Population Council Research that makes a difference

Preventing unintended pregnancy among HIV-positive women through family planning (FP) services is one of the four cornerstones of a comprehensive program for preventing mother-to-child transmission (PMTCT) of HIV. Reducing unintended pregnancies among HIV-positive women through FP reduces the number of children potentially orphaned when parents die of AIDS-related illnesses. It also reduces HIV-positive women's vulnerability to morbidity and mortality related to pregnancy and lactation. The benefits of contraception for women on antiretroviral therapy (ART) include reduction in stress related to fear of unintended pregnancy; the avoidance of certain complications of pregnancy related to antiretrovirals such as anemia and insulin resistance; and access to a wider range of antiretrovirals, as some antiretrovirals cannot be used during pregnancy.

The government of South Africa, the private sector, and NGOs have tended to provide ART services in different ways at the health facilities they support. However, rates of unwanted pregnancy remain high, and many ART providers report that fertility intentions and the provision of contraception are not routinely discussed during ART consultations.

Women with HIV should be able to exercise their reproductive rights freely, whether they choose to plan a pregnancy, space their children’s births, or limit childbearing. If upon learning their status HIV-positive women do not express a desire for fertility control, promoting FP services requires careful attention to ensuring their informed choice. There should be access to termination of pregnancy in cases of unplanned pregnancy, care for survivors of sexual assault, and so forth.

A growing number of women who desire to delay or limit childbearing take advantage of the provided antiretroviral services. This creates an opportunity to offer FP to HIV-positive clients accessing antiretroviral or other HIV services at the ART sites.

Evidence from research completed mostly in developed countries indicates that pregnancy does not have an adverse effect on HIV disease progression. However, for a variety of reasons that are not entirely clear, HIV infection appears to place women who are pregnant at increased risk of complications and is regarded as an indirect cause of maternal death. Pregnancy makes the management of HIV care and ART more complex: drug regimens must be adapted and side effects carefully monitored. The WHO eligibility criteria for contraception aims to ensure an adequate margin of safety to protect women and men from the potential adverse effects of contraceptives, while ensuring that they are not denied suitable choices. It is therefore highly relevant to ensure that adequate FP services are provided to HIV-infected women.

The Population Council will provide technical and financial assistance to the North West Province Department of Health in conducting a baseline assessment of FP service provision at ART/Wellness and Down Referral sites, while simultaneously strengthening integrated FP/ART services, referrals from ART facilities to other sexual and reproductive health services, and links between communities and health services in order to facilitate access to services.