Stigma as experienced by women accessing prevention of parent-to-child transmission of HIV services in Karnataka, India

In Karnataka, India only one-third of HIV-infected pregnant women received antiretroviral prophylaxis at delivery in 2007 through the state government’s prevention of parent-to-child HIV transmission (PPTCT) program. The current qualitative study explored the role of HIV-associated stigma as a barrier to accessing PPTCT services in the rural northern Karnataka district of Bagalkot using in depth interviews and focus group discussions with HIV-infected women who had participated in the PPTCT program, male and female family members, and HIV service providers. Participants discussed personal experiences, community perceptions of HIV, and decision-making related to accessing PPTCT services. They described stigma towards HIV-infected individuals from multiple sources: healthcare workers, community members, family and self. Stigma-related behaviors were based on fears of HIV transmission through personal contact and moral judgment. Experience and/or fears of discrimination led pregnant women to avoid using PPTCT interventions. Government, cultural and historical factors are described as the roots of much the stigma-related behavior in this setting. Based on these formative data, PPTCT program planners should consider further research and interventions aimed at diminishing institutional and interpersonal HIV-associated stigma experienced by pregnant women

Meeting the need: youth and family planning in sub-Saharan Africa

Abstract Background: The need for a concerted effort to address the gaps in family planning services for youth in sub-Saharan Africa has been underreported and underexplored. Study Design: Trends in fertility, childbearing, unmet need for family planning options and contraceptive prevalence (CP) among youth are described with data from six African countries with four consecutive Demographic and Health Surveys. Estimates of exposure to risk of pregnancy and number of new contraceptives users needed to maintain and double CP in 2015 are calculated using current CP and projected youth population size in six African countries. Results: The youth population is expected to range from approximately 3 to 35 million in six African countries by 2015. Accounting for population growth and current estimates of sexual activity among youth, family planning services will need to absorb more than 800,000 and 11.3 million new contraceptive users total to maintain and double CP, respectively, in 2015 in those six African countries alone. Conclusion: Our findings support existing literature that calls for a reorientation of family planning policies and programs, especially improved access to modern contraceptive methods among African youth

Setting priorities for safe motherhood interventions in resource-scarce settings

Objective Guide policy-makers in prioritizing safe motherhood interventions.Methods Three models (LOW, MED, HIGH) were constructed based on 34 sub-Saharan African countries to assess the relative cost-effectiveness of available safe motherhood interventions. Cost and effectiveness data were compiled and inserted into the WHO Mother Baby Package Costing Spreadsheet. For each model we assessed the percentage in maternal mortality reduction after implementing all interventions, and optimal combinations of interventions given restricted budgets of US$0.50, US$ 1.00, US$ 1.50 per capital maternal health expenditures respectively for LOW, MED, and HIGH models.Results The most cost-effective interventions were family planning and safe abortion (fpsa), antenatal care including misoprostol distribution for postpartum hemorrhage prevention at home deliveries (anc-miso), followed by sepsis treatment (sepsis) and facility-based postpartum hemorrhage management (pph).Conclusions The combination of interventions that avert the greatest number of maternal deaths should be prioritized and expanded to cover the greatest number of women at risk. Those which save the most number of lives in each model are 'fpsa, anc-miso' and 'fpsa, sepsis, safe delivery' for LOW; 'fpsa, anc-miso' and 'fpsa, sepsis, safe delivery' for MED; and 'fpsa, anc-miso, sepsis, eclampsia treatment, safe delivery' for HIGH settings. Safe motherhood interventions save a significant number of newborn lives.Maternal mortality Cost-effective Family planning Safe abortion Postpartum hemorrhage Misoprostol