Maternal health in the age of AIDS: implications for health services in developing countries

Abstract

In developing countries, the HIV/AIDS epidemic will have a major impact on all phases of women's reproductive lives, and will alter many standard approaches to the management of MCH (maternal and child health) services related to fertility regulation, pregnancy, delivery and the postpartum period. AIDS-related increased caseloads, occupational risk to health workers and reduced resources will further compromise MCH services. MCH programme managers and service providers need to better understand the nature of both technical and service-related issues intersecting both the MCH and AIDS fields to mitigate this impact.

PIP: More than 90% of the 14 million HIV infections occurring worldwide from the beginning of the pandemic to mid-1993 were in developing countries. Among adults, these infections resulted in more than 2.5 million cumulative cases of AIDS. The emergence of HIV has, compared to men, significant implications for women, as well as for the health services established to serve them, especially in developing countries. Changes will be needed in many standard approaches to the management of maternal and child health (MCH) services related to fertility regulation, pregnancy, delivery, and the postpartum period. AIDS-related increased caseloads, occupational risks to health workers, and reduced resources will further compromise MCH services. MCH program managers and service providers need to better understand the technical and service-related issues related to both MCH and AIDS. HIV/AIDS in women is discussed with attention to modes of transmission, natural history, reproductive tract complications, and AIDS-related mortality. The impact of HIV/AIDS upon maternal health is then considered with regard to the prenatal period, voluntary testing and counseling, the termination of pregnancy, the impact of pregnancy upon the course of HIV disease, pregnancy management in HIV-infected women, childbearing, blood transfusion, pregnancy outcome, perinatal transmission, the postpartum period, breastfeeding and HIV transmission, and family planning. A closing section looks at the impact of HIV/AIDS upon maternal health services in terms of the risk to health care workers and financing and managing maternal health care.