| Core Support
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An estimated 200 million women become
pregnant each year, of whom only about 1.8 million are
HIV positive. Thus, 99 per cent of pregnant women are
HIV negative. Even in countries where HIV prevalence
is high, many women are HIV negative.
In most developing countries, pregnancy
is the one time when women seek access to health services.
Thus, their contact with health services is an opportunity
to ensure that they remain healthy. By preventing HIV
infection in the mother in the first place, prevention
of transmission to her unborn child is assured.
However, women have the right to
remain free from STI/HIV infections not only because
they should not transmit infection to their babies but
for their own sake as individuals.
In the face of limited resources,
concentrating efforts on the majority – that is, on
uninfected women — has been the basic rationale for
UNFPA’s focus on pregnant women. UNFPA stresses the
importance of ensuring that pregnant women remain HIV
negative during pregnancy and delivery and while breastfeeding
The UNGASS Declaration of
Commitment on HIV/AIDS calls on all Governments to:
reduce the proportion of infants infected with HIV by 20 per cent, and
by 50 per cent by 2010, by ensuring that 80 per cent of
pregnant women accessing antenatal care have
information, counselling and other
HIV prevention services
available to them."
UNFPA collaborates with other UN
partners, notably UNICEF and WHO, to contribute to bringing
about a comprehensive programme for HIV prevention in
pregnant women, mothers, and their children to meet
the relevant UNGASS goals, but also in the context of
its mandate to promote safe motherhood and provide quality
maternal health care.
Risk factors that make pregnant
women more vulnerable to the acquisition of HIV include,
in certain social and economic settings, their difficulty
in obtaining control over their sexual relations, particularly
during pregnancy; the presence of STIs, often asymptomatic
in women, which increase their vulnerability to HIV
infection; limited access to antenatal services early
in pregnancy and the limitations of antenatal services
themselves, which sometimes provide little access to
voluntary counselling and testing (VCT) services or
even to basic screening for curable STIs; and limited
knowledge about or accessibility to commodities which
would permit them to adopt safer sexual practices, such
as the importance of barrier methods to protect pregnant
women, irrespective of their HIV status, from STIs and
from re-infection with HIV in HIV-positive pregnant
women. Early antenatal care is especially important
for young mothers.
UNFPA should consider appropriate
attention to prevent HIV infection in pregnant women.
Prevention should be integrated into reproductive health
programmes that aim at preventing unwanted pregnancies
through adequate family planning services, preventing
and managing STIs and providing maternal health. As
always, interventions should be designed within the
framework of maternal health and reproductive rights
of pregnant women.
Making comprehensive interventions
widely available depends upon the ability to influence
political will and policy formulation, to strengthen
human resources and infrastructures, and to mobilize
enough funds to implement an intervention package.
In this respect, UNFPA must provide
technical and policy support to strengthen, at the national
level, the capacity to plan, design and integrate STI/HIV-prevention
services for pregnant women into the existing reproductive
health services; advocate for support and the building
of partnerships among interested parties to ensure continued
attention to women’s needs, to maximize available resources
and to ensure better coordination and integration of
maternal health interventions.
UNFPA should ensure that the development
and dissemination of IEC/BCC messages and materials
on the prevention of HIV infection in pregnant women
are available as well as tools and protocols on HIV
prevention among pregnant women aimed at strengthening
the skills of maternal health care providers.
UNFPA support may include the integration
of programmes that educate outreach community volunteers
and community health workers to provide to pregnant
women, families and communities information on HIV/AIDS
and STIs, VCT, safer sexual practices (including condom
use), breastfeeding and the importance of proper antenatal
delivery and postnatal care.
The Fund would also
need to further facilitate access to procurement of reproductive
health commodities – primarily commodities for HIV prevention such
as STI and HIV test kits, male and female condoms, equipment and
supplies for safe and clean delivery and drugs for the treatment of
STIs and assist in the maintenance of functional and efficient
UNFPA should integrate the
following intervention package for the
prevention of infection among pregnant women in its supported
maternal health care interventions.
The package includes:
Providing access to
VCT services so that pregnant women can find out their HIV status
and thereby adopt safer sexual practices;
- Providing access to
appropriate antenatal, safe delivery and post-delivery care,
including screening and treatment for STIs and access to trained
personnel for the care of the mother during pregnancy, and for safe delivery.
- Avoiding unnecessary
interventions during delivery, such as routine episiotomy and early
rupture of membranes; and balancing benefits and risks associated
with caesarean section; and
- Supplying and managing
reproductive health commodities, in particular, those for HIV
prevention: male and female condoms, HIV testing kits, STI screening and diagnostic
kits, equipment and supplies for safe and clean delivery, and drugs
for the treatment of STIs.
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