Thursday, October 22nd, 2009 - No comments

Young and positive: Bearing the brunt of maternal mortality

I’d like to highlight the massive impact of maternal mortality and morbidity on two groups of women – young women and women living with HIV.

They have much in common because they so often lack choices and decision-making power: the power to choose if and when to have a child, to access comprehensive health services, protection by the law and support from their own communities; the freedom to make even the most basic choices which affect their lives.

Women in these groups bear more than their share of illness, disability and death due to childbirth and pregnancy, and most of it is preventable. In fact, ironically, there is no greater threat to the life of a teenage girl than pregnancy and childbirth. The pain and needless loss of life represent the violation of basic human rights: the rights to health and to the benefits of scientific progress; the rights to confidentiality and privacy; the right to information; the right to self-determination; and that most basic right – the right to life.

Traditional values

Cultural norms, sometimes called ‘traditional values’, can be tragically detrimental to the health of girls, young women and women living with HIV. When girls and young women are denied the right to comprehensive sexuality education, they may be unaware of how to access and use contraception, including condoms.

When this results in unwanted pregnancy, they may feel forced to seek an abortion or, as teenage mothers, they may be stigmatized and excluded. Others don’t survive, or suffer disability and debilitating illness such as fistula or uterine prolapsed. Women living with HIV, including teenage mothers, are also severely stigmatized and discriminated against.

Criminalization frames HIV as a crime

In some parts of the world, HIV-related criminal laws pose a major threat to the lives and health of women living with HIV. Although these laws are often seen as a measure to ‘protect women’, such laws are not gender specific and application of the criminal law does not address the economic, social, political and personal marginalization that underpins gender violence and women’s vulnerability to HIV. Criminalization frames HIV as a crime, rather than as an infection with major health implications.

Women who suspect or know they are pregnant are more likely to access health services, and thus more likely to find out their HIV status than their male partners. Knowing that they have HIV puts pregnant women at greater risk of prosecution.  In some countries, women can also be prosecuted for transmitting HIV to a fetus during pregnancy or to an infant during breastfeeding.

The needs of a woman

Positive HIV status can also lead to women being denied safe, quality maternity services. Even when pregnant women living with HIV have access to a full range of services, the health provider’s priority is often on preventing HIV transmission to the fetus rather than also meeting the needs and desires of the woman.

Political, religious and community leaders must be persuaded to encourage a pragmatic approach that recognizes the reality of people’s lives. Creating and sustaining health systems and societies that support and meet the needs of young women and women living with HIV is a daunting challenge, but it is one we cannot afford to delay.

Women must enjoy their human rights

By ensuring girls’ education, challenging gender stereotypes, demanding equitable laws and policies, ensuring universal access to comprehensive sexual and reproductive health services, and dedicating resources to meet the needs and priorities of marginalized women, we can build a world that will make it possible for all pregnant women to enjoy their human rights, and especially the right to health and the right to life.

The views expressed in this blog-post are solely those of the author.