What Works for Women and Girls

good care to women and their infants. Topics such as perinatal ARV therapy and breastfeedingcontinue to raise questions. Some of the scientific evidence points to contradictory conclusionsand further guidance from the WHO is anticipated. “…After more than two decades ofintensive research into HIV, the precise mechanism or even route of the vertical transmissionof the virus remains unknown” (de Vries and Peek, 2008: 679). But pregnancy is a timewhere many women have multiple contacts with health providers, “creating an opportunity toassess and address women’s sexual risk and HIV and STI status” (Kershaw et al., 2006: 310).However, one fact remains clear: it is vital that HIV-positive women are given counseling andsupport with the most accurate and comprehensive information available so that they canmake informed decisions about their health and the health of their children.9A. Safe Motherhood and Prevention of VerticalTransmission: Preventing Unintended PregnanciesReducing unmet need for family planning so that all women who do not want to becomepregnant now or in the future have access to contraception could have a significant effect onpreventing perinatal transmission of HIV—in part because many women do not know theirHIV status. “Increasing voluntary contraceptive use had been an underused approach, despiteclear evidence that preventing pregnancies in HIV-infected women who do not wish to becomepregnant is an effective strategy for reducing HIV-positive births…The lack of attention tocontraception as an effective HIV prevention strategy is particularly disconcerting given thatthe evidence of contraceptive efficacy is juxtaposed by high levels of unintended pregnanciesamong women living with HIV. Unintended pregnancies account for 14–58% of all birthsin countries where the burden of HIV is the greatest” (Wilcher et al., 2008: ii54). Additionalinformation about contraception services for women living with HIV, along with linkagesto HIV services can be found in Chapter 8. Meeting the Sexual and Reproductive Health Needsof Women Living With HIV and Chapter 13. Structuring Health Services to Meet Women’s Needs.What Works—Safe Motherhood and Prevention of Vertical Transmission: PreventingUnintended Pregnancies1. Preventing unintended pregnancies can reduce perinatal transmission.210 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION