problem statement for research in obg

Nursing seminars & Nursing improvement

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Sunday, January 9, 2011

Research statements under muhs university from year 2008, 57 comments:.

hi, thanks a lot 4 such a smart work with regards, -Msc students, hyd

Anonymous April 27, 2012 11:40 PM hi, thanks from d core of ma heart for sincere work with regards, -Msc students, Indore

thankz a lot dear ! with regardz ! ~ MSC Studentz Kashmir

hi, i was a bit confused in selecting my problem statement. thank u very much! M.Sc.student Bangalore

This comment has been removed by the author.

THANKS A LOTTTTTTTTTTT :}

It is useful for nursing profession.Specifically research scholars.

Its really helpful for me thanks great job .. Keep uploading recent pls frm-sumedh k. Lata mangeshkar hosp.(Nagpur)

Thanx a lot

Thanx a lot ,its very useful info to research aspirants. Specially for Basic Bsc student. -Roshan Parab B.B.Sc Nsg GMC/CON/JJ hosp/mumbai.

You have done a great job THANKS A LOT

thank u done a good job for others. it will really help.

thank u very much its very useful all nsg students it will realy help others

thank you very much, i am so confused to select a problem statement its very useful to all nsg students keep it up'

Useful for research scholars...thanks alot.Keep adding new info. Nursing Research scholar from SKIMS Kashmir

The Data is very useful and will be of great information to search for its special category in list of special studies available in the state and hospitals.

Thanks sir from heart.......you save me from punishment of my mam Becoz I got maximum statement in minimum time..Thanks a lot

thAnka aLot fOr prOviding me wIth lOt of ideAs fOr my reSearch prOject!!! ( M.sc stuDent)

it is quite informative.information about neurological and orthopedic system are little but lacking.

Thanks a lot

That's a lot information for students looking for career in nursing. They certainly can make well use of this post. Thanks for sharing this post. Good work.

how i select the nursing reserch statement

thankyou amit

I hope you will keep wriring.

As we have seen they have done everything and also they enumerated everything in points and also the explanation given contributing to the great values, looking forward to have such kind of the cap ideas. capstone research project ideas

Thanks for providing information

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Obstetric and Gynecological Nursing Research Paper Topics

The diverse array of obstetric and gynecological nursing research paper topics underscores the critical importance of this specialized field of nursing. Obstetric and gynecological nursing encompasses a wide range of topics that address the health and wellness of women from adolescence through menopause and beyond. This includes the management of pregnancy and childbirth, preventive care, and the diagnosis and treatment of diseases and disorders specific to women. As the healthcare needs of women continue to evolve, so does the need for ongoing research and development of evidence-based practices in obstetric and gynecological nursing. This article provides a comprehensive list of research paper topics that will be of interest to students and professionals seeking to expand their knowledge and contribute to the body of knowledge in this vital area of healthcare.

100 Obstetric and Gynecological Nursing Research Paper Topics

Obstetric and gynecological nursing is a specialized field of nursing that focuses on the health and well-being of women throughout their lifespan. It encompasses a wide range of topics including pregnancy and prenatal care, labor and delivery, postpartum care, gynecological disorders, reproductive health, maternal and newborn health, high-risk pregnancy, women’s health across the lifespan, menopausal health, and ethical and legal issues in obstetric and gynecological nursing. The significance of this field cannot be overstated as it plays a crucial role in ensuring the health and well-being of both women and newborns. This article provides a comprehensive list of obstetric and gynecological nursing research paper topics, divided into 10 categories, each containing 10 topics.

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Pregnancy and Prenatal Care:

The role of prenatal vitamins in preventing birth defects.
The effects of maternal stress on fetal development.
The impact of prenatal exercise on maternal and fetal health.
The role of routine ultrasound examinations in prenatal care.
The effectiveness of non-pharmacological interventions for nausea and vomiting during pregnancy.
The impact of maternal obesity on pregnancy outcomes.
The role of folic acid supplementation in the prevention of neural tube defects.
The effectiveness of smoking cessation interventions during pregnancy.
The impact of maternal alcohol consumption on fetal development.
The role of prenatal education in preparing expectant mothers for childbirth.

Labor and Delivery:

The effectiveness of epidural analgesia in managing labor pain.
The impact of birthing positions on labor outcomes.
The role of continuous support during labor and delivery.
The effectiveness of non-pharmacological pain relief methods during labor.
The impact of induced labor on maternal and neonatal outcomes.
The role of midwives in managing labor and delivery.
The effectiveness of water birth in reducing labor pain.
The impact of cesarean section on maternal and neonatal outcomes.
The role of intrapartum fetal monitoring in preventing adverse outcomes.
The effectiveness of active management of the third stage of labor in preventing postpartum hemorrhage.

Postpartum Care:

The role of breastfeeding support in promoting successful breastfeeding.
The impact of postpartum depression on mother-infant bonding.
The effectiveness of skin-to-skin contact in promoting neonatal thermoregulation.
The role of postpartum exercise in promoting maternal physical and mental health.
The impact of early postpartum discharge on maternal and neonatal outcomes.
The effectiveness of postpartum contraceptive counseling in preventing unplanned pregnancies.
The role of routine newborn screening in the early detection of congenital disorders.
The impact of maternal-infant rooming-in on breastfeeding success.
The effectiveness of postpartum home visits in promoting maternal and newborn health.
The role of pelvic floor exercises in preventing postpartum urinary incontinence.

Gynecological Disorders:

The effectiveness of hormonal therapy in managing polycystic ovary syndrome.
The impact of lifestyle modifications on the management of endometriosis.
The role of screening in the early detection of cervical cancer.
The effectiveness of non-surgical interventions for uterine fibroids.
The impact of human papillomavirus vaccination on the incidence of cervical cancer.
The role of hormonal replacement therapy in managing menopausal symptoms.
The effectiveness of conservative management for ovarian cysts.
The impact of early detection and treatment on the prognosis of ovarian cancer.
The role of lifestyle modifications in the prevention of gynecological cancers.
The effectiveness of surgical interventions for pelvic organ prolapse.

Reproductive Health:

The role of contraceptive counseling in preventing unplanned pregnancies.
The impact of long-acting reversible contraceptives on reducing the rate of unintended pregnancies.
The effectiveness of fertility awareness-based methods in preventing pregnancy.
The role of preconception care in promoting healthy pregnancies.
The impact of sexually transmitted infections on reproductive health.
The effectiveness of barrier methods in preventing sexually transmitted infections.
The role of hormonal contraceptives in managing menstrual disorders.
The impact of infertility on mental health.
The effectiveness of assisted reproductive technologies in managing infertility.
The role of male involvement in promoting reproductive health.

Maternal and Newborn Health:

The impact of gestational diabetes on maternal and neonatal outcomes.
The effectiveness of kangaroo mother care in promoting neonatal health.
The role of antenatal corticosteroids in preventing neonatal respiratory distress syndrome.
The impact of maternal anemia on neonatal outcomes.
The effectiveness of newborn resuscitation in preventing neonatal mortality.
The role of immunization in promoting maternal and newborn health.
The impact of maternal mental health on neonatal outcomes.
The effectiveness of neonatal intensive care in improving the survival of preterm infants.
The role of early intervention services in promoting the development of high-risk infants.
The impact of maternal-infant bonding on neonatal outcomes.

High-Risk Pregnancy:

The role of antenatal care in managing high-risk pregnancies.
The impact of multiple pregnancies on maternal and neonatal outcomes.
The effectiveness of nutritional interventions in managing gestational diabetes.
The role of bed rest in managing preterm labor.
The impact of advanced maternal age on pregnancy outcomes.
The effectiveness of antihypertensive medications in managing preeclampsia.
The role of fetal surveillance in managing intrauterine growth restriction.
The impact of preconception care on the outcomes of high-risk pregnancies.
The effectiveness of interventions for preventing recurrent preterm birth.
The role of specialist care in managing high-risk pregnancies.

Women’s Health Across the Lifespan:

The impact of lifestyle modifications on the prevention of cardiovascular diseases in women.
The effectiveness of breast cancer screening in early detection and treatment.
The role of hormone replacement therapy in managing menopausal symptoms.
The impact of osteoporosis on women’s health.
The effectiveness of interventions for preventing urinary incontinence in women.
The role of regular exercise in promoting mental health in women.
The impact of domestic violence on women’s health.
The effectiveness of interventions for promoting healthy eating in women.
The role of stress management in preventing chronic diseases in women.
The impact of depression on women’s health.

Menopausal Health:

The impact of menopause on cardiovascular health.
The effectiveness of hormonal replacement therapy in managing menopausal symptoms.
The role of lifestyle modifications in managing menopausal weight gain.
The impact of menopause on mental health.
The effectiveness of non-hormonal interventions for managing hot flashes.
The role of regular exercise in preventing osteoporosis in postmenopausal women.
The impact of menopause on sexual health.
The effectiveness of dietary interventions in managing menopausal symptoms.
The role of stress management in promoting menopausal health.
The impact of menopause on the risk of developing gynecological cancers.

Ethical and Legal Issues in Obstetric and Gynecological Nursing:

The role of informed consent in obstetric and gynecological procedures.
The impact of religious and cultural beliefs on women’s health decisions.
The effectiveness of mandatory reporting of domestic violence in promoting women’s safety.
The role of confidentiality in obstetric and gynecological care.
The impact of legal restrictions on abortion services.
The effectiveness of legal interventions in preventing female genital mutilation.
The role of ethical considerations in assisted reproductive technologies.
The impact of legal and ethical issues on the practice of obstetric and gynecological nursing.
The effectiveness of legal interventions in promoting maternal and newborn health.
The role of ethical considerations in the management of high-risk pregnancies.

The importance of research in obstetric and gynecological nursing cannot be overstated as it plays a crucial role in ensuring the health and well-being of both women and newborns. The diverse range of topics listed above provides a comprehensive overview of the various aspects of obstetric and gynecological nursing. It is our hope that this list will serve as a valuable resource for students and professionals seeking to expand their knowledge and contribute to the body of knowledge in this vital area of healthcare.

The Range of Obstetric and Gynecological Nursing Research Paper Topics

Obstetric and gynecological nursing is an essential branch of healthcare that focuses on the well-being of women during pregnancy, childbirth, and the postpartum period, as well as the diagnosis and treatment of diseases of the female reproductive system. The significance of this field is immense, as it plays a crucial role in ensuring the health and safety of both mothers and newborns, and in managing and preventing gynecological disorders. The scope of obstetric and gynecological nursing research paper topics is vast, encompassing a wide range of issues from pregnancy and prenatal care, labor and delivery, postpartum care, gynecological disorders, and much more.

