Without strong integration of family planning into PMTCT services in Rwanda, clients remain with a high unmet need for effective family planning.

Abstract

In 2008, about 33.4 million people were estimated to be living with HIV worldwide, including about 15.7 million women and 2.1 million children under the age of 15. 1 The majority of new infections in children occur as a result of vertical transmission, either in the course of pregnancy, during labour, or through breastfeeding. The risk of mother to child transmission can be reduced from 15-45 percent to less than 2 percent with highly active antiretroviral therapy which, along with the practice of delivering babies of HIV-positive mothers by elective Caesarean section and bottle feeding, has effectively eliminated vertical transmission in highincome countries. 2-4 Prevention of unintended pregnancies and adequate birth spacing among HIV-positive women have been shown to be cost-effective and essential components of a comprehensive approach to prevention of mother to child transmission (PMTCT). 5-7 However, low-income countries that have implemented PMTCT programs have tended to focus almost entirely on delivery of antiretrovirals, and have neglected measures to reduce the rate of unintended pregnancies among HIV-positive women. This practice has been attributed to factors such as funding exigencies created by spending limitations placed on the purchase of contraceptives, lack of clear policy and operational guidance on how prevention of unintended pregnancies should be implemented in the context of PMTCT and within the framework of national HIV prevention programs, as well as stigma directed towards HIV-positive clients seeking reproductive health care services. 8 In Rwanda, along with a continuing need for FP services, there is a generalised HIV epidemic, with 3 percent prevalence in the general population and 4.3 percent prevalence among pregnant women. Recognising the importance of the role of FP in the HIV response, the government initiated family planning-HIV (FP-HIV) integration in 2007, linking FP to PMTCT services. At the request of Rwanda’s National Committee for the Fight against AIDS and the Ministry of Health, a situation analysis of family planning-PMTCT (FP-PMTCT) integration was conducted in 2008 with the goal of providing information to improve integrated services and to optimise the potential for scale-up. 9 This brief provides a report on two of the study objectives, focusing on HIV-positive women and their service providers: (1) to determine the need for family planning services among PMTCT clients after birth and (2) to describe the readiness of antenatal and postnatal service providers to offer FP.