President’s speech: Raymond Belaiche
Good afternoon. I would like to welcome you to this meeting in Paris. The General Assembly initially planned for this date in Hammamet could not take place for various reasons: the Ramadan festivals, for our Tunisian friends, and the difficulty of finding another date during this period which suited all the delegates. The next General Assembly will take place from 1st-3rd June 2007 in Hammamet, Tunisia, and the local organisation is already well in hand. Our Tunisian colleague, Dr. Nabil Ben Zineb, is present among us today. I would like to thank him first of all for coming, and for his efficient preparation of our General Assembly.
I hereby declare the meeting open, and I would like to invite Guy Schlaeder, our Secretary-General, to speak.

Report by the Secretary-General: Guy Schlaeder
Other than the usual routine activities, I have had the privilege of attending several international meetings in the name of UPIGO. In November 2005, a conference took place in Strasbourg on the theme of “INTERNATIONAL CO-OPERATION, CULTURES and KNOWLEDGES”. The promoters were the Forum de Delphes (Delphes Forum) and CEFODE (Coopération et Formation au Développement, Co-operation and Training for Development). There was wide participation: speakers came from the Philippines, South Africa and Sub-Saharan Africa, from various European countries and even the Indies. AIDS was discussed, as well as the numerous cultural and sociological problems involved in co-operation.
In March 2006, the “FIRST INTERNATIONAL HUMANITARIAN DAY ON WOMEN’S HEALTH THROUGHOUT THR WORLD” took place in Paris. In numerous countries women remain in a precarious situation with regard to health. In France the situation has worsened in the last two or three years.
Another concern is genital mutilation, which affects about 130 million women throughout the world.
We spoke to recall a few of UPIGO’s campaigns: in particular our commitment to sex and relationship education at the Council of Europe and our motion in Rome against genital mutilation.
In June 2006 an important “ COLLOQUIUM ON MATERNAL MORTALITY IN DEVELOPING COUNTRIES” took place in Paris. The colloquium placed particular emphasis on the AQUASOU project (Amélioration de la Qualité et de l’Accès aux soins obstétricaux urgents; Improvement of Quality of, and Access to, urgent Obstetrical care).
Our friend Christiane Welffens from Abidjan, President of SAGO, analysed the difficulties she had encountered: poor communication between SAGO and national societies; slow transfer of funds and cumbersome administration. Nestor Azendege from the World Health Organisation office in Brazzaville made a very fine analysis of the problem of maternal health in Sub-Saharan Africa. While in developed countries virtually 100% of births are attended by qualified personnel, in Africa more than half of all births take place without professional assistance.
According to Cyril Wissok, from Balance and Populations, the absence of social and political mobilisation is one of the causes of the failure of programmes to eliminate maternal mortality. The decision-makers, as much in the North as in the South, do not take action to ensure that the campaigns become permanent.
Finally, UPIGO regularly collaborates with the Council of Europe as an INGO (International Non-Governmental Organisation), with participative status. As you know, our contribution to sex and relationship education has been well-received. We are currently co-ordinating a group of fifteen INGOs working on Prevention and Health. Any suggestions or contributions by UPIGO delegations are welcome.
Gynaecology and Obstetrics in Tunisia by Nabil Ben Zenib, President of the Tunisian Society of Gynaecology and Obstetrics. A very well-documented report, presented in the form of a slide-show, explained the situation in Tunisia. Let’s quote a few figures: the country covers an area of 164,000km2 and has 9,910,822 inhabitants. The total fertility rate is 2.02, and infant mortality stands at 20.6 per thousand. Maternal mortality is 48 per 100,000, and life expectancy is 73.4 years.
Doctors are trained by four faculties of medicine. There are 700 specialists in gynaecology and obstetrics. A remarkable study on maternal mortality in 1994 allowed found that 87% of cases of maternal mortality were avoidable. Various measures have allowed maternal mortality to be reduced. Cases of maternal mortality are still tracked in order to improve the situation further.

THE DELEGATIONS: ROUND-TABLE DISCUSSION

The EU tissue-directive implemented in Denmark
Directives from the EU parliament are laws in the EU. The EU-directive 2004/23/EF (31.of March 2004) was done with the intension to protect against transmission of disease between donor and recipient when tissues are donated. For some reasons fertility treatment was included. The implementation process in Denmark seems to be ahead of the process in other European countries. The national Health Board in Denmark authorised Lægemiddelstyrelsen (like FDA in USA) to take responsibility over the implementation process. True IVF units will have to rebuild there laboratories to meet the claims, but only minor changes are to be done for office gynaecologists involved in insemination treatment. Sperm wash is, however, restricted to swim-up; Per coll centrifugation is not permitted. Electronic registration is introduced and it must be performed for every insemination. Every clinic will be inspected and authorised at their own level: insemination or IVF.