Pregnancy and Prenatal Care

Proper care during pregnancy is essential for the health and well-being of both the mother and the baby. Prenatal care involves a series of regular check-ups and screenings to monitor the health of the mother and the developing fetus. Obstetric nurses play a crucial role in providing this care, educating expectant mothers about proper nutrition, exercise, and lifestyle habits, monitoring the progress of the pregnancy, and identifying and managing any potential complications. Some obstetric and gynecological nursing research paper topics in this area could include the effectiveness of different prenatal screening tests, the impact of maternal lifestyle habits on fetal development, or the role of prenatal education in preparing expectant mothers for childbirth.

Labor and Delivery

The process of labor and delivery is a critical period that requires skilled care and management to ensure the safety of both the mother and the baby. Obstetric nurses are involved in every stage of this process, from monitoring the progress of labor, providing pain relief, assisting with the delivery, and caring for the mother and newborn immediately after birth. Research topics in this area could include the effectiveness of different pain relief methods during labor, the impact of birthing positions on labor outcomes, or the role of continuous support during labor and delivery.

Postpartum Care

The postpartum period, or the time after childbirth, is a crucial time for both the mother and the newborn. Obstetric nurses provide care to the mother as she recovers from childbirth, monitor the newborn’s health and development, provide breastfeeding support, and educate the new parents on infant care. Some potential obstetric and gynecological nursing research paper topics in this area could include the impact of postpartum depression on mother-infant bonding, the effectiveness of skin-to-skin contact in promoting neonatal thermoregulation, or the role of postpartum exercise in promoting maternal physical and mental health.

Gynecological Disorders

Gynecological nursing involves the diagnosis and treatment of diseases of the female reproductive system. Gynecological nurses provide care to women with a variety of gynecological disorders such as polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, cervical cancer, and more. Research topics in this area could include the effectiveness of hormonal therapy in managing PCOS, the impact of lifestyle modifications on the management of endometriosis, or the role of screening in the early detection of cervical cancer.

The diverse range of obstetric and gynecological nursing research paper topics provides an opportunity for researchers to explore a variety of issues that affect women’s health. By conducting research in this field, nurses can contribute to the body of knowledge that informs clinical practice and helps improve outcomes for women and newborns.

In conclusion, obstetric and gynecological nursing is a vital field that plays a crucial role in ensuring the health and well-being of women and newborns. From pregnancy and prenatal care, labor and delivery, postpartum care, and the management of gynecological disorders, the scope of this field is vast. The wide range of obstetric and gynecological nursing research paper topics provides an opportunity for researchers to explore various aspects of this field and contribute to the improvement of women’s health.

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Home » Problem Statement – Writing Guide, Examples and Types

Problem Statement – Writing Guide, Examples and Types

Table of Contents

A problem statement is a concise description of the issue or challenge that a research project or initiative aims to address. It defines the problem in clear terms and establishes its significance, providing a foundation for developing objectives, methodologies, and potential solutions. Writing a well-defined problem statement is crucial for setting the direction of research and ensuring its relevance.

This article explores the definition, types, and examples of problem statements, along with a step-by-step guide to writing an effective one.

Problem Statement

A problem statement identifies the gap between the current situation and the desired outcome, highlighting why the problem matters. It is typically included in research proposals, project plans, or academic theses, guiding the scope and purpose of the study.

For example: In a study on online education, the problem statement might be:

“Despite the growing popularity of online education, student engagement and retention rates remain significantly lower compared to traditional classroom settings.”

Importance of a Problem Statement

Focuses the Research: Clearly defines the issue to be investigated.
Highlights Significance: Demonstrates why the problem is important to address.
Aligns Objectives: Ensures the research goals are connected to real-world challenges.
Guides Methodology: Shapes the design and approach of the study.
Supports Decision-Making: Helps stakeholders understand the context and urgency of the issue.

Types of Problem Statements

1. academic problem statements.

Purpose: Used in research papers or theses to identify gaps in knowledge or unresolved issues.
“While many studies have explored the psychological effects of social media on teenagers, limited research exists on its impact on their critical thinking skills.”

2. Business Problem Statements

Purpose: Defines operational, financial, or strategic issues within an organization.
“The company has experienced a 25% decline in customer retention over the past year due to outdated customer engagement strategies.”

3. Social or Policy Problem Statements

Purpose: Focuses on societal challenges, policies, or public issues.
“The lack of affordable housing in urban areas has resulted in increased homelessness and economic inequality.”

4. Technical Problem Statements

Purpose: Identifies challenges related to technological development or implementation.
“The current software application fails to handle large-scale data processing efficiently, leading to delays in analysis.”

Elements of a Problem Statement

Example: “Remote work has become the norm for many businesses in the post-pandemic era.”
Example: “However, teams often struggle to maintain effective communication and collaboration in virtual settings.”
Example: “This can lead to reduced productivity, lower employee satisfaction, and missed deadlines.”
Example: “Implementing better communication tools and strategies can enhance team dynamics and improve performance.”

Steps to Write a Problem Statement

1. identify the problem.

Pinpoint the issue or gap that requires attention.
Use specific data or observations to support the claim.
Example: “Customer complaints about delayed deliveries have increased by 40% in the past six months.”

2. Understand the Context

Gather background information to provide context.
Example: “The delays are primarily caused by inefficiencies in the warehouse inventory system.”

3. Define the Impact

Highlight how the problem affects stakeholders, such as individuals, organizations, or communities.
Example: “This has resulted in decreased customer satisfaction and a potential loss of market share.”

4. Propose the Ideal Solution

Describe what the situation would look like if the problem were resolved.
Example: “Upgrading the inventory management software can streamline operations and ensure timely deliveries.”

5. Keep It Concise and Clear

Avoid jargon and excessive details.
Aim for 4–5 sentences that succinctly convey the problem and its significance.

Examples of Problem Statements

Academic example.

Topic: Online Learning and Student Engagement
Problem Statement: “Despite the rapid adoption of online education, recent studies indicate that 45% of students report difficulty staying engaged during virtual classes. This lack of engagement can negatively affect learning outcomes and overall satisfaction. Identifying effective strategies for improving engagement in online environments is critical to ensuring the success of digital learning platforms.”

Business Example

Topic: Decline in Sales Revenue
Problem Statement: “Over the past year, the company’s sales revenue has decreased by 15%, primarily due to outdated marketing strategies and limited digital presence. This decline has affected profitability and market competitiveness. Modernizing the marketing approach and expanding the company’s online visibility can help address this issue.”

Social Example

Topic: Environmental Pollution
Problem Statement: “Urban areas are experiencing increased air pollution levels, with particulate matter concentrations exceeding safe limits in 70% of major cities. This poses severe health risks, particularly for vulnerable populations. Developing and implementing stricter emission regulations and promoting sustainable practices are essential steps to mitigate this crisis.”

Common Mistakes to Avoid

❌ “There are issues with our website.”
✅ “The website’s slow loading times lead to a 20% drop in customer retention rates.”
❌ “We need to implement AI tools to improve productivity.”
✅ “Current manual data entry processes result in errors and inefficiencies, causing delays in project completion.”
Ignoring the Stakeholders: Highlight how the problem impacts people or organizations.
Lack of Evidence: Use data, statistics, or observations to support the existence of the problem.

Tips for Writing an Effective Problem Statement

Use Data: Support your statement with quantitative or qualitative evidence.
Focus on Relevance: Address a problem that is meaningful to your audience.
Keep It Objective: Avoid emotional language or personal opinions.
Review and Revise: Ensure clarity, conciseness, and alignment with the research objectives.

A well-written problem statement is a crucial element of any research or project. It provides clarity, establishes significance, and sets the stage for effective problem-solving. By understanding the types, structure, and examples outlined in this guide, researchers and professionals can craft problem statements that effectively communicate the core issues and their importance.

Creswell, J. W. (2018). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches . Sage Publications.
Bryman, A. (2015). Social Research Methods . Oxford University Press.
Babbie, E. R. (2020). The Practice of Social Research . Cengage Learning.
Kumar, R. (2019). Research Methodology: A Step-by-Step Guide for Beginners . Sage Publications.
Saunders, M., Lewis, P., & Thornhill, A. (2019). Research Methods for Business Students . Pearson.

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Institute of Medicine (US) Committee on Research Capabilities of Academic Departments of Obstetrics and Gynecology; Townsend J, editor. Strengthening Research in Academic OB/GYN Departments. Washington (DC): National Academies Press (US); 1992.

Strengthening Research in Academic OB/GYN Departments.

Hardcopy Version at National Academies Press

2 Is There a Problem?

The previous chapter noted perceived difficulties in supporting research and in training research personnel in obstetrics and gynecology (OB/GYN). This chapter moves from perception to more solid ground by examining objective indicators to establish whether a problem exists. There are three ways to answer the question. The first measure is the level of external support for research and research training in academic departments of OB/GYN, primarily from the National Institutes of Health (NIH) but also from the private sector. The second involves the structural characteristics of departments of OB/GYN, specifically, whether OB/GYN departments differ from other clinical departments in ways that might indicate that problems exist or that might constitute a cause for alarm. The final measure is a research agenda for OB/GYN, the size and depth of which indicate unmet needs for research and promising avenues of investigation with great potential for repaying increased investment in OB/GYN research.

Support of Research and Training in Departments of OB/GYN

Sources of funding for research in departments of OB/GYN include the federal government, foundations, the academic institutions within which the departments exist, the departments themselves, and industry. The Institute of Medicine (IOM) was fortunate in that the American College of Obstetricians and Gynecologists (ACOG) and the Association of Professors of Gynecology and Obstetrics (APGO) include questions in their joint survey of academic manpower that enabled the committee to gain an understanding of the overall level of research support in departments of OB/GYN and the relative contribution of each of the above sectors. Responses from all 136 approved U.S. medical schools indicated a total of $142.2 million in research funds from all sources m 1990. The principal source of research support was the federal government ($77.5 million, or 54.5 percent), followed by institutional support ($26.4 million, or 18.6 percent), industry ($19.3 million, or 13.5 percent), and foundations and other sources ($19.1 million, or 13.4 percent). 1 No data axe available to indicate either past levels of support or changes in distribution, but some OB/GYN department chairs feel that the pharmaceutical industry has become a more significant source. 2 There are also indications that private foundation support, which played an important role in stimulating research in departments of OB/GYN in the past, has diminished in recent years.

The Role of Foundations

According to an inventory of private agencies that contribute to population research, * a small number of foundations—the Ford, Rockefeller, and Andrew W. Mellon foundations—have for years dominated the private funding scene. The Hewlett Foundation, created in 1966, entered the inventory in 1985. The Population Council, which is included in the inventory, is itself a research organization that solicits funds to support its work. However, it also supports investigators—mainly overseas—who collaborate with the council in fertility and contraception work. **

Between 1976 and 1985, several trends in foundation support were notable. Reproductive processes and contraceptive development both lost ground, losing 34 percent and 6 percent in funds, respectively. There was also a large shift of funds to the social and behavioral sciences (a gain of 224 percent) and smaller but nevertheless substantial gains for contraceptive evaluation (184 percent) and population research centers (98 percent). 3 These trends suggest that OB/GYN departments may have been losers, since the largest gains appear in areas in which other departments have a major stake. The area most specific to OB/GYN—that is, reproductive processes—experienced the greatest loss.

