In HIV Prevention, Protect the Mothers: A Message to the World Health Assembly 2012

It is critical that the barriers facing women in relation to accessing supportive peri-natal services are fully understood and addressed including structural drivers such as poverty, gender-based violence from partners, in-laws and neighbours, and property and inheritance rights loss. If we do not address these issues, we can not "save the babies."

This article is co-authored with Susan Paxton, Violeta Ross, and Sophie Dilmitis.

In the wake of a new “cupcake” campaign to “believe it, do it” from UNAIDS and in this week of the World Health Assembly meeting of all the world’s ministers of health in Geneva, Switzerland, we who are women living with HIV working professionally on gender, HIV and rights issues — all of which have also profoundly affected us personally — have some reflections. Medication is now available that can ensure all babies are born HIV-free. Women with HIV — more than anyone — want to ensure their babies are born free of HIV.  However, we are concerned that talking about “saving babies,” as this campaign does,  without putting equal emphasis on upholding women’s rights to safety and good health care is a short-term, unsustainable approach to the issue.

We know from longitudinal studies that the best way of keeping babies and children healthy during their first ten years is to ensure that their mothers are healthy along with them[1]. Happy healthy and safe women with HIV result in happy, healthy, and safe children.

Most women with HIV are now diagnosed in ante-natal clinics, often without pre-test counselling, a violation of their rights.[2] In many centers, women experience coerced testing as a pre-condition for ante-natal care, are separated from other women if their test result is HIV-positive, are blamed for getting pregnant, and may be coerced into abortion, hormonal contraception, or sterilization simply because they are HIV-positive and pregnant. A growing body of research indicates the high levels of gender-based violence experienced by women living with HIV upon diagnosis,[3] a a reality that is not being effectively addressed.

Arecent study of over 750 pregnant HIV-positive women in six Asian countries[4] found that woman known to be HIV-positive are often mistreated by health care staff. Many faced abuse and delayed treatment when attending ante-natal clinics, coerced abortion and sterilisation, and neglect and abandonment during delivery.

“When I went to the obstetrics department the staff were afraid of me and said, ‘How dare you have a baby’… The doctor gave me many reasons why I should not continue with the pregnancy.” (Kieu, Viet Nam)

“During the delivery the doctor wanted to put on two sets of gloves. He had put up on one set of gloves but the baby was already coming out and the doctor tried to push it back in so he could put on another set of gloves.” (Saru, Nepal)

Because of the fear of how they will be treated by health staff many pregnant HIV-positive women avoid ante-natal clinics and are then blamed as being irresponsible and jeopardizing their baby’s health. In many countries women are thrown out of their homes and lose their older children when it is found they have HIV; some women risk criminalization for HIV transmission to their child.

It is critical that the barriers facing women in relation to accessing supportive peri-natal services are fully understood and addressed including structural drivers such as poverty, gender-based violence from partners, in-laws and neighbours, and property and inheritance rights loss.

Abuse of women’s rights has a deeply damaging effect on women’s lives and a long-term negative impact on their children. How women with HIV are treated is critical to them and to their children’s health and well-being and long-term capacity to remain HIV-free.

Many programmes that are geared towards meeting targets of numbers of children born HIV-free do not address these major long term global challenges which women with HIV who are having babies face. Programs need to be holistic and sensitive. Simply testing women for HIV and then providing them with appropriate medication presents a “sticking plaster” approach and perpetuates existing attitudes that result in women with HIV continuing to experience abuse of their right to optimal health care.

The focus of publicity campaigns connected to mothers’ day in the US and elsewhere on keeping babies HIV-free is the “safe” option, the simple end of the messy real world that HIV inhabits, the saving the “innocent babes” approach, the importance of which no-one will dispute. However in the process it must not be forgotten that those who are potentially best placed to keep babies and children HIV-free are also those who most dearly wish to do so — their mothers — women with HIV.

As we look ahead to Rio and the Sustainable Development Goals, upholding women’s rights is at the core of sustainable long-term change. How do we create sustainable lasting rights-based change – for women and children? We trust that the Ministers of Health from around the world meeting in Geneva this week at the World Health Assembly will understand that your support for our advocacy work is essential, in order to move more effectively towards the world we all seek—a world which is safe for women with HIV and free of HIV for the next generation.

An army marches on its stomach. A nation makes advances through the fabric and health of its communities. It is women who weave and hold the fabric of all our communities together around the world. If we are ill, our nations are ill. If we are supported, our nations will be healthy. We also need support if and when we choose to have children and access to comprehensive health services. Support includes the full range of information about and access to all forms of contraception that are under women’s control; access to legal, safe abortion; full knowledge that if we wish to have a baby, we will feel safe to accept the voluntary and confidential offer of an HIV test – ideally before conception, and with a supportive partner being tested and counseled also, secure in the knowledge that if we learn that we have HIV it will make no difference to the care, respect and support we receive from all around us.

Dear Ministers, with your support, we can make a difference and create the HIV-free generation we all crave.

[1] Ronsmans C, Chowdhury ME, Dasgupta SK, et al. 2010. Effect of parent’s death on child survival in rural Bangladesh: a cohort study The Lancet, Volume 375, Issue 9730, Pages 2024-31
[2] UNAIDS/WHO Policy Statement on HIV Testing, June 2004
[3] ICW, 2011, East Africa Report.

Hale F, Vazquez M, 2011, Violence Against Women living with HIV: A background paper UNWomen, DCN, ICW

Salamander Trust, 2008, HIV, Women and Motherhood Audio Project,_Women_and_Motherhood_Audio_Project/

[4] APN+, 2012, “Positive and pregnant: How Dare You”