The Central African Republic: Abdoulaye Sepou
The Central African Republic is an enclaved country, with a surface area of 623,000 km_, and 3,895,139 inhabitants. With a GDP per inhabitant of US$300, this country is among the least developed in the world. The country is bursting with natural riches which are poorly exploited, or not exploited at all (diamonds, wood, and so on). The country is sub-divided into seven health regions, of which Bangui is the capital. There are six specialists in gynaecology and obstetrics, all practising in Bangui and grouped around the Société Centrafricaine de Gynécologie et d’Obstétrique (SOCAGO), which is affiliated to SAGO and to UPIGO. The ratio of maternal mortality is 1,355 deaths to 100,000 live births, and the rate of infant mortality is 132 to 1,000 live births. Uptake of contraception is 6.9%.
To make up for the lack of specialists in these regions, we are planning to train them locally, with support from our partners.

GERMANY: Klaus König
1.) Training of specialists, and definition of the specialisation: We are reviewing problems regarding training, sub-specialities, and conflicts with related specialisations. According to a wider definition of the specialisation, we should not talk about diseases of female genital organs and of the breasts, but in a more general way about problems linked to the female sex. This report will be studied in detail at the General Assembly in Hammamet.
2.) Other problems in Germany: The government has decided to submit a project for the reform of the health system to Parliament, in spite of opposition from all interested parties: doctors, medical insurance funds, hospitals and pharmacists. The state regulates funding of the health system, favours GPs and weakens specialists. A cap has been set on fees, and part of the fee is no longer paid. Recently, our fees have been reduced by 40%. In our opinion, we will see specialist practices closed, and young doctors will go abroad.

GREECE: Nicolas Tsatsaris and Achilles Kalogeropoulos
Greece has about 10 million inhabitants. The birth rate remains very weak (100,000 births per year). The population is ageing. We have always had a surplus of gynaecologists and obstetricians, of which there are about 2,500, located particularly in large urban centres. No measures are envisaged by the State to rationalise medical demography. More than half of births take place in the private sector, and more than 80% of practitioners work on a partially or wholly private basis.
Certain specialisations are still encroaching on our domain, for example, surgeons, for breast-care, urologists for urinary incontinence, endocrinologists for amenorrhea and polycystic ovaries syndrome , and particularly the menopause.
Currently our biggest problem is the huge increase in legal proceedings, especially in the practice of obstetrics and in prenatal diagnoses. Compensation has seen a sharp increase, and is often in excess of the maximum set down by PCR insurance contracts. The big, private gynaeco-obstetrical centres (some of which carry out 10,000 – 15,000 births per year and may be floated on the stock exchange) must set aside sums in their budget to cover compensation which may be awarded. This situation will be examined in detail at the next congress for private maternity hospitals in December 2006, to which UPIGO has been invited.

ITALY: Giovanni Adinolfi and Pier Francesco Tropea
In order to make clear the actual situation of UPIGO it's proposed that the Presidency and the General Secretariat would like to inform all the Professional and Scientific Societies of Gyn-Obs of the European countries belonging UPIGO and also those not belonging UPIGO that, after the creation of EBCOG, UPIGO itself, in order to avoid overlapping and confusion, during an extraordinary General Assembly hold in Rome, established, with success, a new strategy. Moreover it's important to specify the various points and topics of the new strategy and also the enlargement to the east and African countries of UPIGO itself
The fight against maternal mortality, which is still too high in numerous countries, must be pursued by UPIGO.

FRANCE: Guy-Marie Cousin
The greatest professional worry in France remains insurance and civil and professional liability for obstetricians in private practice (those working in hospitals are covered by the hospital’s insurance). This problem is difficult to deal with for obstetricians, who feel unsafe, and young obstetricians are hesitant to set up in private practice, putting in danger a certain number of obstetrical teams which are not able to replace team members who retire.
The main insurance firm on the market terminated all contracts on 1st October, and now offers a new insurance contract for 2007 with a tariff, for obstetrics alone, of 30,000 euros, and, for obstetrics and surgery, 36,000 euros (for a client with no prior claims). The average cost of insurance was between 15,000 and 20,000 euros in 2006.
The specialisation is resolutely committed to risk management, with a professional body which associates a learned society with a trade union, which will be recognised by the French National Authority for Health. As a counterweight to the commitment of each practitioner to risk management, which will oblige each professional to declare accidents and “near-misses” and to follow the recommendations for good practice which have been drawn up, medical insurance funds will be responsible for between half and two thirds of insurance costs (to a maximum of 12,000 euros in 2006). We are working on a project which is similar to the Danish system, with compensation paid by contributions to “solidarity funds” where "no fault" is found with the professional concerned.

