Pregnant women living with HIV often experience stigma and discrimination in intimate relationships, families, communities, and health facilities. In a recent review of the literature from low-resource settings, our team found that HIV-related stigma and discrimination are significant contributors to the low uptake and utilization of PMTCT and maternal HIV treatment services in a multitude of settings. This evidence has led our team to advocate for the integration of stigma-reduction programming into maternal, neonatal, and child health services globally.
Meanwhile, the maternal health community has developed the Respectful Maternity Care Charter in an effort to tackle disrespect and abuse of women seeking and receiving maternity care. This Charter includes the rights of all childbearing women to information, informed consent, choice, confidentiality, privacy, and freedom from discrimination. Women may be denied these rights because they are poor, because they belong to marginalized racial or ethnic groups, or because they are young or unmarried. These rights are also often denied to pregnant women living with HIV or those at high risk of HIV.
It is time for the HIV and maternal health communities to work together to ensure that these rights are upheld for all childbearing women, with a focus on the special vulnerability of women living with HIV.
Respectful Maternity Care interventions can include or adapt evidence-based stigma reduction tools and measures developed in the HIV field. HIV-related stigma reduction interventions that aim to improve outcomes for childbearing women and their families should take into account the wider context of maternity care, and address other types of non HIV-related disrespect and abuse experienced by women in seeking and receiving maternity care. A pilot project in Kenya suggests that introducing services for prevention of violence against women within antenatal care services (including stigma-reduction training for health workers) will have benefits for all pregnant women and can be especially important in settings where women may fear or experience partner or family violence related to HIV testing or HIV-positive status disclosure.
I recently attended the Maternal Health, HIV, and AIDS meeting coordinated by the MHTF, USAID, and CDC and held in Boston, June 10-12, 2013. Meeting participants from the HIV and maternal health communities from around the globe agreed that working together to ensure respectful maternity care—including care free from stigma and discrimination for any reason—should be an important joint goal for both the HIV prevention and maternal health communities.
This post is part of a blog series on maternal health, HIV, and AIDS. To view the entire series, click here.