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| The empowerment of women |
Without going into too much detail of the nature of the assignment, I'll just say that the work involved an in-depth discussion with a group of women who are living with HIV, and they were helping some of us researchers conduct a study about HIV-positive mothers' or expecting mothers' access to and quality of maternal and child health services in various countries in South East Asia.
There were a lot of things discussed that day. But two things hit me hard. The issues of forced termination of pregnancies and coerced sterilisation of HIV-positive women. The operative words being forced and coerced.
In so many of the countries we were surveying, the reports (albeit anecdotal) were the same. There are doctors and health care professionals who impose their own personal prejudices when attending to women who are HIV-positive. This is despite beautiful national-level policies on maternal and child health programmes, and the prevention of HIV transmission from parent to child. What is on paper, documented as the 'official' government policy may not necessarily be translated into actual practice. Especially in the rural areas where in some of these countries literacy rates are low and the role of women in society is still highly oppressed. And often, in these settings, doctors are figures of authorities. Women seldom question the treatment or recommendations given to them by their health care providers. I can relate to that. A lot of times I find myself putting on so much trust in my doctor. If they say so, then it must be the best thing for me.
We received so many reports of medical professionals advising HIV-positive pregnant women to either a) terminate their pregnancies; or b) undergo sterilisation e.g. tubectomy/tubal ligation; or c) both. This is purely on the basis of the fact that the mother is HIV-positive. No discussions about the probabilities of actual transmission of HIV from mother-to-child, or the ways available to prevent or lower the likelihood of such transmission. What is worse, instead of presenting the mothers with these options, what is often done is that they are told that they are required to undergo these procedures in order to receive the free-of-charge health care services.
Despite the fact that the services should have been free-of-charge anyway.
It is shocking. At one point, when one of the women told us about one woman who was six-months pregnant, unsure about her HIV status (her husband is HIV-positive, she has not been tested), and the doctor gave her some 'medications' upon knowing that the woman's husband is HIV-positive. It was only when she showed the medication to her outreach worker was it discovered that the medication was an abortion inducer. Thank goodness she was taken to a different doctor and was taken off the pill immediately. She carried on her pregnancy and safely delivered.
But as I was hearing that, I felt like running out of the room and go cry in the toilet. Maybe its the hormones and being pregnant myself. It is just unthinkable. It is criminal. And yet it is going on.
I am not saying all doctors do this. It is a probably a very small number of incidences (though my numbers do tell me otherwise, in certain regions). And of course I have a lot of respect for all the selfless medical professionals who do such amazing work helping women go through safe deliveries.
Here are some bottom lines.
Yes HIV can be transmitted from mother-to-child.
But the probability of transmission (which is not high in the first place) can also be drastically reduced with proper measures that we call PMTCT (prevention of mother-to-child transmission), which involves treatment with antiretrovirals, the appropriate choice of delivery method, and the appropriate choice of infant feeding (either exclusively breast-feeding or exclusively formula feeding).
Parents should be informed of their options. And the decision should be theirs; they must give consent to whatever is done to their bodies and their child.