Private foundations have also made significant contributions to the training, development, and support of OB/GYN academic manpower. The principal foundations involved have been the Mary R. Markle Foundation; the Josiah Macy, Jr. Foundation; the Rockefeller, Ford, and Mellon foundations; and, more recently, foundations formed by OB/GYN professional groups. The history of the contributions of these organizations is detailed in Appendix A . The foundations played an important role in stimulating the research careers and bringing to prominence many of today's leaders in academic OB/GYN. It is particularly useful to note the contributions of the Macy and Mellon foundations, which provide good examples of the impact of foundation giving and of the factors that may cause a change in the programs these foundations support.

The program of the Josiah Macy, Jr. Foundation focused specifically on the furtherance of reproductive biology through faculty development, conferences and seminars, and support of research time for medical students. In the 1950s and 1960s, funds flowed into selected medical schools and to individuals in residency programs. There were also funds for interdisciplinary research. The program supported faculty fellows and postdoctoral fellows, many of whom later became distinguished contributors to their discipline. When the program ended in 1966, about 50 people had received training support; by 1979, 15 of the 50 were department chairs. Also of importance were the Macy-sponsored conferences, at which new directions for reproductive science were presented, discussed, and refined. It is estimated that between 1955–1970 the Macy Foundation allocated $6. 4 million to the development of academic OB/GYN research.4 Its heavy involvement in OB/GYN came to an end with a change in leadership within the foundation. 5

Another foundation that formerly made important contributions but that has today diminished its involvement is the Andrew W. Mellon Foundation. Beginning in 1977, the foundation attacked the problem of world population growth through research aimed at contraceptive development. It helped support talented investigators entering the reproductive sciences and brought a number of young molecular biologists into the field. Major grants were awarded to 17 reproductive biology centers, supporting the development of more than 200 young M.D. and Ph.D. investigators and untenured faculty. A 1986 review of the program noted that Mellon funds were particularly valued by departments because of their flexibility—the money could be used to support individuals at crucial early phases of their careers, to bring into the centers people of various backgrounds to create multidisciplinary research teams, or to undertake areas of contraceptive investigation that NIH could not fund. 6 These young investigators were starting to make important contributions to the field when the decision was made in 1989 to wind down the program. It is currently funded at $1 million per year, down from the former level of $2.5 million.

In 1980, the Mellon Foundation also started providing reproductive research project grants, often to institutions with Mellon reproductive biology center grants. Roughly $1.2 million per year was allocated to these grants, which were discontinued in 1989. It is estimated that between 1977 and 1988 the Mellon Foundation contributed a total of $27.5 million to reproductive biology, including support of young investigators. 7 Reasons for the reduction in Mellon support of the field of reproductive research are complex, but interviews with foundation staff indicate that contributing factors include a sense that few of the investigators who were supported have continued working in areas related to contraceptive development and that the project money was an add-on to NIH funds for work similar to NIH-supported research. In general, the foundation concluded that its greater strength lay in the humanities rather than in the biomedical field, a view reinforced by new leadership at the foundation. Moreover, discussions between scientists and foundation staff did not yield a focus that closely matched the foundation's goals, so it decided to transfer funds to applied research and other areas in the population research field. 8

Islands of strength in OB/GYN research and leadership exist today in part because of the efforts of these foundations. They invested in OB/GYN research and the development of research personnel, and the flexibility of that money was particularly valuable as an adjunct to more regulated government support. The withdraw of the support that was so important in developing OB/GYN research leaders has generated fears that, as the generation of leaders whose development was assisted by the foundation programs approaches retirement, a vacuum in research leadership will become apparent. Whether it was within the power of those in OB/GYN to persuade the foundations to maintain their investment in reproductive sciences is uncertain. To some extent foundation policies are driven by external events, and to some extent by factors internal to the foundations such as a change in leadership. Moreover, foundations choose priority areas in many different ways: through internal priorities, personal contacts, and advisory committees. 9 Some foundations seek underfunded areas in which their support can make a difference, which may today represent an opportunity for OB/GYN.

In addition to awards specifically for reproductive sciences or to support individuals trained in OB/GYN, which have suffered a major decline in number and in level of funding, foundations today offer awards for which eligibility is less constrained and for which young OB/GYN investigators may be eligible. For example, the Searle Scholars Program awards three-year grants of $180,000 to individuals in the first or second year of their first appointments as assistant professors. The idea is to identify promising investigators at an early and crucial stage in their careers. Since its inception in 1980, the program has made 191 awards—mainly to basic science investigators, according to the program director, who notes that the selection committee seeks evidence of a departmental commitment to the candidate. This, he believes, is more often found for basic than for clinical scientists. Other foundations that give substantial awards to young biomedical investigators in many fields include the Lucille P. Markey Charitable Trust, which supports 16 individuals per year, and the David and Lucille Packard Foundation and the Pew Charitable Trusts, each of which supports 20 individuals per year. 10

Other Private-Sector Training Support

Today, much private-sector support of OB/GYN training comes from industry, although OB/GYN professional associations and their foundations also contribute. ACOG has identified a total of 14 awards currently being made by the private sector, including some substantial fellowships:

The James Kennedy Fellowship Award of the American Association of Obstetricians and Gynecologists Foundation (the funding arm of the American Gynecological and Obstetrical Society) provides $40,000 per year for two years for fellows and requires a $15,000-per-year institutional commitment. This postdoctoral award targets individuals who need research training to move toward an investigative career. The program began in 1984 and had awarded a total of 17 fellowships by July 1990. Thirteen of these fellows attended a retreat in June 1990 at which an impressive summation of their research activities was presented. 11
The Berlex Foundation offers one or two scholarships per year with a stipend of $50,000 plus $10,000 for laboratory support for an individual who already has a record of independent research.
ACOG has joined with Ortho Pharmaceutical Corporation to provide two $30,000 fellowships annually, to be awarded to an ACOG fellow or junior fellow identified as progressing toward academic OB/GYN. The award is meant to allow the recipient to undertake an investigative project and basic research training.
There are in addition a number of smaller professional association/industry grants that provide start-up funds for research projects, as well as some monies for training support. 12

It is estimated that approximately six to eight physician/scientists are being trained annually in these major programs supported by the private sector. 13

Many of these programs have their roots in assessments from inside the discipline that academic research needs enhancement and that a vitalized research effort would upgrade the status of OB/GYN. 14 The initiatives have resulted in a small but significant body of awards to further the development of investigators. The future magnitude of professional and industry support of OB/GYN research training will depend on a continuing sense in the discipline that an enhanced research capability would benefit it generally, both in terms of the status of academic OB/GYN and in the quality of clinical practice.

Voluntary Health Agencies

Voluntary health agencies—often founded by the friends and families of individuals with a particular disease—sometimes use their funds for disease-related research and training. They can make important contributions to the careers of scientists by supporting fellowships, initial research, and other career development awards. Voluntary health agencies do not, however, usually make long-term commitments to research. 15 OB/GYN departments are well positioned to tap into the resources available from these agencies since OB/GYN interests overlap to some extent with the interests of three of the largest—the American Cancer Society, the March of Dimes-Birth Defects Foundation, and the National Easter Seal Society. Data on the level of OB/GYN funding by such voluntary health agencies are not available; however, each of the three agencies mentioned above was included in lists of sources of support received by the committee from chairs of departments of OB/GYN.

FINDINGS: The committee found cause for alarm in the diminution of foundation support for the development of OB/GYN research personnel and for OB/GYN research. Foundations played a vital role in preparing many of the current leaders of the field, and without this support there may not be enough well-prepared individuals to step into leadership positions when the current generation reaches retirement age. Today only approximately 11 young investigators each year benefit from major private-sector training awards, including those supported by the joint public/private Reproductive Scientist Development Program but excluding those who are awarded other NIH training support. Increasing the number of available awards by at least another six would return significant benefits to OB/GYN research.

RECOMMENDATIONS: OB/GYN leaders should take the initiative in demonstrating to foundation and voluntary health agency trustees and other representatives, to leaders of professional associations, and to relevant foundations of industrial corporations, ways in which expanded support of training for OB/GYN investigators would be a worthwhile investment. The purpose of such investments would be to ensure that sufficient research personnel are available to allow OB/GYN to fulfill its promise of improving women's health, contraception, and pregnancy outcomes. The committee encourages foundations to develop programs for OB/GYN, such as the former Josiah Macy, Jr. Foundation program, the current Searle Scholars Program, or other foundation efforts that can be regarded as models with characteristics that may be worth emulating.

OB/GYN leaders should seek additional research support from the types of organizations mentioned above. The promise of the research, together with a willingness to adapt research programs to correspond to foundation priorities, will provide powerful arguments that have a chance of salvaging some lost foundation support. By the same token, decision makers in foundations that are concerned with the development of scientific personnel—or with population problems, women's health, cancer, pregnancy outcomes, and other topics that OB/GYN is well positioned to address—should be aware of the role that their support of training and research could play at this crucial time in the development of OB/GYN research.

The committee also recommends that the American College of Obstetricians and Gynecologists and the Association of Professors of Gynecology and Obstetrics continue to include in their manpower survey questions on sources of research support received by departments of OB/GYN. This information will for the first time allow tracking of the level of research activity in departments of OB/GYN.

Federal Support

A 1980 report on the status of academic obstetrics noted that ''federal funding of research in academic departments of obstetrics and gynecology in the United States has never been substantial, and the situation is not different today.'' 16 That sentiment might be echoed in 1992.

The discussion below focuses on NIH support of departments of OB/GYN. * Other federal agencies also contribute, but their support is difficult to identify and is not thought to be sizable. 17 A survey of departments of OB/GYN in 1990 revealed a total of $77.5 million in federal research funds. 18 NIH data indicate that, of this amount, $45.7 million (59 percent) came from NIH, and there are reasons to believe that the NIH contribution exceeds 59 percent. (For example, the figure omits awards that flow to academic departments but that are awarded to other entities, such as hospitals.) Staff at federal agencies outside of NIH agree that their funding of research in departments of OB/GYN is limited. In 1989, the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) provided $1.6 million in research funds.

Trends in NIH Support of Departments of OB/GYN

NIH funds flowing to departments of OB/GYN increased from $6.9 million in 1968 to $16.1 million m 1978 and to $45.7 million in 1990 (this latter figure represents a slight decline from the $46.5 million awarded in 1989). In constant dollars, however, the increase over the 1968–1989 period was 74 percent; it was 43 percent between 1978 and 1989 ( Figure 2-1 ). Since the average amount of money per award increased over time, the number of awards has not grown at the same rate as dollar support. Thus between 1980 and 1989, the dollars going to departments of OB/GYN more than doubled, while the number of awards increased by less than 5 percent, more closely reflecting the real-dollar increase.

