductive system in the context of physical, mental and social well-being. Reproductive Health tackles research ranging from sexual health and service provision, to gynaecological and obstetrical studies. Here Belizán explores the issues of preterm birth and reproductive health interventions, as well as discussing the challenges of conducting research in low and middle income countries, and the balance between basic and applied research.
What got you into the field of reproductive health?
I started doing obstetrics and gynaecology when I finished my studies but I was very attracted by a group in Montevideo, Uruguay, that was doing a lot of research on pregnancy and childbirth, so I decided to go there to improve my research skills. During this period of time the southern part of South America was very strong in the field of reproductive health, and there was a program from the World Health Organization located in Uruguay, Argentina and Chile. I was fortunate that I received a fellowship to join the program in reproductive health. Chile was very strong in two fields; one of them was women’s contraception – they developed many contraceptives – and another was maternal health. Argentina was very strong in male fertility, and Uruguay was very strong in obstetrics and childbirth. So that was a great opportunity, and what led to my calling in reproductive health.
What has been the most important development in reproductive health since your career began, and what is the biggest global challenge still to be addressed?
The greatest achievement has been to give couples, and in particular women, the choice and the accessibility to plan their reproduction – to plan when and where they are going to have kids or not.
The biggest global issue is equity – equity in access to healthcare and equity in access to tools to help plan reproductive life. Every woman in the world, and every couple in the world, should have the opportunity to plan birth. So the main challenge is, how this can be achieved for every woman in the world.
Reproductive Health recently published a series of reviews on preterm birth. Why is this such an important issue and what are the key challenges in addressing preterm birth?
Preterm birth is the main contributor to infant mortality, not only mortality around the delivery but also mortality in children from 0-4 years old. To achieve the millennium development goal to reduce infant mortality in the world, we need to improve the survival of preterm babies.
The greatest challenge is that the figures for preterm birth, in high, medium and low income countries, does not improve over the years. We need a lot more research into preterm birth to assess what are the causes. We don’t have good measures and good interventions to prevent preterm birth. We need to improve the care of preterm babies particularly in low and medium income countries. So there are many challenges and no doubt a lot of ongoing research into these.
Reproductive Health has a further two supplements coming up on essential and preconception interventions. Why it is important for these issues to be brought to public attention?
There is a lot of focus on developing interventions during pregnancy because it is easy to achieve during this time. However the main challenge is to develop interventions that can be implemented before pregnancy because there are many conditions prior to pregnancy that really impact the development of the foetus and child health. So it is essential to start communicating and using interventions prior to pregnancy to improve later quality of life.
In relation to essential interventions, the World Health Organization made great efforts to find and analyse interventions that could make a real improvement in reproductive health, by applying rigorous methodology to assess and identify these interventions. The idea is to promote the use of essential interventions all over the world to positively impact reproductive health.
What approaches to scientific research do you feel are most likely to provide higher benefits for lower and middle income countries?
There is a new discipline called implementation research or implementation science. It focuses on how we can implement interventions that we know are of benefit to the population, in our case in reproductive health. There are many constraints we face, such as constraints due to health providers’ attitudes and constraints related to poverty. I think that the approach of implementation science – testing interventions that could result in better implementation – should be heavily promoted among researchers.
The percentage of Argentina’s biomedical research funds given over to applied clinical and public health research is relatively low. What are your thoughts on basic versus applied research?
This is a problem that we’re seeing in other countries too, but in particular in low and middle income countries where we especially cannot waste the money that we have for research. The money that we have for research is mainly devoted to basic research. For example, in Argentina only six percent of biomedical research funds are devoted to applied clinical and public health research. I am not going to deny the merit of basic research, but there is a need for more investment in clinical and public health research all over the world. We need to consider the final benefits of research to the people and how it can be implemented in the population.
The European Union recently voted to pass new laws ensuring that drug clinical trials are publicly registered and results are reported. How important is access to data from clinical trials?
There is no doubt that we need to report all the research that is performed. In some instances, for example, negative results are not published. We need to see the results of every research experiment performed – not only to those that give positive results, but also to those that give negative results. Also there is a need for access to databases that collect information from all over the world. This information is mainly restricted to the researchers that are doing the research, and is not publicly accessible. There is a real need to have access to databases in order to save money, save time, and avoid replicating efforts already made. The aim of research is to improve the well-being of people, and to share what we have is important in order to achieve this well-being.
What do you think is the current attitude to trial transparency in Latin America?
Latin America is following the major trends observed in many countries, namely the promotion of trial transparency – that is the communication of protocols, negative results, and methodologies. One of the major achievements that I have seen in the last 30 years is that research methodology has improved all over the world in all investigations.
Also, there are major efforts towards creating compilations of results, meta-analyses, and protocol applications. The publication of protocols is needed, as this increases transparency, ensures that the process is reproducible, and also encourages the publication of all the results including negative results.
How important is open access to researchers in lower and middle income countries, and how much difference has it made?
It is a major contributor to the improvement of health and research in low and middle income countries. I’m sorry to say that when I started doing research we in middle and lower income countries didn’t have any access to the literature because there were no libraries with all of the journals. Obtaining a journal or an article was really impossible. Then there was a great limitation in lower and middle income countries to do research because they didn’t have access to the medical literature. Medical literature was concentrated in league universities in high income countries. So open access made a major difference to everybody in the world who now only had to pay for access to the internet in order to access the journals. I think that it is a must for all journals and publications to be open access.
More about the Editor
José Belizán is Chairman of the Department of Mother & Child Health Research at the Institute for Clinical Effectiveness and Health Policy, Argentina. He received his medical degree at the National University of Rosario, Argentina, and his PhD in reproductive health sciences from the Universidad del Salvador, Argentina. During his career he has held several notable positions including, World Health Organization fellow in reproductive biology at the Latin American Center for Perinatology and Human Development (CLAP), Assistant Professor in the Department of Obstetrics at the School of Medicine of the National University of Rosario, Argentina, and Head of the Perinatal Intensive Care Unit of the Hospital ‘20 de Noviembre’ of the Social Security and Services Institute for State Employees, Mexico, Director of the CLAP, Uruguay. Belizán is also Adjunct Professor of the Tulane University School of Public Health and Tropical Medicine, USA, Adjunct Professor of the School of Public Health at the University of North Carolina at Chapel Hill, USA, and Adjunct Professor of the Master in Reproductive Health at the University of Concepcion, Chile.