The effectiveness of contraception in reduction of matrenal mortality in HIV positive patients.

Name:Instructor’s name:Course:29 December 2016
Abstract
Proper family planning using modern contraceptives is a significant intervention towards the prevention of unwanted pregnancies which aside from providing societal, familial, and personal benefits do provide health benefits. Contraception is also one of the most cost-saving techniques of lowering the burden of a mother transmitting HIV to her unborn child for women who have been infected with HIV and wish not to get pregnant. However, some issues have been raised about certain contraception methods that have the potential of reacting with certain HIV medication and increasing the chances of a person transferring the virus to her partner who might, in turn, infect her with a different strain of the virus. Once a woman is infection from a different strain of virus in an occurrence referred that scientists call superinfection, they can become resistant to otherwise effective treatment and die as a result if that, hence increasing the proportion of maternal deaths related to HIV. Therefore, it is important for one to talk to their doctor before deciding to use one contraception method over the other and ensure that one strictly adheres to her HIV treatment even as they use contraception. With this kind of integrated care, contraception plays a significant role in reducing maternal mortality and morbidity, without it, it is not very effective.
Keywords: Maternal mortality, Maternal Morbidity, Contraception, Integrated care, HIV, Transmission.

Effectiveness of Contraception for Reducing Maternal Morbidity and Mortality for Women Living with HIV Aids
Introduction
Towards the end of 2014, the world was made aware of the signs of progress that had been achieved in the “attainment of the Millennium Development Goals (MDGs)” (Gorman 271). By then, the world had indeed made some remarkable progress. For instance, the number of underweight children below the age of 5 in developing nations had reduced to 17 percent from 28 percent from 1990 to 2011. Great progress has also been made towards the achievement of reducing the mortality of children below the age of five. In 1990, 12 million children below five years of age died, in 2011, the number of children below the age of five that died was 6.9 million. Also, in 2011, there was a 24 percent reduction in the number of people that were newly infected with HIV from the 2001 figure of 3.1 million (Gorman 271). However, one MDG; MDG 5 that deals with the improvement of maternal health, has been quite recalcitrant to this progress.
The improvement of maternal health does not only involve the reduction of maternal mortality but also the increase in the number of births that “are attended to by skilled health personnel but also achieving universal access to reproductive health” (Gorman 271). Some of the things that indicate progress towards the global access to reproductive health are the prevalence rate of contraceptives, the birth rate of adolescents, and coverage of antenatal care. Just a few nations are on track with the implementation of MDG of the reduction of maternal mortality by 75% (Gorman 271). African nations south of the Sahara Desert are in the worst position due to the inadequacy of resources in this region. The regional mortality of these nations as at 2014 was 640 maternal deaths for every a hundred thousand live births, with an annual decline of just 0.1 percent per year. This article mainly discusses the means through which contraception impacts on the maternal morbidity and mortality of HIV-positive women.
The Maternal Mortality Rate Associated with HIV
One might wonder what it is that is contributing to the high maternal death rates that are experienced in regions like Sub-Saharan Africa to date. In 2010, world experts from UNICEF, WHO, “the World Bank, and United Nations Population Fund” came together to generate a report the worldwide maternal mortality trends (Gorman 272). A portion of the report that was not as publicized as the other parts revealed that a strong link exists between maternal mortality and HIV infection. This critical link has been given little attention by both the popular media and research even though the contribution of HIV infection towards maternal mortality is quite significant. The authors of the report approximated the number of pregnant women that dies due to HIV/AIDS in 2008 alone at 42,000 (Gorman 272). Nine percent of the total maternal deaths in sub-Saharan nations from 1990 to 2008 were because of HIV. In regions with high HIV prevalence rates like the Southern and Eastern Africa, “HIV has become the leading cause of death among women during pregnancy and the postpartum period” (Gorman 272).
A much more recent research re-emphasized the considerable and definite contribution of HIV/AIDS towards the universal rates of maternal mortality. The authors of this recent meta-analysis discovered that, at the population level, there was a high proportion of deaths related to pregnancies that could be attributed to HIV infection. They estimated that 5 percent of the deaths related to pregnancy worldwide, and 25 percent of the same in sub-Saharan Africa could be attributed to HIV. However, the authors also point out the fact that the exact cause of deaths of pregnant women with HIV/AIDS is not clear. Some scholars have even suggested that maybe getting pregnant accelerates the progression of HIV or that HIV infection might increase the danger “of obstetric complications” (Gorman 272). However, the particular mechanism through which HIV adds to maternal mortality is not known, and more research is needed in that area.