NIH support of departments of OB/GYN, current and constant (1968) dollars SOURCE: Special tabulation by NIH.

Departments of OB/GYN very slightly increased their share of the overall NIH budget. Their share of the NIH funds going to departments of medical schools has remained virtually unchanged. During the 1980s the NIH budget increased by 150 percent, while OB/GYN departments gained 190 percent. OB/GYN departments maintained their share of NIH medical school support at 1.4 to 1.5 percent between 1968 and 1989, although they received less than might be expected on the basis of faculty size: 3.8 percent of all medical school faculty are in departments of OB/GYN, but they were awarded only 1.5 percent of the NIH funds going to medical schools.

An important element in the extent of support, at any given time, of specific areas of science or of specific disciplines relates to the fortunes of the NIH institute that provides the funds. Because public and congressional perceptions of the importance of the health or science issues undertaken by each institute have varied over time, budget appropriations for individual institutes do not always parallel overall NIH budget growth.

Historically, the National Institute of Child Health and Human Development (NICHD) has been the major NIH supporter of departments or OB/GYN, providing between 55 percent and 70 percent of NIH support since 1968. NICHD has received approximately 6 percent of total NIH funds since 1978, and departments of OB/GYN have increased their share of NICHD funds from 5.4 percent in 1978 to 7.5 percent in 1989.

The National Cancer Institute (NCI) has been the second largest NIH supporter of OB/GYN departments. However, the NCI contribution fell from 31 percent of total NIH funds going to departments of OB/GYN in 1978 to 9 percent ($4.6 million) in 1989. Although NCI's share of the total NIH appropriation has itself fallen substantially, NCI is still by far the largest institute, accounting for more than 20 percent of NIH's 1989 funds.

NIH offers many types of research and research training awards. Research grants absorb the largest proportion of NIH funds, a proportion that has risen from 77 percent of total NIH support awarded in 1980 to 84 percent in 1989. Awards to departments of OB/GYN followed a similar trend: research grants increased from 90 percent to 92 percent of OB/GYN awards over the same period. The largest component of this group of awards is the category of investigator-initiated awards (RO1s). Also included in the group of awards are First Independent Research Support and Transition (FIRST) and New Investigator Research awards, both of which can be pivotal support for young investigators; Research Program Project grants; and research center grants, which play a role in solidifying the research efforts of a department and ensuring the presence of a new generation of investigators. NIH also supports research training at both the pre- and postdoctoral levels. This aspect of NIH activities has experienced a relative decline, falling from 6.6 percent of the NIH extramural budget in 1980 to 4.3 percent in 1989. Again, the trend for departments of OB/GYN is similar, with training support falling from 3 percent of NIH support of departments of OB/GYN in 1980 to 1.3 percent in 1989.

In sum, departments of OB/GYN have made a very small gain in terms of share of NIH resources, but the funds they receive remain an extremely small component not only of the NIH budget as a whole—which is to be expected—but also of the budget of NICHD, the institute that has the mandate to improve reproductive health. Closer examination of the data causes a greater sense of alarm about how OB/GYN departments are faring. The following sections take such a look, viewing the state of NIH support of departments of OB/GYN from three perspectives: the types of awards applied for and received by departments of OB/GYN, the academic degrees of investigators, and how OB/GYN departments compare with some other clinical departments.

Competition for NIH Funds

To assess how OB/GYN departments are doing in gaining NIH support, the committee compared their applications with applications from departments of internal medicine, pediatrics, surgery, and radiology. Departments of internal medicine were chosen for this purpose because they are the largest of all the clinical departments and are widely considered to be leaders in research capabilities. Pediatric departments were selected because pediatrics is a major focus of interest for NICHD; thus those departments share with OB/GYN some dependence on that institute. Surgery was chosen because it shares a technical orientation with OB/GYN—a characteristic that is also thought to affect the likelihood of success in NIH funding. Finally, departments of radiology were chosen because they are similar to OB/GYN in research intensity as measured by the percentage of faculty who are principal investigators (PIs) on NIH and ADAMHA grants. Although radiology faculty are more numerous than OB/GYN faculty, the two departments are nevertheless closer in size than the other departments chosen. Internal medicine had nearly six times as many full-time faculty as OB/GYN in 1988, while pediatrics and surgery had more than twice as many. Other departments or subspecialties might provide more appropriate comparisons, but data problems prohibited analysis.

All Competing Applications

In the decade 1980–1989, the five clinical departments submitted a total of 46,148 competing applications to NIH ( Table 2-1 ). Fifty-nine percent were submitted from departments of internal medicine (which have 44 percent of the full-time faculty in the five departments), 15 percent by departments of pediatrics (with 19 percent of faculty), 13 percent by departments of surgery (with 17 percent of faculty), 7 percent by departments of radiology (with 13 percent of faculty) and 6 percent by departments of OB/GYN (with 7 percent of faculty). Thus departments of internal medicine submitted a disproportionately large number of applications in relation to faculty size; OB/GYN, pediatrics, and surgery submitted a roughly proportional number; and radiology was slightly underrepresented. However, on a per capita basis, physicians in departments of OB/GYN submitted fewer applications than M.D.s from three of the other four departments ( Table 2-2 ).

TABLE 2-1. Success Rates of Competing Applications Submitted to NIH by Departments of Obstetrics and Gynecology, Internal Medicine, Pediatrics, Radiology, and Surgery, 1980–1989.

Success Rates of Competing Applications Submitted to NIH by Departments of Obstetrics and Gynecology, Internal Medicine, Pediatrics, Radiology, and Surgery, 1980–1989.

Per Capita Competing Applications Submitted to NIH by Selected Departments, 1989.

The success rate (percentage of applications funded) varied from 37.6 percent for internal medicine to 26.5 percent for OB/GYN. The differences in success rates among OB/GYN and the other departments, except for surgery, are statistically significant. The low relative success rate of OB/GYN departments became more acute toward the end of the decade.

Analysis by degree reveals that the success rate of applications from Ph.D.s in departments of OB/GYN was significantly lower than the success rates of Ph.D.s in departments of medicine and radiology. The differences in success rates for Ph.D.s among departments of OB/GYN, pediatrics, and surgery were not significant; indeed, OB/GYN departments, with a 28.2 success rate, were not far off the average of 31.7 for all five departments. However, in the latter years of the decade, the success rate of Ph.D.s in OB/GYN departments fell below that of the other departments.

Applications submitted by M.D.s from departments of OB/GYN fared significantly worse than those from any of the comparison departments. Compared with an average success rate of 36.3 percent for the five departments, OB/GYN's 24.2 percent success rate was significantly lower than each of the other four departments, including surgery, which was the next lowest at 30.1 percent. Thus it is apparent that the major portion of the weakness observed in the overall success rate of departments of OB/GYN is attributable to applications from M.D.s.

But success rates only tell part of the story. To win awards, applications must be submitted, and physicians in departments of OB/GYN submit relatively small numbers of applications per capita.

Investigator-Initiated Research

The RO1 grant is the heart of the NIH extramural program. It is the traditional award for investigator-initiated research and in 1989 represented almost two-thirds of all NIH research grants.

The pattern observed above for all awards is repeated for RO1s: Ph.D.s from departments of OB/GYN have better success rates than their M.D. colleagues; M.D.s in departments of OB/GYN have a significantly lower success rate than each of the comparison departments. Thus research proposals from M.D.s in particular, and to a lesser extent from Ph.D.s in departments of OB/GYN, are relatively unsuccessful in the competition for the important RO I research grants.

There are distinctive differences among the five departments in the proportion of RO1s submitted by M.D.s, despite similar proportions of M.D.s and Ph.D.s on their faculties. During the 1980s, almost two-thirds of RO1 applications from internal medicine and pediatrics came from M.D.s; for surgery, roughly one-half were from M.D.s, for OB/GYN, one-third, and for radiology, one-quarter. Thus access to RO1 funds for departments of OB/GYN was enhanced by the number of submissions from the more successful basic scientists.

Beginning Research Awards

NIH offers research grants that are designed to help beginning researchers move from trainee status to independence. These First Independent Research Support and Transition (FIRST) awards support an investigator's initial independent effort and help in the transition to attaining an RO1. Departments of OB/GYN submitted few applications—a total of 165—for FIRST awards between 1980 and 1989; only 51 of the applications were from M.D.s. Since the success rate was significantly worse than that of each of the comparison departments, OB/GYN also received only a small number of FIRST awards—29 in total, 4 for M.D.s. Only radiology had a similarly low number of applications.

FIRST awards are small—for five years, with no more than $350,000 in total—but they help the investigator who must prove his or her worth before winning traditional types of NIH support. * The poor showing of departments of OB/GYN in general and of their M.D. applications in particular is disconcerting—the inability of M.D. investigators in departments of OB/GYN to win these awards may indicate weakness in younger es hers that bodes ill for the future. The low number of applications may indicate a lack of research interest in the younger generation that also has serious implications for the future.

NIH makes other awards that provide useful support for young investigators. For example, small grants (RO3s), often in the $20,000–$25,000 range, are well suited to investigators who are developing the preliminary data needed for an RO1 application. Between 1987 and 1989, departments of OB/GYN submitted seven applications for RO3s—four from M.D.s and three from Ph.D.s. One M.D. was awarded an RO3. Thus it appears that another award of potential, if limited, use is not receiving much attention from OB/GYN.

Research Training

NIH offers training support in two forms: fellowship awards to individuals and training grants to institutions, which then make awards of traineeships to individuals they select. Differences in success rates for these awards among the five comparison departments axe small and not statistically significant. Again, however, OB/GYN departments submit few applications and therefore win few awards. During the 1980s, OB/GYN submitted a total of 194 applications, 56 of them from physicians. This translated into only 84 awards, of which 24 went to physicians. Of the comparison departments, only radiology had comparably small numbers. Research training is the precursor of careers in investigation, and the paucity of awards does not bode well for future OB/GYN research manpower.

Career Development

NIH offers several types of career development awards to support the training of scientists with clear potential who require additional training to reach independence. Some of these awards are for physicians only, some target individuals at particular stages of their development, and others target specific areas of work. The total number of investigators winning career development awards has not changed much over the past decade; however, there has been a shift away from Ph.D.s. toward M.D.s through an expansion of clinical investigator awards, which provide opportunities for medical scientists who will pursue research in areas of interest to the awarding institute. In addition, there axe two new programs for physician/scientists: one provides individual support and the other offers an institutional award for newly trained physicians to train in multidisciplinary programs.

As with research training awards, departments of OB/GYN, between 1980 and 1989, experienced success rates for career development awards similar to the rates of the four comparison departments. But, like radiology, OB/GYN submitted few applications; thus only 21 career development awards (18 to physicians) went to departments of OB/GYN during the decade. However, the number of individuals whose training has been supported exceeds the number of awards because the Reproductive Scientist Development Program (RSDP), previously called the Reproductive Scientist Training Program, which takes in three physician trainees each year, is counted as one award.

