Increased Elective C-Sections Decreases HIV Transmission in Ukraine
In the postpartum ward of Simferopol Maternity Hospital N. 2, Viktor helps his wife, Natalia, (names changed) to care for their baby boy. Viktor and Natalia, both HIV-positive, were referred to the Simferopol Maternity Hospital N. 2 by the AIDS Center, after they were assured that they would receive the same treatment as any other couple expecting a child.
The couple was told that Natalia would deliver in a family delivery room and then share a postpartum room with other women in the Mother and Infant Health Project’s maternity ward. Viktor would take part in the delivery and then he, or other family members, would be able to visit the mother and child at any time. He was also asked to warm his baby after the delivery through skin-to-skin contact to help prevent hypothermia while his wife was recovering from cesarean delivery (C-section).
“I was amazed when the doctor proposed that I warm my son. It was an unforgettable feeling to see my baby crawling on my chest. I could have held him forever,” explained Viktor, savoring his memory.
Viktor and Natalia’s experience would have been much different just a few years ago. When USAID launched its Maternal and Infant Health Project in Ukraine in 2003, maternity hospitals had a history of treating HIV-positive pregnant women as outcasts. They were placed in isolated delivery/operation rooms, sometimes located in the basement, and postpartum rooms where guests were not allowed. In a few instances, overcautious health care providers and oblast health authorities—driven by fear that HIV-positive mothers and their newborns could spread the virus to other women in the ward—established separate maternities for HIV-positive women. The mistreatment added to the unjustified stigma that often burdens those infected.
Since its inception, USAID’s Mother and Infant Health Project (MIHP) has worked with healthcare providers in 20 maternities of 12 oblasts to change their attitudes and improve care skills for HIV-positive women. It has introduced and mastered evidence-based perinatal technologies recommended by the World Health Organization, including elective C-section for HIV-positive women and timely antiretroviral therapy; family delivery and early mother-baby or father-baby skin-to-skin contact; co-habitation with other delivering mothers; and, elimination of isolation rooms.
During all training for maternity personnel on preventing mother-to-child transmission, MIHP specialists involved AIDS-center specialists, representatives of the National Alliance of People Living With HIV/AIDS, international health- and HIV-related NGOs and local health authorities, to create a link among all institutions working with HIV-positive people to master the same approaches for care of HIV-positive women and their families in all maternal and child health-care settings.
Today, as a result of such cooperation, all HIV-positive women in MIHP maternities deliver using elective C-section, which dramatically reduces the vertical HIV-transmission to newborns. In Donetsk, the Oblast Health Department has instituted mandatory elective C-section for all HIV-positive women delivering in the oblast.
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| The graph reflects the increase of elective cesarean deliveries among HIV-positive women in Donetsk and Simferopol between 2005 and 2006 |
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