Improving maternal healthcare in Kenya – Integration of HIV services with maternal healthcare

Adapted from Relief Web.Date: 24 Nov 2010

Around 350,000 girls and half a million women die from pregnancy-related causes every year. Almost all of these deaths occur in the developing world. HIV and AIDS increase maternal mortality as suppressed immunity causes a higher risk of pre-natal and childbirth complications.

But for the first time in 30 years, evidence is showing that the efforts made to reduce maternal mortality have led to a drop in deaths worldwide. One significant reason is the contribution HIV services have made to women accessing health services. Providing both HIV and reproductive health services in the same room can increase the uptake of both.

In Kenya, AIDS related deaths have fallen by one third since 2002, but the government estimates more than 32,000 babies a year are still born HIV positive and around 1.1 million women are living with HIV.

In Uhuru, an area in Nairobi, communities and women are now working together to help women tackle the challenges they face and take control of their lives.

Lean On Me is one such support group, which was founded by Maurine Murenga, a HIV positive woman. It helps young mothers cope once they learn they are HIV positive and provides services which help the prevention of mother to child transmission. Maurine’s experience as a HIV positive woman giving birth was part of the motivation for her founding the support group.

Women make up 50% of HIV positive people in Africa – the fastest growing group. They face stigma, discrimination and gender inequality which further limit their access to maternal and sexual health services.

UKaid from the Department for International Development supports the International HIV/AIDS Alliance (the Alliance) through a Partnership Programme Arrangement (PPA). The Alliance is supporting its Kenyan partner KANCO (the Kenya AIDS NGO Consortium) who provide advice, training and financial support to community based organisations, such as Lean On Me.

Originally set up as a general health and empowerment group for young people, one of Lean on Me’s projects is a group for mothers. Women who attend the nearby maternal health clinic, if tested positive for HIV, go to its mother-to-mother support groups, where a variety of emotional and practical support is provided.

“A positive woman often discloses her status to her husband and finds that he is not speaking to her or even that he leaves her, that she is totally alone. We can give each other hope,” explains Spirah Kaari, a “mentor mother” who offers advice and support to HIV positive women at Lean on Me.

Maurine herself had a very difficult pregnancy and birth experience after learning she was HIV positive six years ago. She was treated very badly by her son’s father, her family and fellow worshippers at her church, and the only person who attended her during the birth of her child was a passing cleaner. But she managed to pull through with the support of other women.

Integration of services

Many mothers living with HIV are ‘lost’ to follow up care because mothers, newborns and children are treated separately for HIV and the prevention of mother-to-child transmission. Integrating these different services and treating mothers, newborns and children together has provided more effective healthcare.

Combining HIV testing and support into routine ante-natal care can fast-track women diagnosed with HIV into programmes providing holistic care, including ART, to maintain the mother’s health and reduce the chance of transmission of the virus during pregnancy to less than 1%.

Currently UKaid from DFID is supporting the scaling up of prevention of mother-to-child transmission (PMTCT) programmes in sub-Saharan Africa.

Key facts

* Globally, HIV is the leading cause of death among women in reproductive age – and a major cause of maternal and childhood mortality and illness.

* Currently more than five million people worldwide have access to life-saving antiretroviral treatment – more than a tenfold increase over five years.

* DFID, working through partners is focusing on effective interventions such as the prevention of mother-to-child transmission, condom distribution and use, family planning, harm reduction, and addressing underlying factors that fuel the epidemic, such as gender-based violence and poverty.

Kenya