The RSDP was developed in response to a perceived shortage of OB/GYNs with research expertise. Designed to give outstanding clinically trained individuals the basic research training in cell and molecular biology that would allow them to become competitive for research grants, the award was modeled after one developed in pediatrics. An individual is eligible for an RSDP award after completing residency training or a clinical fellowship. An awardee enters a laboratory to work with an outstanding mentor and to learn basic science skills, as well as to participate in research. This phase of the training program was originally expected to last two years; however, some trainees have requested and received support for a third year in the laboratory. Following the years of basic research, trainees spend three years as junior faculty members in the department of OB/GYN that originally sponsored them, with a guarantee of at least 75 percent time spent in research under a preceptor. The RSDP is funded by NIH and by $25,000 per year each from the American College of Obstetricians and Gynecologists, the American Fertility Society, the American Gynecological and Obstetrical Society, the Association of Professors of Gynecology and Obstetrics, Ethicon Incorporated, and GynoPharma Incorporated.

The first three trainees entered the RSDP in 1988 and presented their work in 1990 at a meeting of the Society for Gynecologic Investigation. The quality of the trainees is impressive, and the number of outstanding candidates has grown each year. Many members of the OB/GYN community believe that the RSDP represents the most hopeful endeavor for training new investigators that the discipline has seen for many years.

Although NIH data do not document the number of physicians in departments of OB/GYN who received research training and career development support from NIH in the past decade, according to one estimate the total for the decade is only 50 people. 19

During the past year NICHD has changed the terms under which it grants the Clinical Investigator Award, an award for physicians who have completed clinical training and have had between three and seven years of postdoctoral training. Providing salary support of up to $50,000 per year, plus $10,000 for supplies, the award is designed to help an investigator work on a defined problem under the auspices of a sponsor and to assist in the investigator's transition to independence. 20 Previously NICHD granted the Clinical Investigator Award for only three years; now up to five years of support may be awarded. This extension can make a significant difference for young investigators struggling to prepare themselves to compete on their own for grant support.

The ability to adapt awards to respond to changing needs or other circumstances is a strength of the NIH system. Thus, for example, the Physician Investigator Award was established in response to a perceived need to enhance the supply of physicians engaged in research. This year the National Heart, Lung, and Blood Institute initiated a new award to replace its Physician Scientist and Clinical Investigator awards. The change was made ''to allow greater flexibility in developing a program suited to the experience and capabilities of the candidate." Thus the holder of the award may integrate research and subspecialty clinical training, interrupt the grant to continue clinical training, or develop a program that is suited to his or her level of research experience. 21 The ability of NIH institutes to creatively tailor awards to try to accomplish specific outcomes, not only for career development awards but also for training and research grants, should not be underestimated.

"Umbrella" Grants

These multiproject grants include research centers, such as the General Clinical Research Centers (GCRCs) and Specialized Centers, as well as Program Project Grants. They involve large numbers of researchers, are often targeted to interdisciplinary areas of work, and can support both core and ancillary activities such as animal facilities, epidemiology units, or hospital beds used for the research—depending on the type of award. They provide funding mechanisms for the development of junior staff, for specialized research nurses and dieticians, and for research facilities for inpatient and outpatient studies. Many have laboratories with advanced technologies. 22 GCRCs are valued for the resource brought together that facilitate clinical research for investigators and subjects.

"Umbrella" grants are sometimes initiated when NIH—often at the behest of Congress—makes an announcement of the research area in which an institute wants to fund a center; generally NIH staff work closely with the applicant institution's staff during the development of applications. Once granted, the award is closely monitored by NIH staff. In general, these grants are awarded to institutions that have a proven track record in research (most of the investigators on center grants are also RO1 awardees) and are therefore thought to be able to sustain these large-scale efforts.

There is tension between the level of funding for RO1s and the number of centers funded by NIH, partly because the funding of one decreases the funding of the other. On the other hand, academic departments value the flexibility of center grants; investigators between RO1s may be supported on such grants; interdisciplinary synergy between basic and clinical scientists is easier to generate; and center funds usually prove to be more stable, longer term support than other types of NIH funds. There are also differences between center grants and RO1s in terms of the work that can be accomplished. One observer noted that more clinical, innovative, and risky research is accomplished with center grants. In particular, research requiring three to four years to obtain data is more likely to be undertaken in the more stable context of a research center. Finally, the prestige attached to having a center can be used to stimulate contributions from nonfederal sources and to attract distinguished scientists to the departments.

Several awards of this umbrella type that pertain to OB/GYN research topics have been made. An example is the Specialized Centers (P50) awards for perinatal research centers, which include centers that focus on, for example, diabetes and pregnancy or premature labor. The Pregnancy and Perinatology Branch of NICHD supports six current P50 grants, of which two axe m departments of OB/GYN and four in departments of pediatrics. Other awards axe Research Project Cooperative Agreements, under which a maternal fetal medicine unit network and a neonatal intensive care unit network are supported. These networks were established in response to the notion that much obstetric and neonatal clinical management were not based on strong evidence of efficacy; groups were asked to design clinical trials to compare various clinical management approaches.

Departments of OB/GYN have fared differently depending on the type of umbrella grant they sought. The number of Program Project Grants awarded by NIH has increased over the past decade, but OB/GYN departments have not shared in this expansion. OB/GYN departments submitted only 28 Program Project Grant applications during the decade (one-quarter the number submitted by radiology, the department with the next fewest number of applications) and were awarded 13 grants. However, of the 33 applications for research center grants that were submitted by OB/GYN departments, 24 gained awards, for a success rate of nearly 72 percent—the highest among the five comparison departments. The high success rate for these awards (compared with many other NIH awards) is partly due to the understanding of departments that it is futile to apply unless a critical mass of investigation is already being conducted, and partly due to the consultation that takes place between NIH staff and applicants before the application is submitted.

FINDINGS: The committee finds cause for acute concern about the research capabilities of physicians in departments of OB/GYN. Ph.D.s in departments of OB/GYN who apply for NIH funding have success rates comparable to the rates of Ph.D.s from some other clinical departments, but the submissions from physicians in departments of OB/GYN are sparse and fare poorly in the competition for NIH funds. In response to this weakness, the committee focused its recommendations on ways of developing and strengthening physician investigators in departments of OB/GYN, enabling them to compete more successfully for NIH funds in the future.

RECOMMENDATIONS: NICHD program staff should exercise to the fullest extent possible their ability to target training support to expand the number of research training opportunities for physicians in OB/GYN.

Chairs of departments of OB/GYN should work with NIH staff to improve the success rate of applicants for FIRST awards. FIRST awards are particularly useful mechanisms in this regard, since their average length exceeds that of RO1s and applicants under 36 years of age have the best success rate.

The committee believes that survival of the Reproductive Scientist Development Program is essential for the future health of OB/GYN research. Professional groups and the private-sector organizations that support the Reproductive Scientist Development Program should ensure its stability through a long-term commitment of resources. Because of the importance of the program NICHD should continue support of the Reproductive Scientist Development Program.

The committee also recommends that NICHD tailor another career development award to OB/GYN physicians. This award should be flexible in terms of the type of training it provides and the timing of training, as is the Clinical Investigator Development Award of the National Heart, Lung, and Blood Institute. And because the supply of research manpower in OB/GYN is of great concern, the committee also recommends that NIH develop a system to track OB/GYNs who are receiving federal training and career development support.

Structural Characteristics of Departments of OB/GYN

Data on the relative success of departments of OB/GYN in competing for NIH funds are one indicator of a possible problem in their research capabilities.

A different set of indicators pertains to the departments themselves: how they differ from other clinical departments, the relative intensiveness of their research efforts, the composition of the departments in terms of the academic degrees of faculty members, and theft ability to provide a healthy research environment.

Overview of Faculty in Clinical Departments of Medical Schools

The number of faculty members in the clinical departments of U.S. medical schools grew by 69.5 percent between 1978 and 1989, from almost 29,000 to a little over 49,000 (see Table 2-3 ). However, not all departments shared equally in this expansion. Departments of internal medicine led the way with a growth rate of 86.1 percent, widening the gap in size between internal medicine and all other clinical departments. At the other end of the spectrum are the departments of physical medicine, which are small (only 561, or 1 percent of clinical faculty members in 1989) and which experienced a relatively meager growth of 24.4 percent between 1978 and 1989. Departments of OB/GYN are relatively small and slow-growing: their 1989 total faculty size of 2,383 * was below the 3,167 average and represented only 5 percent of total clinical faculty. Theft growth of 58.3 percent between 1978–1989 was below the 69.5 percent average.

Change in Number of Faculty Members in Clinical Department, 1978–1989.

Composition of Faculty by Degree

The principal factors driving faculty size are teaching load and clinical duties—research is usually secondary. The number of Ph.D.s in a department is considered an indicator, albeit an imperfect one, of research activity. In 1986, Herman and Singer remarked that ''the major efforts of clinical investigation have moved from the bedside, where patient contact and research were closely linked, toward the basic science laboratory and its emphasis on cell culture, enzyme systems, and animal models." This, they posited, accounted for the growth in the number of full-time Ph.D. faculty appointments in clinical departments—up from 3,500 in 1972 to 5,900 in 1982. The authors suggested that Ph.D.s may have been recruited to compensate for the failure of M.D.s to maintain their share of the total research effort. 23

Table 2-4 shows changes in the type of degree held by faculty of clinical departments between 1978 and 1989. The proportion of faculty with the Ph.D. or M.D./Ph.D. degree grew from 18.1 percent to 21.2 percent; because of substantial overall growth in faculty, this translates into significant numerical growth—from 3,859 in 1978 to 10,436 in 1989. There is wide variation in the presence of Ph.D.s and M.D./Ph.D.s in clinical departments, from only 13 percent of anesthesiology faculty to 45 percent of departments of public health. OB/GYN departments, with faculty rosters that are 14.3 percent Ph.D. and 5.4 percent M.D./Ph.D., were not far off the average for clinical departments of 15.7 percent and 5.5 percent, respectively. Departments of OB/GYN are close to the average clinical department in both the direction of change and the makeup of their faculty. Therefore, to the extent that the presence of faculty with basic science degrees indicates that departments are structured to undertake research, departments of OB/GYN are positioned to compete in the research arena.

Change in Degrees of Full-Time Faculty, 1978 and 1989, as Percentage of Department Faculty.

Age and Gender Composition of Faculties

A body of empirical work, mainly pertaining to nonphysician scientists, suggests that there is at least a weak relationship between age and research productivity, as measured by publications. 24 The best available data on physician investigators come from a 1980 survey by the Association of American Medical Colleges (AAMC), which queried physician faculty listed in its Faculty Roster System. The data were analyzed to determine variations in time spent in research and in numbers of publications as they relate to age. 25 These data indicate that research productivity as measured by time spent in research does not peak at the same time as productivity measured by volume of publications. By both measures the latest peaks are at about 45 years of age.

