Integrating family planning and prevention of mother-to-child HIV transmission in resource-limited settings

Mother-to-child transmission prevention programmes often lack the budget, organisational structure, and technical expertise to provide comprehensive services. A review of programmes in 11 countries in Africa, Asia, and Latin America and the Caribbean reported that family-planning services were generally separately organised and not integrated, and often not tailored to the needs of HIV-infected women, resulting in missed opportunities to provide counselling and service (Rutenberg N, unpublished). Although strengthening existing contraceptive services will be helpful, integrated services offer unique advantages. Integration links family planning counselling and services closely in space and time to mother-to-child transmission prevention programmes. Mother-to-child transmission prevention programmes identify childbearing HIV-infected women (the target group for the second component of the UN strategy described earlier), who could be at risk for subsequent unintended pregnancy but who may not otherwise access family planning services. Integration takes advantage of mother-to-child transmission prevention providers' knowledge of the HIV status of their clients and being sensitive to their needs. The experience of integrating family planning with other HIV services suggests that integrated services increase contraceptive use and reduce unwanted pregnancies for both HIV-positive and HIV-negative couples. At a voluntary counselling and testing site in Haiti with integrated reproductive health services, 19% of clients presenting for an HIV test became new users of a contraceptive method.17 Introducing contraceptive services into a Rwandan voluntary counselling and testing clinic resulted in increased use of hormonal contraception, reduced contraceptive discontinuation (from 50 to