The atmosphere of maternity wards in hospitals has always intrigued me. Women have told me that keeping the extreme pain and discomfort of labour aside, giving birth to a baby is the most satisfying and fulfilling experience for any woman. I do not know about that yet but what I do know is that the prospect of nurturing another living creature inside your own body, or giving continuity to one’s lineage is considered highly in any society. However, pregnancy can be full of turmoil, tension and confusion for women with specific diseases or health conditions such as HIV. With World AIDS Day being observed all around the world, I think it is high time we start thinking more seriously about pregnancy with AIDS.
Deciding on whether to give birth is a woman’s right. If a woman living with HIV decides not to have a child, she can practice safe sex and prevent pregnancy. However, if a woman with HIV decides to get pregnant then a huge conflict is likely to occur between her right to give birth and the responsibility of protecting one’s baby as there are many issues to consider while making the tough decision.
First and foremost, the viral load of the woman is of major concern. Whether or not the woman is on Anti-Retroviral Treatment (ART) also affects the outcome of pregnancy. If she is already on ART, assessment should be done on whether the treatment combination should be continued, changed or stopped altogether, keeping in mind the health of the mother and the baby. If not on ART, assessment should be done on whether or not it should be started. This assessment should be done on a case by case basis.
In a country like Nepal, where a large proportion of girls and women are anaemic, nutritional status of the mother, which is directly related to her financial status, also plays a huge role in making decisions regarding pregnancy. If the woman is anaemic or has nutritional problems, it directly affects the nutritional support mechanism and might result in a baby with low birth weight or other nutritional deficiencies. In such a case, nutritional and economical rehabilitation and enrichment and supplementation should be done for which education and awareness plays a crucial role.
During pregnancy, appropriate care is very important to prevent transmission of virus from mother to child. The woman should have proper access to medical support as pregnancy is in itself a complicated state of health, which when coupled with HIV becomes extremely serious. Along with other health services, the woman should be properly oriented on possible complications and risks associated with pregnancy and childbirth. The counsellors and medical team should provide information both about normal and caesarean section delivery and let the woman decide on what she wants. Similarly, many scientific studies have shown that the chance of transmission of HIV through breast milk is highest during earlier lactation period. So, in presence of other safe alternatives, women should be advised not to breast-feed their babies.
Giving birth to a child and rearing and caring of the newborn becomes a lot easier in a supportive family environment. So, before deciding to give birth, a woman should also carefully analyze whether she has or can get support from her partner, family or society to take care of her and her baby during and after pregnancy. She should also consider who will take care of the baby in case she becomes sick or loses her life.
As informed and aware human beings, I think it is our responsibility to help each and every woman living with HIV to make the right decision on pregnancy by providing her right information and ensuring her access to health and other related services. After carefully considering all the aspects, in the end, it is for her to decide whether or not she wants to say ‘yes’ or ‘no’ to pregnancy.
Writer is National Focal Point from Nepal of Global Youth Coalition on HIV/AIDS
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Dear Vinita JI, I agree with you bringing a new born baby into this world is big decision and to top it if the Mother is HIV positive it means added brainstorming decision. I do agree that proper counselling is a must for them before taking this big step. Motherhood is a bliss but if the future of the child is at fix then it will become a curse.
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