The MHTF, working in collaboration with the CDC, are pleased to announce two new resources on maternal health and HIV: a technical summary, Maternal Mortality and HIV, and a working paper, Research and Evaluation Agenda for Maternal Health and HIV in sub-Saharan Africa.
Learn more about these exciting new resources
Maternal mortality and HIV, two primary causes of death among women of reproductive age, disproportionately affect women living in developing countries. The burden of these two epidemics is greatest in sub-Saharan Africa, with the region comprising over half of the global proportion of maternal deaths (up from 23% in 1980) and being home to 69% of the 34 million people living with HIV worldwide at the end of 2011 [Hogan et al. 2010; UNAIDS 2012 (pdf)]. A recent estimate suggests that 24% of deaths in pregnant or postpartum women are attributable to HIV in sub-Saharan Africa [Zaba et al. 2013]. In 2008, almost 1 in 10 maternal deaths in sub-Saharan Africa resulted from HIV-related causes; without the presence of HIV and AIDS, the maternal mortality ratio (MMR) in sub-Saharan Africa would have been 580 rather than 640 deaths per 100,000 live births [WHO 2010 (pdf)]. Globally, HIV/AIDS caused an estimated 56,100 maternal deaths in 2011 [Lozano et al. 2011].
While the number of people newly infected with HIV has been declining since its peak of 3.5 million newly-infected individuals in 1996, women and girls are increasingly and disproportionately affected by the epidemic and now comprise over half of those living with HIV. In sub-Saharan Africa, three to eight women aged 15-24 are infected with HIV for every man [UNAIDS 2010 (pdf)]. The feminized HIV and AIDS epidemic is one factor limiting progress in the reduction of maternal mortality.
Some common determinants of maternal mortality, HIV infection and progression to AIDS are sociocultural: both women with HIV and women at high risk of maternal mortality are usually disempowered, have limited decision making capacity over their sexual lives and reproduction, and tend to have low educational attainment and socioeconomic status [WHO 2009 (pdf)]. Other determinants are biological: poor health and malnutrition associated with HIV infection have adverse health outcomes (e.g. anemia and decreased immune function) that strongly affect maternal and perinatal health as well as sexually transmitted infections [Quinn and Overbaugh 2005]. Within the health system, factors like discrimination, lack of skilled personnel, poor quality of facilities, and delays in receiving care contribute to increased risk of maternal morbidity, maternal mortality, and poor or non-existent care for women with HIV [Guidozzi and Black 2009]. Environmental factors such as geographic barriers, conflict settings and urban/rural residence are other common determinants of maternal mortality, HIV infection and progression to AIDS in so far as they can impede women’s access to information and quality health care services [WHO 2000 (pdf); Abdool-Karim et al. 2010].
Due to the AIDS epidemic and co-infections with diseases like tuberculosis, countries such as Zambia and South Africa have reportedly experienced significant shifts from direct to indirect causes of maternal mortality [Garenne et al. 2008; Ahmed et al. 1999]. In South Africa between 1998 and 2004, the MMR for direct maternal deaths increased by 22% whereas the MMR for indirect causes of death rose by 93% [Cross et al. 2010]. The country’s combined MMR in 2008 was higher than in 1980. During a seven-year period at the King Edward VIII Hospital in Durban, for example, the facility-based MMR increased from 434 deaths per 100,000 live births in 1998 to 1,023 deaths per 100,000 live births in 2004 [Ramogale et al. 2007]. The health system in South Africa and other sub-Saharan countries face increasing challenges from the intersection of the HIV and maternal mortality epidemics.
Integrated and comprehensive responses can create positive synergies for improving maternal health and addressing HIV among women of reproductive age. Some examples include: the relationship between the quality of antenatal care provided at health facilities and the successful implementation of antiretroviral treatment to prevent mother-to-child HIV transmission [Ekouevi et al. 2012]; health benefits for both HIV-negative and HIV-positive women and their children of outreach by community-based health workers–including increased condom use [le Roux et al. 2013]; and reductions in maternal mortality associated with women with HIV receiving treatment for their own health instead of only to prevent transmission to their child [Zaba et al. 2013; Myer 2013].
The role of the MHTF
During the MHTF’s first three years, the Task Force supported maternal health, HIV, and AIDS programs with CEDPA and mothers2mothers. CEDPA’s work focused on integrating maternal health with HIV and AIDS in India (pdf), and mothers2mothers explored the use of cell phones to improve client retention in prevention of mother-to-child transmission of HIV programs. The MHTF also convened a Maternal Health Dialogue on integrating HIV, AIDS and maternal health services, in collaboration with the Woodrow Wilson Center and UNFPA.
In August 2012, the MHTF-PLOS Maternal Health Collection featured a paper by Turan et al. on HIV-related stigma in the utilization of skilled childbirth services in Kenya. At the Global Maternal Health Conference 2013 (GMHC2013) in Arusha, Tanzania in January 2013, the topic of maternal health, HIV, and AIDS was well represented with 4 panels, 25 presentations, and 4 posters. Maternal health, HIV, and AIDS presentations from GMHC2013 are available for viewing on the MHTF’s Vimeo channel.
Building on research shared thus far, the MHTF collaborated with USAID and the CDC to convene Maternal Health, HIV and AIDS: Examining Research through a Programmatic Lens, a technical meeting in Boston, Massachusetts on 10-11 June 2013. The purpose of the meeting was to discuss emerging research linking maternal health and HIV, identify research gaps, and consider programmatic implications.
Additionally, the MHTF coordinates a blog series (on the MHTF Blog) with posts from experts working to address maternal health, HIV, and AIDS. Posts share lessons from specific countries, organizations, and projects; experiences managing HIV-related comorbidities and obstetric complications; and analyses of a persistent barrier to integrating and/or improving quality of maternal health care and HIV/AIDS care for women, for example.
Send us your feedback!
We are always looking for new resources, research or stories about maternal health and HIV and AIDS. Please let us know about any resources we may have missed! We welcome your feedback.