As has been mentioned before, more studies are required to determine the biological link between HIV and maternal mortality. Many studies reveal that there is indeed a connection between the two; they are just not sure why or how it exists. Some recent progress has been made in comprehending the link between maternal death and HIV. One research conducted in South Africa revealed that the rate of maternal deaths among women infected with HIV/AIDS was ten times greater than that of HIV-negative pregnant women in the state. The study also revealed that the most frequent cause of maternal death for HIV-positive women were infections that were not even related to the pregnancy. These diseases included AIDS, Tuberculosis, and pneumonia. However, the study also noted that the HIV-positive pregnant women were also at a greater risk of succumbing to sepsis related to pregnancy and the complications caused by abortions. These specific findings point at a possible double burden for women infected for women living with HIV: “both improper treatment of and attention to their HIV infection as well as” the possibility of the virus directly contributing to maternal deaths related to pregnancy (Gorman 272). These burdens leave these women more exposed to postpartum problems than their HIV- free counterparts.
Besides understanding the biological factors that cause the maternal deaths that are directly related to HIV, a greater understanding of the contextual elements that particularly lower the access that HIV-positive women have to prenatal care is vital. Could it be that these women face discrimination in the health system, therefore, are ashamed of seeking the prenatal care they very much need? One study in Kenya discovered that women with greater perceptions of stigma related to HIV were more unlikely to give birth in health centers with skilled personnel than those with lower perceptions of this stigma. Giving birth in a health facility under the observation and assistance of skilled personnel is one way of reducing childbirth complications that often lead to obstetric complications which in turn result in maternal deaths that could have otherwise been avoided.
Defining Contraception
Contraception is the deliberate application of humanmade methods or other measures to prevent the pregnancy that results from sexual intercourse. The market offers so many varieties of contraception for one to pick from that it is highly unlikely that one would miss a technique that best suited them. Every method is different in terms of the degree of effectiveness and the duration over which they remain useful within the body as well as where one can find them. There are two major types of contraception, namely, barrier methods and hormonal methods. Hormonal methods feed one’s body with hormones that make it act abnormally (Haddad et al. 474). Some of these completely stop one from releasing eggs while some just make it hard for sperms to get to the egg that has been produced. An example of a hormonal contraceptive is the contraceptive pill. The barrier methods, on the other hand, make it impossible for sperms to get anywhere close to the egg by stopping them as soon as they find their way into the woman’s reproductive organ. The most common hormonal contraceptive in use today is the condom (Haddad et al. 450). Many other methods are available, but one needs to reach their health provider to get more information on the suitability of these methods on their bodies. All these contraceptive methods help prevent pregnancies; however, only the male and female condom help prevent sexually transmitted infections (STIs).
Finding the Relation between Contraception and Maternal Mortality and Morbidity
First of all, it is important to note that all contraception method are meant to prevent pregnancies; only the condom serves both the purpose of prevention of pregnancies and prevention of STIs. For one to find a link between contraception and the reduction of maternal mortality and morbidity, they must first understand what makes contraception necessary for HIV-positive women. In short, they should know why it is not safe for HIV-infected women to have unprotected sex. One of the obvious reasons for this is to avoid infecting their partners and to avoid getting pregnant. One of the less obvious reasons is to safeguard the HIV-infected woman from other sexually transmitted infections. As was mentioned before, so far, only the condom can help prevent sexually transmitted diseases; therefore, it is the only one that can assist in that respect.
When a woman is HIV-positive, using condoms while having sex with HIV-negative partners will protect the partner from contracting HIV and protect both of the parties from contracting any other STIs from each other. At times serodiscordant couples choose to engage in unprotected sex since they desire to make a baby of their own (Carter n.pag.). However, it is advisable to talk to one’s doctor to ensure that both parties are healthy enough before they try to conceive. However, many HIV-positive women choose to have unprotected sex with a partner who they also know is HIV positive as well. The assumption is that they are already infected with HIV, so they are subjecting themselves to no further risks. However, these women need to take a few things into consideration even as they make that choice.
First, they need to note that if they have vaginal sex without protection, then they are likely to get pregnant. As mentioned earlier, there are other methods of contraception that can be used to prevent pregnancy while having unprotected sex with any partner, whether infected or not. Other than condoms, women living with HIV (WLWH) have the option of using other contraceptives like hormonal contraceptives to prevent pregnancy since without pregnancy, there is no risk of maternal mortality. However, certain anti-HIV medications react with the hormonal contraceptives. Therefore WLWH need to ensure that they talk to their doctor first before they decide to adopt a contraceptive measure (Carter n.pag.).