SLOVAKIA: Jan Stencl, Anna Bohacikova
The subspecialities are well recognised. We look forward to finding out about the situation in other countries on the occasion of the planned study of “The exercises of Gynaecology and Obstetrics”.

SWITZERLAND: Mario Litschgi
A new law on IVF and medically assisted procreation is under discussion. The restrictions included in Danish law are not are not envisaged in Switzerland. A new programme for the training of specialists has been drawn up. Medical gynaecologists will train for five years, and gynaecological surgeons for seven years. Feto-maternal medicine, gynaecologic oncology, gynaecological endocrinology and reproductive medicine and urogynaecology are either already recognised sub-specialisations, or will shortly become so.

LUXEMBOURG: Annik Conzemius
The arrival of a number of foreign doctors specialising in medical gynaecology, from Belgium or Germany or other countries, is a problem for us. They are taking part of our clientele, but are not under an obligation to be on call for urgent obstetrical cases or operations.
In another domain, we are currently thinking about the Nordic “no fault” system. The professional body takes responsibility for complications in medical acts whether or not there has been medical malpractice. This would allow the cost of our insurance for professional civil responsability to be reduced, and the number of lawsuits to be limited.

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Report from the Treasury: Pier Francesco Tropea, Treasurer, and Raymond Belaiche, President
A detailed statement will be given at the meeting. The accounts have been audited, and the final balance is €42,198.51 .
Reminder of the new UPIGO statutes (adopted in 2004 at the General Assembly in Berlin).
UPIGO is a Professional Union, and its principal objectives are:
- to defend the professional interests of obstetricians and gynaecologists;
- to study, represent and defend the ethical, professional and material interests of the specialisation before all international authorities;
- to ensure quality care for women and unborn children;
- to establish relations with any appropriate national or international organisation.
It should be noted that UPIGO is not a learned or academic society, even if it regularly numbers academics in its ranks.
Themes for the General Assembly in Hammamet (1st - 3rd June, 2007):
- the limits of the specialisation and the conditions in which it is practised: Guy-Marie Cousin, Klaus König and Guy Schlaeder;
- medico-legal problems associated with shoulder dystocia: Raymond Belaiche and Pier Francesco Tropea;
- relations between gynaecologists in the public and private sectors in Tunisia: Nabil Ben Zineb;
- insurance for professional civil responsibility, international comparisons: Jean Marty.
Closing speech by the President: Raymond Belaiche
Dear friends, the session is drawing to a close and I would like to thank you for your presence, and for the most productive work which has been accomplished. It has given me great pleasure to have among us Dr Nabil Ben Zineb, representing Tunisia. I would like to congratulate him on his brilliant paper and to thank him warmly for his help in organising the next General Assembly in Hammamet.
We have also been able to receive the “spokesperson” for our Japanese colleagues, whom we have invited to join in our work in 2007. We have moreover received Professor Abdoulaye Sepou, representing the Central African Republic, and we welcome him warmly to UPIGO.
I can only congratulate UPIGO on the collaboration of all concerned, and on our common desire to progress. I look forward to seeing you in Hammamet, Tunisia, on Ist June 2007.

List of the delegations present in Paris:
Germany: K.König; Central Africa: Abdoulaye Sepou; Denmark: H.H. Wagner, S. Lenz; France: G.M. Cousin; Greece: N.Tsatsaris, A. Kalogeropoulos; Italy: G. Adinolfi; Luxembourg: A. Conzemius; Slovakia: A. Bohacikova; Switzerland: M. Litcshgi .As board members: President: R. Belaiche ; Vice-Presidents: A. Conzemius, Jan Stencl; Secretary-General, G. Schlaeder; Treasurer: P.F. Tropea.
Guest:
Nabil Ben Zineb, Tunisia.
Observer:
Naoko Okuda, Japanese Medical Association.
Apologies:
Mali: M.Diakite ; Senegal: R. Wardini-Hachem; F. Wade; Poland: M. Spaczinski; Serbia: V. Kesic (correspondent member)

Report drawn up by G.Schlaeder
Secretary-General, UPIGO
Strasbourg, November 2006