Over the past two decades, Laos has made remarkable progress in improving maternal health outcomes, achieving one of the fastest reductions in maternal mortality globally. Thanks to investments in midwifery training, free universal maternal services, and strengthened national health strategies, Laos has reduced maternal deaths by over 80% since 2000. Despite this progress, challenges remain — particularly in reaching remote communities where access to skilled birth attendants and well-equipped facilities is still limited. As Laos continues to build on these gains, the country’s experience highlights the importance of community-based care and targeted support for equity in maternal health.

Professor Amanda Henry is a clinical academic and obstetrician based in Sydney, with a career dedicated to improving women’s health through both clinical care and research. She is the Program Head for Women’s Health at The George Institute for Global Health, Professor of Obstetrics in the Discipline of Women’s Health at the University of New South Wales, and practices as an obstetrician at St George Public Hospital in Sydney.

This year, Amanda was invited to speak at the Laos O&G Society Annual Congress. In this article, Amanda describes her experience in Laos, the insights she shared, and what she took away from her time at the Congress.

What inspired you to accept the invitation to speak at the Laos O&G Society Annual Congress this year?

Professor Donald Marsden, who for many years was a Sydney-based CGO (including during my FRANZCOG training at the Royal Hospital for Women), has been living and working in Laos for about 15 years and runs regular education for Laotian O&G trainees. Each year, to coincide with the Laos O&G society conference, he organises a special workshop at Setthathirath Hospital in the capital, Vientiane. In the days surrounding the Congress, trainees from across Laos gather for teaching from both local specialists and international visitors.

Over the last 15 years, many FRANZCOGs have made the trip to Laos for these events, including RANZCOG Past-President, Dr Rupert Sherwood, the late Dr Peter Scott, Associate Professor Richard Millard, and Dr Michael Campion. Donald first invited me a few years ago, but unfortunately that coincided with the emergence of the COVID-19 pandemic. So, when he and Dr Keokedthong Phongsavan, the current President of the Laos O&G Society, extended the invitation again this year, I was ready to take up the challenge!

What inspired me most was the opportunity to contribute at the pre-Congress workshops for trainees, and to hopefully pay forward some of the excellent teaching I’ve received over the years. It also aligned well with my current role as Program Head for Women’s Health at the George Institute for Global Health in Sydney—our program’s mission is to improve the health of millions of women and girls worldwide. I decided to use my learning and development allowance this year to attend. Plus, I’ve never been to Laos before and it was a great opportunity to experience a country that I knew very little about and gain more than a “tourist” or “casual conference goer” perspective.

Professor Amanda Henry and Dr Keokedthong Phongsava

O&G Trainees and Faculty

What were some of the key themes or messages you wanted to share with the trainees and colleagues in Laos?

For the workshops one of the most important things was reinforcing the fundamental principles of pregnancy care – history-taking, examination, and core principles of diagnosis and management. These apply in any setting and support high-quality care, even when there are resource constraints.

For example, encouraging women to enter pregnancy care before 16 weeks, taking a thorough history and checking blood pressure can help identify a significant proportion of those at risk of preterm preeclampsia. Even without access to full multi-modal screening, initiating preventative strategies such as aspirin, calcium and exercise can make a meaningful difference.

“Doing the basics and promoting first trimester care and then regular ongoing antenatal care means many issues can be picked up early and managed before they become a crisis — regardless of the setting.”

I also wanted to emphasise that “do a Caesarean” is not the answer to every medical complexity in pregnancy!
Another key message I shared, with both trainees and colleagues at the Congress, was the importance of considering long-term maternal health after pregnancy complications. In particular, the understanding that chronic diseases like cardiovascular disease and type 2 diabetes are much higher for women after hypertensive pregnancy and gestational diabetes. These women need ongoing follow-up and support to improve their health across the life course.

You led sessions on proactive care across pregnancy — from preconception to hypertensive disorders. How did the participants engage with this theme in a local context?

The participants engaged really well. Before I arrived, Donald was quite concerned that no one would ask questions— whether due to cultural sensitivities, concerns about saying the “wrong thing” or not wanting to challenge anything said by the “expert.” But in fact, I received a lot of thoughtful questions — especially about how to apply proactive care principles in the local context, where a particular test might not be available, or a certain treatment option might be located hours away.

What were some of the most insightful or surprising questions you received from trainees during the workshops?

We had a vigorous discussion about gestational diabetes and how to diagnose it. Some of the local specialists joined in, which was great. The conversation started with a question about how to approach cases where women can’t tolerate a glucose tolerant test (GTT), and then moved to the lack of consensus in Laos about diagnostic thresholds.

That gave me a chance to speak about the broader international uncertainty about what’s considered “correct” (The updated ADIPS guidelines hadn’t been published yet while I was there, but I knew they soon would be). I think it was quite challenging for some in terms of that lack of certainty. However, I think we all agreed that for each country or region to have a rationale to make the diagnosis and management decisions that they do, and then have consistency in those policies, was where we needed to get to.

What stood out to you most about the strengths or challenges within Laos’ maternity care system?

In terms of strengths, there is absolutely a determination to reduce Laos’s maternal mortality, which was nearly 600 per 100,000 in 2000 and had reduced to 126 per 100,000 as COVID arrived. While that’s still many times higher than Australia or Aotearoa New Zealand, it shows just how much progress is possible.

Challenges remain. There is still significant reliance on foreign money in healthcare. To the extent that hospitals are commonly referred to by their donor country (e.g. “the [X country] hospital”).

The healthcare landscape is a mix of public and private providers, with insufficient universal screening and care availability. Some challenges would sound quite familiar to those of us in Australia and Aotearoa New Zealand, such as disparities in care between cities and remote or regional areas.

Setthathirath Hospital, Vientiane, Laos

Could you share a moment or lesson that particularly stayed with you?

There wasn’t a single defining moment, but what really stayed with me were the various contrasts between what is available in Laos and what we often take for granted in Australia. For example, access to universal cervical screening programs is something we rarely stop to question, yet in many settings it simply doesn’t exist. That contrast really drove home how privileged we are.

How did your experience in Laos shape your views on global collaboration in women’s health?

My experience reinforced just how vital global collaboration in women’s health really is — especially in a time when so much funding for low- and middle-income countries has been, or is in the process of being withdrawn by the current US administration.

How do you see your experience in Laos influencing your future work in education or policy development?
It has certainly given me insights into the need to spend time in specific settings if you plan to undertake meaningful education, research or policy work in a particular country or region. Just as we see with culturally and linguistically diverse patients in Australia — where there are shared challenges, but also important differences depending on background — the same is true across low- and middle-income countries. There are common themes, but it is definitely not “one size fits all.”

“Nothing beats time on the ground and learning from the locals about what their needs are to help ensure that what you are contributing is both meaningful and lasting.”

If you had one message for Australian colleagues about international women’s health engagement, what would it be?

Contribute, with humility, where you can. High-quality women’s healthcare and standards are absolutely achievable in resource-constrained settings. Reinforce the positives and the capabilities of our global colleagues through education and collaboration.