Ulf Ulmsten Lecture: When Care Becomes Advocacy

Ulf Ulmsten Lecture: When Care Becomes Advocacy

Leon N. Plowright, MD, FACOG, FACS, URPS

Assistant Professor, University of Florida College of Medicine – Jacksonville

Moderators: Anna Rosamilia (Australia)

Speaker: Ranee Thakar (United Kingdom)

This year’s Ulf Ulmsten Lecture was delivered by Dr. Ranee Thakar (United Kingdom), Past President of IUGA and recently completed President of the Royal College of Obstetricians and Gynaecologists. The honor recognizes not only her seminal work in the prevention and management of obstetric anal sphincter injuries (OASIS), but also her broader efforts to position pelvic health as a global women’s health priority. It was a lecture rooted equally in science, leadership, and humanity.

She opened with the story of a patient she could not forget—a woman who apologized throughout the consultation: for her incontinence, for her bowel symptoms, for crying, and even for taking up time. The condition itself, Dr. Thakar reflected, was only part of the suffering. The deeper wound was the silence, stigma, and normalization surrounding it. It was a powerful reminder that many women live with pelvic floor disorders for years before seeking help, often believing their symptoms are simply part of life. That silence is far from rare. Dr. Thakar highlighted the staggering global burden of pelvic floor dysfunction, affecting nearly one in two women worldwide, and emphasized the inequities that shape who is heard and who is dismissed. A recent BJOG study underscored this reality: nearly 70% of women reported their symptoms had been minimized during obstetric and gynecologic encounters, while feeling heard emerged as the strongest predictor of patient satisfaction. Her message was simple and profound: listening costs nothing.

The lecture then shifted toward action. Dr. Thakar challenged clinicians to normalize and destigmatize pelvic health through community education, meet women on the platforms they actually use, build multidisciplinary services centered around women rather than institutions, and prioritize outcomes that matter to women—function, dignity, and quality of life. She highlighted the FIGO white paper led by Dr. Aparna Hegde challenging the traditional 6-week postpartum paradigm as an example of evidence-based advocacy in action.

One of the most memorable lines of the lecture was this: “The standard you walk past is the standard you accept.”

Dr. Thakar brought the lecture full circle through her own professional journey—from her clinical work in OASIS, to her IUGA presidency and creation of the IUGA Patient Advisory Council, to her leadership at RCOG and direct engagement with UK health policymakers. She paid tribute to her mentors, Drs. Paul Riss and Stuart Stanton, and with characteristic humor acknowledged her husband, Dr. Abdul Sultan, joking that after receiving the IUGA Lifetime Achievement Award the day before, he perhaps deserved “a lifetime achievement award for living with me.”

Her closing words anchored the lecture in its most enduring truth: “Advocacy begins the moment a woman feels safe enough to tell the truth—and the moment we decide her suffering is not acceptable."

It was a lecture that reminded us that advocacy does not begin in policy documents or parliaments. It begins in the clinic, in the quiet space where women entrust us with their stories—and where we decide whether or not to act.