A woman infected with HIV can pass HIV to her child during pregnancy, delivery, or breastfeeding. Antiretroviral preventive measures (prophylaxis) given to the mother during pregnancy and labor can reduce the chances that the baby will be infected while developing in the uterus or during delivery. Antiretroviral therapy for the mother, if she needs it for her own health, may help reduce the chances of HIV transmission through breast milk.

How can family planning providers help prevent mother-to-child transmission of HIV?

• Help women avoid HIV infection (see Sexually Transmitted Infections, Including HIV, Preventing Sexually Transmitted Infections).
• Prevent unintended pregnancies: Help women who do not want a child to choose a contraceptive method that they can use effectively.
• Offer HIV counseling and testing: Offer counseling and testing to all pregnant women, if possible, or offer to refer them to an HIV testing service, so they can learn their HIV status.
• Refer: Refer women with HIV who are pregnant, or who want to become pregnant, to services for prevention of mother-to-child transmission, if available.
• Encourage appropriate infant feeding: Counsel women with HIV on safer infant feeding practices to reduce the risk of transmission, and help them develop a feeding plan. If possible, refer them to someone trained to counsel on infant feeding.
  • A woman with HIV should be counseled to choose the feeding option that best suits her situation. If replacement feeding is acceptable, feasible, affordable, sustainable, and safe, she should avoid breastfeeding.
  • If replacement feeding does not meet these conditions, a woman with HIV should breastfeed exclusively for the first 6 months. Mixed feeding—that is, giving the baby both breast milk and other liquids or foods—is riskier than exclusive breastfeeding.
  • To further reduce the risk of transmission, when mothers with HIV switch to replacement foods, they should avoid a prolonged period of mixed feeding. Stopping breastfeeding over a period of about 2 days to 3 weeks poses the least risk of HIV transmission.
  • To destroy HIV in breast milk, express and heat-treat milk before feeding it to the infant: Heat milk to the boiling point in a small pot, and then cool the milk by letting it stand or by placing the pot in a container of cool water, which cools the milk more quickly.
  • Women with HIV who are breastfeeding need advice on keeping their nutrition adequate and their breasts healthy. Infection of the milk ducts in the breast (mastitis), a pocket of pus under the skin (breast abscess), and cracked nipples increase the risk of HIV transmission. If a problem does occur, prompt and appropriate care is important (see Sore or cracked nipples).