Analysis of 1988 data from the AAMC Faculty Roster System ( Table 2-5 ) indicates that the age distribution of physicians in departments of OB/GYN is similar to that of all physician clinical faculty. Indeed, the age distribution of the physician faculty of each of the five clinical departments analyzed is remarkably similar, suggesting that any differences in the research productivity of departments are not due to the age of physician faculty.

Age Distribution of Physician Faculty (as Percentage of Departmental Faculty) of Selected Clinical Departments.

The relationship between gender and research activity is also unclear. Over the past decade, extensive note has been taken of the underrepresentation of women in the scientific work force and of differences in career trajectories for women in science compared with men. 26 Women scientists in general publish roughly 50 percent fewer papers than male scientists of the same age, and differences in publication rates increase with age. 27 This study, however, is concerned with academic scientists in general, and with physicians in particular—a segment of the scientific work force about which only a little is known.

During medical school, differences between men and women in their interest in research are slight. One study revealed that in 1987, the only activity during medical school in which men participated more than women was the authorship of published research—24 percent of men and 19 percent of women. 28 Women lag only slightly in expressing an interest in having research as part of their career—of 1989 graduating medical students, 23.6 percent of the men and 21.2 percent of the women intended to take a research fellowship; 16.1 percent of the men and 13.5 percent of the women expected to be significantly involved in research. 29 Evidently the discrepancies between men and women in this area appear after medical school.

Data on the advancement of women in academic medicine indicate that they have increased their representation in medical school faculty—from 13 percent in 1967 to 21 percent in 1990—and that female medical school graduates are more likely than their male equivalents to join medical school faculties. However, women advance more slowly through the faculty ranks: of the cohort of people who became faculty members in 1976, 25 percent of the men and 19 percent of the women were tenured or on a tenure track in 1987; 12 percent of the men were professors, as opposed to only 3 percent of the women. 30

Clearly something is halting the progress of women through the academic ranks. One possibility is that, to the extent that academic advancement is based on research productivity, women are not equalling men. An analysis of internal medicine faculty members—the only available analysis of gender difference—indicated that in 1982 and 1983, 19 percent of men and 29 percent of women reported no research involvement; women were also less likely than men to have outside research funding and assigned research space. 31 Moreover, 16 percent of the men and 29 percent of the women had not had research training, and 44 percent of the men and 55 percent of the women had not been the first author of an original article. 32

However, a 1989 survey of physicians by the American Medical Association does not substantiate the notion of lesser research involvement by women: 2.8 percent of both male and female physicians in 1989 reported research as a major professional activity. 33 Similarly, women who complete research training and apply for RO1 grants from NIH appear to be almost as accomplished as the men. Since 1980 women have averaged slightly poorer priority scores than men, but the difference in any one year was only from one to eight points, and in 1990 men and women had comparable success rates. 34 On balance, however, the weight of the evidence suggests that women in science are generally less involved in research than are men (reasons for this axe discussed later in this report).

Table 2-6 substantiates the finding that women are clustered in lower level faculty positions. More importantly for this study, departments of OB/GYN have a substantially higher representation of women (23.7 percent) * than the average clinical department (19.6 percent). The only departments with a higher proportion of women faculty than OB/GYN are pediatrics, public health, and physical medicine; the proportion of women faculty in family medicine is similar to that of OB/GYN. In addition, nearly 55 percent of instructors in departments of OB/GYN are women; thus the future ranks of senior faculty will be pulled from a pool in which women axe in the majority. ** The gender distribution in departments of OB/GYN is not likely to contribute in a major way to the current competitive weakness in OB/GYN research identified earlier in this chapter. However, this characteristic of OB/GYN departments suggests that attention to the needs of women seeking research careers would be an investment with a substantial return.

TABLE 2-6. Distribution of Medical School Faculty (as percentage of faculty at each level that are women) in Clinical Departments by Gender and Rank, 1989.

Distribution of Medical School Faculty (as percentage of faculty at each level that are women) in Clinical Departments by Gender and Rank, 1989.

Research Intensiveness

How much time do faculty members spend doing research.

A more direct indicator of the research strength of a department is the time faculty members spend in research activities. Unfortunately, data that would allow comparisons among clinical departments are sparse. AAMC collects data on the activities of medical faculty, but only activities that consume more than 10 percent of a faculty member's time and without distinguishing between activities that consume, for example, 11 percent or 90 percent of time.

In 1983, to gain a better picture of medical faculty involvement in research, the Association of Professors of Medicine, in cooperation with AAMC, asked full-time faculty members in departments of internal medicine what percentage of time they spent in research. * In 1990, ACOG, at the request of this committee, added to its academic manpower survey a question asking whether faculty members spent 20 percent or more of their time in research. The results revealed that 34.5 percent of physician faculty (M.D. and M.D./Ph.D.) spent at least 20 percent of their time in research in 1990, compared with 45 percent of M.D. and 67 percent of M.D./Ph.D. internal medicine faculty, as recorded in the AAMC data for 1983. Ph.D. faculty in both internal medicine and OB/GYN departments are more involved in research than their M.D. colleagues6—90 percent of the internal medicine Ph.D faculty and 92 percent of the OB/GYN Ph.D. faculty spend at least 20 percent of theft time in research. 35 , 36 Data from these two sources are not strictly comparable because of differences in sources of information and time of data collection and the difference between a specialty oriented toward surgical procedures and one oriented toward medicine. Nevertheless, the disparity between the two departments in research activity of physicians is suggestive. Departments of internal medicine, acknowledged leaders in research activity among clinical departments, appear to engage their physician faculty more heavily in research, which also reflects their relatively high success rate in competing for NIH funds (see above). The lesser involvement of OB/GYN in se h may also support the notion, current among OB/GYN leaders, that OB/GYN faculty maintain unusually large clinical practices.

Which Clinical Departments Are Research Intensive?

The final characteristic examined here that may bear on the research capabilities of departments is the percentage of full-time faculty who are principal investigators on NIH or ADAMHA awards. This indicator functions as a proxy measure for the research intensity of departments. A 1988 AAMC study ranked departments of OB/GYN eleventh out of 17 clinical departments, with 9.8 percent of faculty as PIs, compared with an average of 14 percent for all clinical departments.

Ophthalmology ranked first with 36.5 percent; family medicine was at the low end with 1.2 percent ( Table 2-7 ).

Ranking of Clinical Departments by Percentage of Full-Time Faculty Who Are PIs on NIH/ADAMHA Awards (1988).

As might be expected, research involvement varies by degree—11.1 percent of M.D.s, 24.3 percent of M.D./Ph.D.s, and 26.9 percent of Ph.D.s are PIs. Thus, M.D./Ph.D.s are generally more like Ph.D.s in their involvement in research. However, this generalization does not hold for OB/GYN. Both M.D. and M.D./Ph.D. faculty in departments of OB/GYN are below the average for clinical departments in the proportion of faculty that are Pis. On the other hand, Ph.D.s in departments of OB/GYN rank sixth of the 17 departments in the proportion that are PIs (32.2 percent) and are well above the 26.9 percent average. 37 Clearly, to the extent that these data measure research intensity, departments of OB/GYN are among the less research-intensive departments, and their relative weakness in research capabilities can be attributed to the performance of their physicians. *

The research intensiveness of specialties can be analyzed on a different axis—the proportion of departments with significant outside research funding. There are two sources of data on this topic. The 1990 ACOG manpower survey revealed that only 9 of the nation's 136 academic departments of OB/GYN received more than $2 million in federal research funds. At the other end of the spectrum, 38 departments had no federal funds, and this number is larger for other sources of research funding. 38

Data from NIH also indicate that research funding is clustered in a small number of departments. Between 1980 and 1989, approximately 70 departments of OB/GYN per year were recipients of NIH support. However, 10 departments received approximately 50 percent of the funds, and in 1989 only 4 departments had more than ten awards, while 15 had only one award. This concentration of funds in a small number of departments is somewhat more acute than generally occurs for NIH funds going to medical schools, where 20 schools received 50 percent of NIH funds in 1989. 39

These indicators of research intensity suggest a weakness in departments of OB/GYN compared with other clinical departments, both in terms of the proportion of faculty that are PIs and in the concentration of research activity in a small number of departments. The existence of a critical mass of investigators is thought to be necessary to provide an environment in which science can thrive, and in which new investigators can be trained and exposed to role models in an atmosphere of scientific endeavor. These findings suggest that only a small number of departments of OB/GYN support a vital research effort or provide the necessary environment for the generation of new investigators.

FINDING: Data pertinent to the present as well as the future research capabilities of OB/GYN departments indicate weakness. Time devoted to research by physicians is low, the proportion of faculty who are full-time investigators on NIH or ADAMHA grants is below average, and the number of departments with sizable research funding is small. The latter point indicates the small number of departments able to provide a suitable environment for training investigators. The strong and growing presence of women indicates that attention to differences among men and women in recruitment and retention in research will be important to the future health of the OB/GYN research enterprise. The committee's recommendations on these topics are found later in this report.

A Research Agenda for Departments of OB/GYN

The research agenda (which is fully discussed in Chapter 6 ) provides a different sort of evidence of the need for expanded research efforts in OB/GYN, because it identifies areas of investigation likely to repay investment with improvements in the reproductive health of women and in the results of pregnancy. * To ensure that the research agenda fulfills its purposes, the following criteria were applied:

The research should contribute to the resolution of an important health problem . Importance can be defined in terms of high prevalence or incidence of a problem, in terms of the serious effect of the problem on individuals who experience it, or in terms of impact on the health care system where the costs of caring for the problem are incurred.
The research approach should be promising . That is to say, there is reason to think that following the selected avenue of investigation would provide solutions or that answering the question posed by the research is an essential step in finding a solution.
The research should be done in a department of OB/GYN or in collaboration with members of such departments . The mere fact that patients with OB/GYN should be a necessary element. Lack of interest by other specialties the problem are seen in OB/GYN departments is not sufficient justification. Rather, OB/GYN must be the discipline with the knowledge or skill needed to accomplish the research. If the research is interdisciplinary, would also be sufficient justification, since the work would not be accomplished if OB/GYN did not undertake it.

