20 September 2018

Africa: The Role of Family Planning in Preventing Mother-to-Child Transmission of HIV

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Women continue to bear a disproportionate burden of the HIV/AIDS epidemic, with women accounting for more than half of the number of people living with HIV/AIDs worldwide.  A 2013 UNAIDS report showed that an estimated 1.5 million women living with HIV gave birth to children, and 240,000 children worldwide acquire HIV yearly – the majority of whom contract the disease from their mothers during pregnancy, labor, delivery, or breastfeeding, and it is described by the terms “vertical transmission” or “mother-to-child transmission”.  A significant number of these children live in Sub-Saharan Africa.

Prevention of Mother to Child Transmission (PMTCT) are a set of interventions aimed at blocking transmission of HIV from an HIV-infected mother to her child during the period of pregnancy, labor, and breastfeeding.  One of the pillars of PMTCT is the prevention of unintended pregnancies among women living with HIV, which is quite important in ensuring that pregnancy is planned to prevent transmission of HIV to the fetus.  Positive pregnant women who do not undergo any PMTCT intervention have a 25-40% risk of passing on the infection to the child, whilst PMTCT interventions reduce this risk to zero.

While the terms mother-to-child transmission and vertical transmission are used interchangeably, there have been calls to drop the usage of the term “mother-to-child transmission” (MTCT) as it places the blame on the mother, which breeds stigma and scrutiny in circumstances in which newborns are found to be HIV-positive.  This is quite reasonable, but we must also understand that MTCT basically describes the process of transmission, and in counseling, using the term MTCT paints the picture better for the mother in understanding her role and what she can do to mitigate risk of transmission.

The ‘Test and Treat’ strategy which was widely launched last year recommends that all HIV-positive people are put on anti-Retroviral drugs as soon as they are diagnosed, with marked success.  Introduced prior to this was Option B+ which involved initiating all pregnant and breastfeeding women on anti-Retroviral for life, as this was found to be significant to ensuring that mother-to-child transmission of HIV is drastically reduced.

The impact of the Test and Treat strategy cannot be overemphasized, but it will be made more effective by an integrated approach to offering family planning for all women of reproductive age, and most especially, women already living with HIV.  There is a need to step up the efforts in meeting the unmet need for family planning in Sub-Saharan Africa, as this will greatly complement the efforts in preventing new infections in children.  Despite the fact that Sub-Saharan Africa has a high unmet need for family planning, an analysis done in the early 2000s suggested that contraceptive use in Sub-Saharan Africa prevented 22% (or 173,000) of HIV-positive births annually.  Another study determined that family planning can avert about 30% of HIV-positive births, as compared to HIV-testing and Nevirapine prophylaxis.

Evidence from different Sub-Saharan African countries showed an increased demand for Family Planning among HIV-positive women who recognize its benefits, but some challenges still exist for them to access their preferred methods.  These include misconceptions among health workers about safety of contraceptive usage by HIV-positive women, sole promotion of condom use, human resource and service delivery challenges, and a poor understanding of the nexus between family planning and prevention of mother-to-child transmission.

Tackling these challenges will include taking an integrative service approach to family planning and HIV prevention and management services, increasing the mix of contraceptives available, and educating health workers on the significance of family planning to prevent mother-to-child transmission of HIV.  This duty is not limited to PMTCT service providers alone, as commitments to meeting the global unmet need for family planning will also benefit women currently living with HIV.

To quote Rose Wilcher, et al: “Elimination of mother-to-child transmission is not just about how many women take drugs, but also preventing unintended pregnancies among women living with HIV. Voluntary family planning offers far-reaching individual and public health benefits and is essential to realizing the elimination goal”.

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