How Preventing HIV from Mother to Child is Also About Contraception

During the month of July 2012, two landmark gatherings advanced global progress in sexual and reproductive health. The Family Planning Summit was held in London on July 11. Co-hosted by the UK Government and the Bill & Melinda Gates Foundation, the Summit’s goal was to offer millions of vulnerable women around the world renewed hope that they will soon have the means to determine the timing and spacing of their pregnancies through access to modern family planning methods. Less than two weeks later, the AIDS 2012 Conference was held in Washington, D.C. Organized by the International AIDS Society, AIDS 2012 was a multitrack, week-long convention of 24,000 attendees, including heads of state, celebrities, philanthropists, researchers, activists and people living with HIV. Their optimistic vision is to attain an AIDS-free generation.

World Contraception Day offers an opportunity to advance both causes.

Use of effective contraception is essential to achieving family planning goals. However, enabling women to choose how many children to have and when to have them plays an important role in achieving HIV objectives as well. Whether to optimize healthy conception and delivery or to prevent unintended pregnancies, providing fertility counseling and effective contraception to women living with HIV is a powerful intervention for preventing mother-to-child transmission (PMTCT) of HIV.

According to an analysis of data from 25 countries with the largest numbers of HIV-positive pregnant women, approaching the global target of reducing new HIV infections in children by 90 percent will not be met without comprehensive programming that includes efforts to eliminate the current unmet need for family planning. Another analysis of DHS data found that 14 percent of women living with HIV in six African countries have an unmet need for family planning, even though they are in contact with the health system for their HIV care. While these data indicate that the contraceptive needs of women living with HIV are similar to those of women who do not have HIV, they also suggest that opportunities to support women living with HIV in avoiding unintended pregnancies are being missed.

Most attention and resources for PMTCT programs to date have gone toward providing antiretroviral prophylaxis to HIV-positive pregnant women. While this intervention represents a major public health achievement, enabling HIV-positive women to assert their pregnancy intentions and safely achieve them must also be elevated as a programmatic priority. A recent impact evaluation of the national PMTCT program in South Africa reported that perinatal transmission rates had dropped below 4 percent in the country – a success to be celebrated – but close to two-thirds of the pregnancies among HIV-positive women in the study were unplanned. Notably, the only statistically significant risk factor associated with mother-to-child transmission in the study was unplanned pregnancies.

Practical, evidence-based strategies are needed to better meet the contraceptive needs of women living with HIV. One strategy that has extensive policy support from global health and development policymakers and funders is to integrate family planning and HIV services. And, the Integration for Impact 2012 Conference held last week in Nairobi, Kenya, confirmed that family planning/HIV integration is also a growing priority for the ministries of health and implementing partners in many countries in sub-Saharan Africa. Data are emerging to indicate that a variety of HIV service settings can be effective entry points for reaching HIV-positive women and couples with family planning information and services. As this evidence grows, we must ensure that it is translated into widespread practice so that the public health promise that family planning/HIV integration holds is realized. We must also continue to refine our understanding of what drives the successful implementation of family planning/HIV integration at scale so that those practices can be replicated elsewhere.

World Contraceptive Day celebrates the contribution that the field of family planning can make to global sexual and reproductive health as well as broader development goals. By empowering women to decide when and how often to conceive, making effective contraception more accessible advances dual sexual health goals – preventing unintended pregnancies and maternal-to-child transmission of HIV – which, in turn, offers far-reaching health, social and economic benefits.

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