The committee followed several steps n developing the research agenda:

A letter was written to the chair of every U.S. and Canadian academic department of OB/GYN, asking for an opinion on priority areas for future research. Letters were also sent to leading OB/GYN professional associations. All committee members received copies of the replies, as well as a summary of the contents.
A subgroup of the committee met to develop an initial list of research agenda topics, which was then reviewed, discussed, and revised by the full committee.
Taking into consideration the criteria listed above, committee members allocated priorities to each item on the research agenda, and items that received low priority scores were eliminated from the list.
Experts were asked to contribute background papers reviewing the current state of knowledge and identifying useful research approaches (see Appendix C for authors of background papers).
Using the background papers and their own expertise, committee members developed a research agenda. Readers are referred to Chapter 6 for the agenda, which covers the following topics:
-Oocyte and follicular development in the ovary, including follicular formation; follicular atresia; follicular recruitment, selection, and dominance; corpus luteum function; and leukocytes, cytokines, and ovarian function.
-Fertilization.
-Fetal growth and development including embryology and congenital malformations; fetal growth and placental transport; congenital infection and substance abuse; perinatal research; and epidemiological research.
-Preterm labor including preterm, premature rupture of the fetal membranes, complications of pregnancy that compromise fetal or maternal well-being independent of the onset of labor, preterm onset of labor, and preterm labor and infection.
-Contraception including contraceptive implants, contraceptive rings, transdermal delivery, intrauterine devices (IUDs), oral conception, barrier methods, male contraception, antifertility vaccines, and medical abortifacients.
-Infertility including epidemiology, cervical physiology and function, fallopian tube function, endometriosis, male infertility, and in vitro fertilization and new reproductive technologies.
-Premenstrual syndrome.
-The brain and reproduction.
-Menopause.
-Oncology including ovarian cancer, uterine neoplasms, cervical cancers, vulvar malignancies, breast cancer, and trophoblastic disease.
-Sexually transmitted diseases including preventing sexually transmitted diseases by developing clinically effective and safe vaccines: developing cost-effective tests for early diagnosis of STDs; developing new therapies where needed and new cost-effective antibiotics that are easily administered and sufficiently acceptable to maximize compliance; clarifying the natural history of genital infections; defining behaviors associated with the acquisition and spread of STDs; and characterizing the role of STDs in adverse pregnancy outcomes.

From its review of the evidence in this chapter, the committee concluded that there is cause for concern about both the current and the future state of research in departments of OB/GYN. While it is appropriate that many departments of OB/GYN have, and preserve, a clinical focus, it is important to expand the number of departments that can succeed in the competitive research arena. In that way the committee's research agenda can be accomplished, and departments of OB/GYN can fulfill their potential for improving the health of women. The committee concluded that the highest priority is to build physician research manpower so that more departments of OB/GYN can successfully compete for, and effectively use, increased research support. The committee therefore focused its recommendations on ways of recruiting and sustaining OB/GYNs in investigative careers and on developing research capabilities in departments that, with some additional help, have the potential to equal the first-rank research departments of OB/GYN. Recommendations are found earlier in this chapter and in subsequent chapters of this report.

No one entity bears the responsibility for this effort; rather, players to implement the committee's recommendations are to be found at NIH, in the departments of OB/GYN, in other loci in the medical schools, in foundations, and, importantly, in the profession of OB/GYN itself from which must flow the leadership that is a prerequisite to the development of a strong research community in OB/GYN.

The term population research is not synonymous with the research activities appropriate to departments of OB/GYN. In the following discussion it is defined as "studies of the nature, determinants, and consequences of population characteristics and dynamics and the development of basic data and methods for such population analysis. Physical, biological, psychological, cultural, social, economic, geographic, historical and political factors may all be included in population studies" (U.S. Department of Health and Human Services, National Institutes of Health, Public Health Service, Inventory and Analysis of Federal Population Research, Fiscal Year 1988 , Washington, D.C., 1990). Many population research projects are conducted in departments other than OB/GYN. Moreover, OB/GYN departments receive research support from foundations that are not included in the inventory. Nevertheless, this inventory is the best available indicator of trends in foundation support for the areas of science undertaken by departments of OB/GYN.

The Population Council was a major grant-giving organization in the 1950s and early 1960s. There tier it became mainly a research organization funded by foundations, NIH, and other government agencies in the same way that other research organizations and universities are funded.

The following discussion of the NIH role is, unless noted otherwise, based on a background paper by Robert A. Walkington, which is published as Appendix B of this report and to which the reader is referred for additional information. The data for this paper were extracted from the NIH data systems specifically for this study.

The level of support on an NIH FIRST award does not fully cover the salary of a physician/investigator, nor does it cover the total cost of the research. The department chair must therefore make a significant additional investment of departmental funds in the investigator.

According to a survey conducted by ACOG, there were a total of 2,952 full-time faculty members in departments of OB/GYN in July 1990. This survey of all OB/GYN departments has been repeated at intervals since 1977. It documents an increase in faculty of 90 percent since 1977 and 22 percent between 1986 and 1990—a higher rate of growth than that shown by data from the Association of American Medical Colleges (AAMC) discussed in the text. The committee used AAMC data in this section because they allow comparison with other departments.

ACOG survey data note that 29 percent of OB/GYN faculty are women. Again, the committee uses AAMC data since they allow comparisons with other departments.

The pattern of NIH funding of women also indicates their increasing future role in research. Women hold about 18 percent of RO1 funds, 28 percent of FIRST awards, and 31 percent of NIH training grant funds (National Institutes of Health, Women in NIH Extramural Grant Program. Fiscal Years 1981 to 1990 , Division of Research Grams, Bethesda, Md., 1991).

That study defined the following as active researchers: individuals who spend at least 20 percent of their time in research, who have authored or co-authored an original article or other significant research publication, and who have either external funding or assigned research space.

It should, however, be remembered that although NIH and ADAMHA are major sources of research funding, they are not the only sources. Data indicating the relative ability of departments to gamer other research support are not available, but departments of OB/GYN are thought to have relatively good access to pharmaceutical company research funds

The research agenda developed by the committee does not stress the social, health care, and other cost savings that would be generated by research that eliminates or diminishes some of the problems listed. For instance, the high hospital costs of caring for low birthweight babies are only the tip of the iceberg of expenditures incurred as a result of the long-term morbidity and disability that are frequent sequelae.

Cite this Page Institute of Medicine (US) Committee on Research Capabilities of Academic Departments of Obstetrics and Gynecology; Townsend J, editor. Strengthening Research in Academic OB/GYN Departments. Washington (DC): National Academies Press (US); 1992. 2, Is There a Problem?
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A reflection on current obstetrics and gynaecology research in India

Juan f pacheco-páramo, jon cornwall.

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Dr. Juan F. Pacheco-Páramo Cra 21 No. 128D-45, Bogota, Columbia Zip Code 110121 Email: [email protected]

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Collection date 2013.

Introduction

Obstetrics and gynaecology, including topics such as contraception, antenatal care, and maternal and neonatal health, are an important part of medical practice. In recent years there have been many studies examining aspects of this healthcare sector in India. This editorial examines some of the recently published research from this field, and country, with the aim of highlighting the existence and variety of the investigations that have been published on this topic. It is hoped that the review of these works will allow researchers and clinicians in all countries to reflect on the value of parochial research that can focus healthcare intervention on areas that necessitate further promotion or examination.

Contraception

Attitudes and knowledge of both Indian medical staff and the general public to contraception have been reported in recent years. Rahaman and colleagues 1 concluded in their study of attitudes among Indian nursing staff that knowledge of Emergency Contraception (EC) appears to be inadequate, reflecting other research from different countries around the world. One hundred and thirty-one nursing staff participated in the survey, although 19 nurses (14 per cent) had never heard of EC and were thus excluded from the study. Research on adolescent Indian girls’ knowledge about contraception has also been shown to be poor;2 even though overall knowledge about contraceptive method was only 40.76 per cent, only 65.4 per cent were interested in acquiring further knowledge while the remainder had the belief that this type of education will increase adverse sexual practice. In other studies about contraceptive practices in India, Prateek and Saurabh 3 found that there is a great difference between the knowledge and actual use of contraceptives in married women in reproductive age: 52.4 per cent of women knew about contraceptive practices, but only 32.2 per cent of them were using any contraceptive method. Jain and Muralidhar 4 concluded that the preferred contraceptive practice is female sterilisation. In regard to the practice of sterilisation, Srividya and Kumar 5 performed a crosssectional study on 399 women prior to tubectomy and found that most women (73.9 per cent) had not previously used any kind of contraception.

Teenage pregnancy

In an investigation of teenage pregnancy in India, Parasuramalu et al. 6 reported that most teenage mothers seen in primary health centres were married before the legal age of 18 years. In a four month hospital-based cohort study, Banerjee et al. 7 found that 24.2 per cent of pregnancies correspond to teenage pregnancies, and that this group had a greater prevalence of anaemia, preterm delivery and low birth weight than the control group (women of 20-24 years old).

Infant delivery

Unnikrishnan and colleagues 8 reported on Caesarean section (CS) rates in coastal South India. Their paper begins with the observation that there is a rising rate of CS in modern obstetric practice, and goes on to report a CS rate of 23.3 per cent for 2009 as compared to 20.2 per cent in 2005 with the major indication for this being previous CS. The authors considered this a vicious cycle that can only be stopped by reviewing the indications for CS. The reports of increasing rates of CS have also been described in other publications: reports indicate a trend in recent years for an increase from 10 per cent in the year 2000 to 15-25 per cent in 2006 outside India in Malaysia, 9 while Kambo et al. 10 described the rates for CS in India ranging from 24.4 per cent in medical colleges and teaching hospitals to 47 per cent in private sector hospitals. Saha et al. 11 compared deliveries in 2007 with those in 2008 under a new strategy protocol for CS in a tertiary facility care centre, finding an incidence in the retrospective group of 29 per cent and in the prospective group of 18.4 per cent, providing a possible solution to halt the increasing CS prevalence, and determining a necessity to undertake further multicentric clinical trials to examine possible interventions for the increasing trend in CS.

Maternal health

In India, anaemia is the second most common cause of maternal death, accounting for 20 per cent of total maternal deaths. Ezzati et al. 12 established the prevalence of iron deficency anaemia between 33-89 per cent and the National Family Health Survey (2005-2006) and reported the incidence of anaemia in pregnancy in India is 54.6 per cent in urban centres and 59 per cent in rural areas. One particular study aimed to determine the prevalence of anaemia and to explore factors associated with anaemia in one rural Indian pregnant population from Maharashtra, 13 finding that of the 310 subjects who were enrolled, 232 (74.8 per cent) were found to be anaemic. The majority (50.9 per cent) demonstrated moderate anaemia while mild and severe anaemia were recorded in 70 (30.2 per cent) and 44 (18.9 per cent) respectively. A highly significant association was found with the mother‘s age, educational and socio-economic status, religion, parity and body mass index. As normocytic hypochromic and microcytic hypochromic blood pictures were predominant in this study, it indicates deficient iron intake/absorption irrespective of age, type of family, caste, religion or number of children as the prevalence was equally high in all groups in this population. A very high prevalence of anaemia (74.8 per cent) early in pregnancy is an indicator of the failure of national and the WHO is facilitating programmes to address this problem.

Anaemia during pregnancy can be alleviated, however, by iron supplementation - though until recently there was a paucity of up-to-date research investigating the level of adherence for such supplementation in distinct Indian populations. Bilimale et al. 14 examined the adherence to iron supplementation during pregnancy in a rural population. Remarkably all aspects of the diet were considered inadequate in the study population. Forty to fifty per cent of women remained anaemic throughout the study regardless of the study group to which they had been allocated in the randomised trial. Interestingly, those who received the simple intervention of being observed taking their medication were more likely to be compliant with iron supplementation.

