What Works for Women and Girls

EVIDENCE1. Preventing unintended pregnancies can reduce perinatal transmission. 2 [See also Chapter 8.Meeting the Sexual and Reproductive Health Needs of Women Living with HIV]An analysis that modeled the potential benefits of adding family planning to nationalstrategies to achieve universal access to PMTCT found that focusing on unintendedpregancies as well as preventing vertical transmission is highly cost-effective. Modelingwas based on 14 countries which contain four-fifths of all HIV-positive pregnant womenliving in 139 countries: South Africa, Nigeria, Mozambique, Democratic Republic ofCongo, Uganda, United Republic of Tanzania, Kenya, Zambia, Ethiopia, Malawi,Zimbabwe, India, Cameroon, and Côte D’Ivoire. The average level of unmet needfor contraception is 23% in these 14 countries and 17% globally. Even if all women inneed accessed the most efficacious antiretroviral regimen available, this would prevent240,000 infant HIV infections in the 14 countries with the highest HIV prevalence(300,000 globally) at a cost at US$131 million (US$208 globally). However, almost72,000 infant infections would still occur in the 14 countries (over 90,000 gloablly).Preventing unintended pregnancies costs only US$26 million in the 14 countries (overUS$33 million globally). Costs of treatment were based on 28 weeks of ARVs, inlcludingAZT, 3TC, and sdNVP. (Halperin et al., 2009a) (Gray V) (pregnancy, PMTCT, contraception,South Africa, Nigeria, Mozambique, Democratic Republic of Congo, Uganda, Tanzania,Kenya, Zambia, Ethiopia, Malawi, Zimbabwe, India, Cameroon, Côte d’Ivoire)In the fifteen PEPFAR countries, Botswana, Mozambique, Namibia, South Africa,Zambia, Ethiopia, Kenya, Rwanda, Tanzania, Uganda, Côte d’Ivoire, Nigeria, Guyana,Haiti and Vietnam, the annual number of unintended HIV-positive births currentlyaverted by contraception use is over 220,000. Unintended births are composed of boththose that were unwanted (i.e. wanted no more children) and those that are mistimed(i.e. pregnancies that were wanted later). This analysis used estimates of (1) contraceptiveand HIV prevalence; (2) the number of women of reproductive age; (3) the numberof annual births to HIV-infected women; (4) the rates of pregnancy and vertical HIVtransmission; and (5) the proportions of unintended and unwanted births. The productof these estimates is the number of HIV-positive births currently averted by contracep-2 Although this evidence is based on modeling, it is based on the well-established correlation between contraceptiveuse and fertility rates using a linear regression of the contraceptive prevalence rate (CPR) on the totalfertility rate (TFR) (Ross and Frankenberg, 1993). Included in the total fertility rate is unintended pregnancy,including among women who are HIV-positive and may or may not know their status. Therefore expandingaccess to contraception among all women will result in a reduction in unintended pregnancy, including amongwomen who are HIV-positive and do not know their status when they get pregnant. The analysis by Reynolds etal., 2008 also assessed the cost per HIV-positive birth averted by family planning and PMTCT services. Howeverbecause the analysis compared the cost of family planning with the cost of nevirapine, which is no longerrecommended for us in PMTCT programs, that part of the analysis is not included here.WHAT WORKS FOR WOMEN AND GIRLS211