Second, there have been a few incidences of what is referred to as superinfection with a different strain or strains of the virus which might be resistant to the anti-HIV medication. This superinfection could make WLWH resistant to treatment that would have otherwise helped them remain healthy. If an infected woman is pregnant and gets a new strain of the virus due to failure to use a condom, they are likely to die because of the resistance that the virus might then develop. Condoms can be highly effective in preventing the maternal morbidity that results from this kind of situations and the maternal deaths that they lead to. The superinfection cases are rare, and nearly all of them have “involved people who were infected with HIV for less than four years and either were not on HIV treatment or were taking a treatment break” (Carter n.pag.). Finally, unprotected sex puts both the men and women living with HIV at risk of contracting STIs like Gonorrhea, Genital Herpes, Chlamydia, Hepatitis A, B, and C etcetera. Some of these are treatable but some are not, and all of them help weaken the immune system of the HIV-infected person further. Once the immunity of the woman, especially the pregnant ones, has been weakened further, diseases like tuberculosis and pneumonia get in and eventually kill the pregnant women.
Following these, countries and communities need to come up with integrated methods of treating WLWH. The integrated service delivery should aim at meeting the multiple requirements of the HIV-infected women from one visit and if possible, by the same health providers. This way, the woman can optimize her contact with the health providers and more efficiently use the scarce financial and human resources available in countries like those from sub-Saharan Africa. Offering “ART within maternal healthcare services and removing the barriers to ART initiation,” for instance, by providing CD4 testing at the point of care or getting rid of CD4 testing before ART is initiated has been discovered to substantially increase ART uptake among breastfeeding and pregnant women (Kendall et al. 251). The reviews of integrated services towards the deterrence of HIV’s vertical transmission “with other Maternal and Child Health (MCH) services” have revealed positive results regarding coverage; however, few studies give evidence on the health results (Kendall et al. 254). In a similar manner, providing contraceptives in services aimed at treating HIV and like a usual segment of postpartum care has revealed improved uptake by the HIV-infected women. Contraception alone has not been very effective in lowering the rate of maternal demises and morbidity amongst HIV-infected women. However, if combined with other HIV care and MCH services, they have a better chance of saving more lives “of pregnant women living with HIV” (Campbell et al. 1285). In wider times, it might be more thoughtful to take an integrated approach towards attaining the MDGs, bearing in mind that they might not be as separable from one another as may appear. MDG6 that deals with combating malaria, HIV/AIDS, as well as other diseases has to be integrated with MDG5 that deals with bettering maternal health and lowering maternal mortality. Part of the objectives of MDG 6 “would have a direct impact on the reduction of” maternal mortality (Gorman 273). In fact, MDGs 3(eliminating sex disproportions in education), 4 (Reduce the rate of infant mortality by 2/3), 5, and six all have vital connections to each other (Gorman 273).
Conclusion
Several studies have revealed that there is indeed a vital link between HIV infection and maternal mortality. However, most of these studies do not have evidence as to how or why this link exists. Some suggest that HIV infection may get worse when a WLWH gets pregnant or that the chance of obstetric complications might go high when a pregnant woman is infected with HIV. Contraception can effectively reduce maternal mortality by preventing WLWH from becoming pregnant hence avoiding some of the maternal deaths that statistics reveal to occur more often in pregnant women. Other than that, once the women are pregnant, only condoms can help them since they are the only contraception method that can help prevent STIs so far. But even so, without the necessary MCH and HIV services, contraception would not be an effective way of reducing maternal mortality for pregnant WLWH because they would still die if the virus advances due to lack of proper HIV treatment.
Works Cited
Campbell, Oona MR, Wendy J. Graham, and Lancet Maternal Survival Series steering group.
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Carter, M. (2012). Factsheet Unprotected sex. Aidsmap, (September).
Gorman, Sara E. “A new approach to maternal mortality: the role of HIV in
pregnancy.” International Journal of women’s health 5 (2013): 271-273.
Haddad, Lisa B., et al. “Contraceptive methods and risk of HIV acquisition or female-to-male
transmission.” Current HIV/AIDS Reports 11.4 (2014): 447-458.
Kendall, Tamil, et al. “Eliminating preventable HIV-related maternal mortality in sub-Saharan
Africa: what do we need to know?.” JAIDS Journal of Acquired Immune Deficiency Syndromes 67 (2014): S250-S258.