The management of patients with common complications of pregnancy received attention from Roy et al. 15 in their review of treatment with magnesium sulphate compared to phenytoin in eclampsia. In a randomised trial 80 women with eclampsia were randomised to receive either magnesium sulphate or phenytoin. The time taken for return to consciousness was significantly earlier and patients delivered sooner in the phenytoin group compared to those in the magnesium sulphate group, suggesting that phenytoin is better than magnesium sulphate in the bedturnover rate of eclampsia patients from the labour room eclampsia-turret to the post-partum ward. The authors conclude that in low and middle income countries, where there is a high incidence of eclampsia and labour rooms are overflowing with such critical patients, the concept of having earlier delivery, decreased number of Caesarean deliveries, increased bed turn-over (from the eclampsia turret to the labour ward), and lower cost of therapy with phenytoin appear to have practical implications. According to Arora et al. 16 pre-eclampsia and eclampsia are present in 4.6 per cent of all deliveries, with a neonatal mortality rate of 43 per 1000 live births in India. A retrospective study from Guin et al. 17 analysed all maternal deaths between January 2001 and December 2009, dividing data in two phases: before and after the implementation of the Janani Suraksha Yojana, which is a financial incentive to all women delivering in government hospitals. The first phase ran from 2001 to 2005 and the second phase between 2006 and 2009. In the first phase, eclampsia and pre-eclampsia were responsible for 31.4 per cent of the 172 maternal deaths, and in the second phase both accounted for 41.3 per cent of the 341 maternal deaths. Further to this research, and in an attempt to provide information on a suitable intervention for eclampsia, Chaturvedi et al. 18 examined the availability and use of magnesium sulphate for the treatment of eclampsia in the public health system in Maharashtra, India. They found that private care providers used magnesium sulphate in eclampsia, while the public care providers did not routinely use of it because of a fear of complications.

Infectious diseases in antenatal care has also been examined and reported on. Once such study aimed to investigate the incidence of infectious disease was the focus of a report from rural Maharashtra. 19 Kwatra et al. 19 reported a retrospective analysis of data on the utilisation of Integrated Counselling and Training Centre (ICTC) services by pregnant women at a tertiary care hospital. From over 12,000 pregnant women attending the antenatal clinic, 10,491 (82.5 per cent) accepted pre-test counselling and HIV testing. One hundred and forty-five women were found to be seropositive with a seroprevalence rate of 1.4 per cent; 11 per cent did not come for collection of the laboratory report and missed the post-test counselling. Most of the seropositive women were from rural areas, had low socioeconomic status, did not have a formal education, and were unaware of their serostatus and their husband’s risk behaviour. Less than one in three women were using some form of contraception. After registration, the majority of seropositive women (89.7 per cent) attended the antenatal clinic regularly; 11 per cent opted for pregnancy termination; 76 per cent delivered vaginally and 12 per cent underwent CS. A further 86 per cent of women and 80 per cent of newborns received Nevirapine prophylaxis; postnatal follow-up of babies was very limited. Results indicated that HIV seroprevalence among the pregnant population is declining steadily, and the authors were encouraged that a growing proportion of women are attending the facilities of ICTC centres. Other research has found that the seroprevalence of HIV was 0.41, 0.63, 0.67 and 0.76 per cent in 2004, 2005, 2006 and 2007 respectively in a tertiary care centre. 20

Rare pregnancy

Rare obstetric cases have also been topical in the research literature in recent years. Case reports on the rare and potentially life-threatening ovarian pregnancy were reported by Roy and Sinha Babu. 21 This form of pregnancy is a rare event constituting one to three per cent of all ectopic pregnancies, with primary ovarian pregnancy having a better outcome than secondary ovarian or tubal ectopic pregnancy. This study reinforced the position that a high index of suspicion is required for diagnosis to avoid a crisis situation in the ward or operation theatre. Two cases of ovarian pregnancy – one primary and one secondary – were reported as having occurred in the same patient within a six-month period. The authors concluded that unlike tubal ectopic and secondary ovarian pregnancies, patients with primary ovarian pregnancy are likely to experience success in future intra-uterine conception and negligible risk.

Other types of pregnancy have also come under scrutiny. A prospective study by Mahji et al. 22 analysed 180 cases of ectopic pregnancy between 2002-2004, and during this period the incidence of this pathology was one in 161 (0.6 per cent). The risk factors for ectopic pregnancy include infections (pelvic inflammatory disease, Chlamydia trachomatis ), tubal surgery, smoking, induced conception cycle and endometriosis. The incidence is higher in women who had received ovulation induction. 23

Neonatal health

Bhardwaj and colleagues reported on a rare case of neonatal varicella, 24 where the mother had skin lesions at the time of delivery and the neonate contracted the disease during the perinatal period and developed clinical disease on day five post-partum. Specific anti-viral therapy was given to the mother and the baby and the recovery was uneventful. Neonatal varicella can be a consequence of maternal varicella during the last three weeks of pregnancy, and if it occurs near term or soon after delivery can be potentially fatal. 25 In an investigation to determine rates of neonatal varicella incidence in India, Tarang and Anupam 26 reported one case of neonatal varicella from 44 neonates with vesicobullous lesions in Departments of Dermatology and Paediatrics in the Muzaffarnagar Medical College and Hospital between 2008-2009. Although the incidence of this disease is seemingly low, these cases do serve to remind clinicians of its presence in India.

Deformities at birth have also received attention in research publications. Pandy et al. 27 described a case of abdominothoracopagus twins with single heart. The male twins were delivered in the 15th week of gestation following the desire of the parents to terminate pregnancy. This case was considered of particular interest because of the rarity of the abdomino-thoracopagus male twins with a single heart. Other cases include reports from Asaranti et al. 28 who described an autopsy of conjoined twins who shared heart, liver and part of digestive system, and the report of Fishman et al. 29 who describe the separation of thoracopagus conjoined twins with a single heart, and Gerlis et al. 30 who made a review of 36 pairs of conjoined twins, one being a case of single heart.

Conclusions

Research on the topic of obstetric and gynaecology practice in India is seemingly in good health. Recent investigations demonstrate a wide range of topics that include research into contraception attitudes and the importance of antenatal care to rare obstetric cases. Maternal morbidity and mortality, data on Caesarean section prevalence, the prevalence of neonatal disease, adherence of treatment in the case of anaemia, and the treatment in eclampsia are also prevalent. Perhaps of interest and importance is that investigations include both rural and urban populations, providing a balanced perspective from which to explore trends in obstetric and gynaecological care and intervention in India. Given the recent volume of such articles, it is perhaps worth considering how this research can be used to facilitate change in the medical practice in India to affects health outcomes. By reflecting on this, and perhaps taking the results of the research back to the populations of interest, the research will become truly translational - from bedside, to bench top, to bedside once more - and provide the ability for India to facilitate ongoing improvements in obstetric and gynaecological healthcare in India.

PEER REVIEW

Commissioned. Externally peer reviewed

CONFLICTS OF INTEREST

John Cornwall is the Deputy Editor of the AMJ.

Please cite this paper as: Pachecho-Paramo JF, Cornwall J. A reflection on current obstetrics and gynaecology research in India. AMJ 2013, 6, 12, 708-712. http//dx.doi.org/10.4066/AMJ.2013.1953

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student name problem statement guide name 1. abhishek ameta "a study to asses the effectiveness of an information booklet on knowledge of staff nurses regarding baby friendly hospital initiative with a view to develop an information booklet in selected hospitals at udaipur". mr.deepak.b.v. obstetrics & gynecology nursing 1 anuradha vaishnav
(PDF) PROBLEM STATEMENT: "A Study to evaluate the ...
Primary postpartum haemorrhage is the bleeding from or into the genital tract or more than 500ml within 24 hours of child birth, 500ml is an arbitrary figure; the effect of bleeding depends upon ...
RESEARCH STATEMENTS UNDER MUHS UNIVERSITY FROM YEAR 2008
M.Sc. in Obstetrics & Gynaecological Nursing 1 A Study to assess the Knowledge and Practices of Partograph during labour among midwives in selected primary health centers from sangli District. 2 Assess the effect of an Planned Teaching on Legal and Ethical aspects related to Obstetrics Nursing among staff Nurses working in Government Hospitals in
PDF Kind Attestation14th Batch Student's Sub: Problem Statement have been
OBG (N) A study to assess the need, with a view to develop and evaluate the effectiveness of an intervention program on Respectful Maternity Care in terms of knowledge, attitude and practices of nurses and peri-natal care experiences of mothers in selected hospitals of Delhi NCR. 8 Ms.Sivapriya.S Prof (Dr) Sudha A Raddi Dean, Nursing Faculty
Obstetric and Gynecological Nursing Research Paper Topics
The diverse range of obstetric and gynecological nursing research paper topics provides an opportunity for researchers to explore a variety of issues that affect women's health. By conducting research in this field, nurses can contribute to the body of knowledge that informs clinical practice and helps improve outcomes for women and newborns.
Scientific Paper: Dissertation Topic in Obg Nursing
Problem statement on obstetric nursing 1. ... Please dear can you give any information for online guidence in research presentation on OBG. Delete. Replies. Reply. Unknown November 20, 2021 at 12:02 AM. ... Dissertation writing is a interesting topic which includes deep study and research. A nursing statement is easy to write if you take help ...
Problem Statement
Problem Statement. A problem statement identifies the gap between the current situation and the desired outcome, highlighting why the problem matters. It is typically included in research proposals, project plans, or academic theses, guiding the scope and purpose of the study. For example: In a study on online education, the problem statement ...
Is There a Problem?
The previous chapter noted perceived difficulties in supporting research and in training research personnel in obstetrics and gynecology (OB/GYN). This chapter moves from perception to more solid ground by examining objective indicators to establish whether a problem exists. There are three ways to answer the question. The first measure is the level of external support for research and ...
How to Write a Problem Statement
A problem statement looks different depending on whether you're dealing with a practical, real-world problem or a theoretical issue. Regardless, all problem statements follow a similar process. Note Generative AI tools like ChatGPT can be useful at various stages of the writing and research process and can help you to formulate your research ...
A reflection on current obstetrics and gynaecology research in India
A very high prevalence of anaemia (74.8 per cent) early in pregnancy is an indicator of the failure of national and the WHO is facilitating programmes to address this problem. Anaemia during pregnancy can be alleviated, however, by iron supplementation - though until recently there was a paucity of up-to-date research investigating the level of ...

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Problem Statement – Writing Guide, Examples and Types

Problem Statement

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Elements of a Problem Statement

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2. Understand the Context

3. Define the Impact

4. Propose the Ideal Solution

5. Keep It Concise and Clear

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A reflection on current obstetrics and gynaecology research in India

Introduction

Contraception

Teenage pregnancy

Infant delivery

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Rare pregnancy

Neonatal health

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