According to a new study published in the journal PLoS Medicine, expectant mothers in one Kenyan province often choose to give birth away from health-care facilities, due to the fear of being labeled as HIV-positive.
Researchers from the University of Alabama at Birmingham discovered a strong association between HIV-related stigma and the fact that only 44.2% of expectant mothers give birth in facilities with skilled caregivers in Nyanza Province, Kenya. According to the researchers, around 16% of women aged 15-49 in the area are HIV-positive.
Each year, more than 250,000 women in developing countries die during childbirth. 1 in 5 pregnant women in Nyanza are HIV-positive, having skilled care during pregnancy and birth increases the chances that HIV-positive women receive antiretroviral drugs that prevent the passing of HIV from mother to child.
Earlier studies in Nyanza have found that women who are labeled as HIV-positive are often abused by male partners, and seen as promiscuous in the eyes of their families. However, researchers were unclear about the degree to which stigma kept expectant mothers from accessing skilled care for childbirth.
Janet Turan, Ph.D., associate professor in the Department of Health Care Organization and Policy at the UAB School of Public Health, said:
“Our work shows that women in Kenya are deeply afraid of the HIV label, so stigma-reduction programs would increase the use of HIV services and of skilled attendance at delivery for all women. It’s also essential that these facilities warmly welcome the poorest, least-educated women, because they deliver their babies with skilled care most often.”
The researchers found that many Kenyans consider the region’s clinics the best place for women with pregnancy complications to give birth. However, those who choose to give birth at clinics run the risk of being labeled HIV-positive.
The stigma is so strong the many people have adopted a low opinion of anyone living with HIV, and not without cost. The researchers discovered that women were around 50% less likely to deliver their baby in a clinic is they had such opinions.
The researchers conclude that government campaigns seeking to stop mother-to-child transmission by encouraging HIV-positive mothers to give birth in health clinics may be inadvertently promoting the idea that childbirth there is primarily for those who are HIV-positive. They state that public health messages should be adjusted to highlight that giving birth in a heath care center with skilled workers is essential for all women, not only women with pregnancy complications or HIV.
“Kenya has made only limited progress towards reaching the 2015 United Nations Millennium Development Goals, which include lowering the maternal death rate in developing countries by 75%. In this context, understanding women’s use of skilled delivery and HIV-related health services is an urgent priority, since skilled care during childbirth prevents most avoidable deaths.”
Written by Grace Rattue