What Works for Women and Girls

9C. Safe Motherhood and Preventionof Vertical Transmission: Antenatal CareGood antenatal care is essential for safe motherhood. Clinical exams, rapid syphilis tests,tetanus toxoid, supplementation with iron and folic acid are all considered the standard of carefor pregnant women (Villar et al., 2001). Of critical importance is to inform women, their partners,families and communities of the danger signs during pregnancy and ensure access toemergency obstetric care. Antenatal care is also an opportunity for HIV counseling and testing.Women who test HIV-negative still need information and support to remain HIV-negative.[See Chapter 3. Prevention for Women, Chapter 4. Prevention for Key Affected Populations, andChapter 11. Strengthening the Enabling Environment] Women who test HIV-positive need to beinformed of their treatment options, both for their own health and to prevent vertical transmission.Women who test HIV-positive also need information and counseling concerning infantfeeding options. Improving quality of care in maternal health services can increase the likelihoodthat women will go to health facilities in case of obstetric emergencies, thus increasingthe chances of positive maternal and infant health outcomes (Gay et al., 2003). Women livingwith HIV also need sexual and reproductive health services and treatment for critical co-infections.Further efforts are needed to screen and treat pregnant women for co-infections thatpotentially increase mortality for women and their infants. [See also Chapter 8. Meeting theSexual and Reproductive Health Needs of Women Living With HIV and Chapter 10. Preventing,Detecting and Treating Critical Co-Infections]Syphilis co-infection can be especially dangerous in pregnancy, particularly for HIV-positivepregnant women. There is some evidence that HIV-syphilis co-infection may increase the riskof perinatal HIV transmission. While numerous countries have policies to provide universalscreening for syphilis for pregnant women, not enough women are actually screened andtreated in practice. In 2007, WHO estimated that syphilis prevalence in pregnant women inAfrica ranges from 4–15% (WHO, 2007d). As a result, infants are dying from syphilis despiteaccess to ARVs for mothers and infants (Peeling et al., 2004). Universal screening and treatmentfor syphilis in pregnancy could prevent 492,000 syphilis-related stillbirths and perinataldeaths per year in sub-Saharan Africa (Saloojee et al., 2004). Syphilis testing and treatmentin conjunction with HIV testing can prevent congenital syphilis and may reduce HIVtransmission.Antenatal care is also an opportunity to discuss with pregnant women and their partnersthe benefits of infant male circumcision, which may reduce HIV acquisition and transmissionwhen the infant becomes sexually active. Male circumcision has now been shown in threerandomized clinical trials to reduce the risk of HIV acquisition for men by 50–60% (Auvertet al., 2005; Bailey et al., 2007; and Gray et al., 2007). Male circumcision at birth as part ofpostnatal care could result, upon sexual initiation and for his lifetime, in a reduction in therisk of HIV acquisition and transmission (Weiss et al., 2009; Nagelkerke et al., 2007). [See alsoChapter 3C. Prevention for Women: Male Circumcision]220 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION