The transmission of the HIV virus from mothers to infants can occur before or during birth, or during breastfeeding. Since the start of the epidemic, an estimated 4.3 million children below the age of 15 years have died of AIDS worldwide. Another 1.4 million children are currently living with AIDS. [i] More than 90% of these children were born to HIV-infected women. [ii]

This raises complex issues surrounding a pregnant woman's right to chose freely whether to be tested for HIV, and the right of women who know they are infected to make independent, informed choices about childbearing and breast-feeding.

The focus on Mother-to-child transmission should be shifted to reflect the true path of transmission which is often men-to-women-to-child.

Should HIV-positive mothers be told not to breastfeed?

Breastfeeding has been the cornerstone of child health and survival strategies for the past two decades, and has played a pivotal role in reducing infant mortality in many countries. Even in the era of AIDS, breastfeeding remains the best choice for women who are HIV-free or who do not know their HIV status. However, for women who are HIV positive and breastfeed there is roughly a 15 percent chance of transmitting the virus to their infants. Therefore, all HIV-infected mothers should receive counseling and information on the risks and benefits of various feeding options. It is also the individual mother's right to decide how she will feed her child; any attempt to influence her decision, no matter what the circumstances or motives, is an abuse of her human rights and freedom of choice.

Women at childbearing age and HIV

Currently, almost 14 million women of childbearing age throughout the world are HIV positive. In the worst affected countries, the virus is spreading fastest among young people below the age of 24 years - at the peak of fertility.

Do HIV-positive Women Have the Right to Have Children?

It is every woman's fundamental right to decide for herself, without coercion, whether to have children. The responsibility of the government and health services is to provide HIV-positive women and their partners with comprehensive information and education about the risks to ensure that they have real choices of action.

No matter how good the information, counseling and services a woman has access to, the decision may still present her with agonizing dilemmas. In many parts of the world bearing children is of paramount importance, and may be a woman's only path to social status and self-fulfillment. On the other hand, if prejudice against people with HIV/AIDS is strong -- as it still is in many societies -- she may also risk her personal safety through a decision not to have children by raising suspicion that she is infected.

Pung, Thailand:

"It all happened with my first pregnancy when I had a blood test. The nurse asked me some questions and finally told me I was infected with the HIV virus…The nurse suggested aborting the child and added it would be free of charge. I talked to my husband and we both agreed to have an ultrasound to see if our child was healthy…The technician said the child was healthy and strong. Then she looked at my HIV status and suddenly replied: 'No, no you cannot keep the child'; her voice was so threatening. 'You must abort the child', she insisted….I had my child aborted, with a special deal: abortion with sterilization - free of charge. But I still don't know what kind of sterilization I got. I have no way of knowing what has been done to my own body"

"Living with HIV"
Nontburi:NAAM-CHEWIT Project

What can be done to prevent babies from acquiring HIV from their infected mothers?

Three complementary strategies can prevent mother-to-child transmission of HIV:

Taking steps to protect girls and women from becoming infected with HIV in the first place.
Provision of efficient and accessible family planning services to avoid unwanted pregnancy and births.
An integrated package of measures consisting of voluntary HIV counseling and testing, the provision of anti retro virals (ARV's) to HIV-positive pregnant women and their babies together with counseling on infant feeding options.

[i] UNAIDS (2000): “Report on the Global HIV/AIDS Epidemic”, December 2000

[ii] Division for the Advancement of Women(2000): “ Gender and HIV/AIDS – Update on the UN response” United Nations, New York, November 2000

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Women, Gender and HIV/AIDS in East and Southeast Asia

Mother-to-Child Transmission of HIV/AIDS A Question of Rights

Should HIV-positive mothers be told not to breastfeed?

Mother-to-Child Transmission of HIV/AIDS
A Question of Rights