Integration: Family Planning and HIV/AIDS
Integration: Family Planning
ANC and PNC contacts are important opportunities to talk with women about intentions for spacing or limiting subsequent pregnancies, exclusive breastfeeding, and FP options. Most postpartum women want to delay their next pregnancy; some would like to limit future pregnancies. Counseling centered on the clients’ individual needs and preferences is essential in enabling women to choose an appropriate method. Male partners also should be involved.
As a part of PNC, every woman should be provided with the postpartum family planning method of her choice or referred to a site that offers the desired method. Lactational Amenorrhea Method has a particular advantage in the postpartum period because it serves as a method of birth spacing while also contributing to reducing neonatal mortality and morbidity through exclusive breastfeeding. For more information on postpartum family planning, including intrauterine contraceptive device insertion, see the Family Planning TRM and the Community-Based FP Toolkit.
HIV testing; voluntary counseling, and testing; or provider-initiated counseling and testing are recommended components of ANC in endemic areas. Counseling sessions need to emphasize safe sex practices and, if possible, services should be integrated (e.g., facilitating pregnant women’s access to PMTCT services during ANC and making sure that FP methods are provided as part of PAC and PNC). In cases where ANC services are understaffed and under-resourced, PMTCT interventions should not be offered at the expense of providing basic MNC to the wider community. PMTCT services should strengthen MNC, which often can serve as an appropriate and convenient entry point:
- ANC: Programs can increase the likelihood that women take their prophylactic antiretroviral (ARVs) drugs according to national guidelines by providing women who are known to be HIV-positive with ARVs during an ANC visit—usually at 28 weeks or later.
- Labor: Health providers can provide counseling and testing during labor to women who were missed during pregnancy; use infection prevention measures for all women; avoid unnecessary procedures, such as artificial rupture of membranes and episiotomy; give ARV prophylaxis, as appropriate, to HIV-positive women and their newborns; and counsel mothers on infant feeding.
- PNC: The postnatal period is an opportunity to test and counsel women and provide ARVs to the baby, as well as counsel the mother about infant feeding and breast care.
Key Resources for HIV and MNC:
- WHO, 2010. WHO Guidelines on HIV and Infant Feeding
- EngenderHealth, 2004. HIV Prevention in Maternal Health Services
- Turan, 2012. Stigma and Discrimination: Key Barriers to Achieving Global Goals for Maternal Health and Elimination of New Child HIV Infections
- WHO, 2014. Care of the HIV-Exposed or Infected Newborn