When a Woman With HIV Decides About Pregnancy
Women with HIV may face difficult considerations when deciding about having a baby (239). Health care providers can help people with HIV address these considerations and think through their reproductive and family planning options (see Box: What People With HIV Need to Know About Pregnancy and Preventing Pregnancy).
Perhaps the most important consideration for many people when deciding about pregnancy is the baby’s health and potential risk of dying. Even with treatment and special care, there is currently no way that a mother with HIV can completely eliminate all risk of transmitting the infection to her baby (see 'Special Care Can Help Reduce the Risk of MTCT'). Consequently, many women with HIV weigh this decision very carefully. For example:
My decision-making process was a five-year battle between my heart and my head. My head said, “It’s simply too big a risk. There are other ways to feel fulfilled. It’s profoundly, deeply selfish to put a baby at risk. And besides, you have been in such good health for so many years now—what if the stress of pregnancy undermined your own health?”.... My heart, interestingly enough, had never been in conflict with this issue. It said simply, “I want this.” —Rebecca, United States (46)
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A young mother with HIV was able to prevent transmitting the virus to her baby by taking nevirapine at the time of delivery. Women with HIV face difficult considerations when deciding about having a baby. Those who decide to become pregnant can take steps to lower the risk of transmitting the virus to their babies and uninfected partners.
(Photo: Susan Winters Clarke)
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I have never been pregnant, so I don’t know what it feels like, but I am conscious that for me becoming a mother is more complex than for women who are not living with HIV. Some people have said to me that women who are HIV-positive will automatically put their babies at risk. In fact, all pregnancies involve risk, whether a woman is HIV-positive or not. HIV does not take away my right to become a mother. —Violeta, Bolivia (96)
A couple with HIV also may consider the risks that pregnancy can pose for their own health. For example, women with HIV may consider how pregnancy can increase the risk of miscarriage and other complications (see 'HIV Infection Increases Risk of Poor Pregnancy Outcomes'). Serodiscordant couples may consider the risk of transmitting the virus to the uninfected partner when attempting conception (see 'Serodiscordant Couples Can Take Steps for Safer Conception').
Even though I would like to have a child, I will not. Before, I was frightened that, without access to nevirapine to prevent mother-to-child transmission, the baby would be infected. Even though nevirapine has recently become available in Kathmandu, I am still afraid I would have an unsafe delivery because of my poor health. —Asha, Nepal (96)
Couples with HIV may also consider how their health in the future may affect the child and think about the possibility of leaving a young orphan.
The most serious worry I have is dying and leaving [my children] behind. Where will I leave them? I have no-one else to turn to. When it’s my turn and God takes me, who will look after my children? —Selafina, Rwanda (55)
Having Maddy has made me feel more mortal than ever. There are still days when I panic and say to myself, “Please let me see her grow up.” Even though I’ve lived with this disease most of my adult life, it’s my challenge every day to not panic and slide into a dark place. —Dawn, United States (210)
What Can Health Care Providers Do?
To help women with HIV and their partners with their decision, health care providers can:
- Give appropriate and accurate information. When making reproductive and family planning decisions, women need HIV-specific information and services. Providers need to be sure that they know the chances of mother-to-child transmission, for example, and neither exaggerate nor underplay them in discussions with clients (see 'Women With HIV Need the Facts About Pregnancy'). Furthermore, providers can tailor information to a woman’s individual situation. For example, if a couple with HIV desires a child but does not want to undergo pregnancy, providers can help them explore ways to adopt a child.
- Encourage partners’ involvement. Providers can encourage a woman to disclose her HIV status to her partner, suggest testing if a partner’s HIV status is unknown, and encourage couples to make reproductive and family planning decisions jointly (see Box: Helping Women Talk With Their Partners About Contraception and Safer Sex). For serodiscordant couples, providers can help explore options for safer conception (see 'Serodiscordant Couples Can Take Steps for Safer Conception').
- Offer support for decision-making. Many women with HIV who are pregnant or who are considering pregnancy report facing stigma and discrimination from health care workers (41, 224). To ensure that women can freely make informed choices and can carry out their decisions, providers can offer supportive care, free from personal bias and judgment (see Web tool, “Assess Your Attitudes and Beliefs About People With HIV”).
- Help women to carry out decisions. Providers can help women who decide to prevent or delay pregnancy choose an appropriate contraceptive method (see 'Women With HIV Can Safely Use Most Contraceptive Methods'). For women who decide to have children, providers can help them plan for as safe and healthy a pregnancy as possible. Providers also can help pregnant women with HIV plan for postpartum family planning.
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