In South Africa, the Midwives AIDS Alliance is taking the message of HIV prevention to pregnant women

In many ways, pregnant women in South Africa are lucky. Almost all of them visit a health care provider at least once during their pregnancy, and more than 7 of 10 see a provider 4 or more times before they give birth. Nonetheless, the maternal death rate in the country is high and rising, due in large part to HIV and AIDS.

The Midwives AIDS Alliance (MAA), organized by PATH and our partners, is mobilizing midwives across the country to act as catalyst in HIV prevention, care, and treatment. The group has proposed a simple solution: take advantage of patients’ regular visits to midwives to provide information, testing, and counseling about HIV as well as guidance in avoiding unintended pregnancies.

Midwives in South Africa provide a full spectrum of health care services to clients that include children, men, and women—whether pregnant or not.  A vital link to those at risk for HIV infection, midwives could receive training in services such as voluntary HIV counseling and testing, family planning, and prevention of HIV transmission from mother to baby. Trained midwives, in turn, could help make HIV prevention and treatment a regular part of care for mothers and children in South Africa. With a greater voice in health care, they could also mobilize others to achieve Millennium Development Goals 4, 5, and 6, which call for reducing mortality rates for children younger than five, improving maternal health, and combating HIV and AIDS and other major diseases.

The Midwives AIDS Alliance

In South Africa, recent estimates put the maternal mortality rate at between 152  and 400 deaths per 100,000 women of reproductive age each year. Between 2005 and 2007, the rate of maternal deaths in South Africa increased by a stunning 20 percent. The main cause of death was infection unrelated to pregnancy—a category that includes AIDS.

Launched in December 2008, the main aim of the Midwives AIDS Alliance is to provide a platform for midwives to advocate for integration of HIV prevention, treatment, and care into maternal and child health care services. The alliance works as a catalyst for action, mobilizing, motivating, and empowering midwives to expand their role in maternal and child health and the prevention of HIV and AIDS.

To reach this goal, the alliance, with members in all nine provinces of South Africa, has identified actions that could strengthen the role of midwives:

• Ensure comprehensive training for all midwives in HIV prevention, treatment, and care.
• Enhance the role of midwives in clinical practice to include HIV prevention, treatment, and care for mothers and their children— from before conception to after childbirth.
• Provide access to patient records with clear and accurate information on HIV status and history of care.
• Use health and safety measures to protect midwives from HIV transmission.

To advocate for the expanded role of midwives, the alliance’s members plan to mobilize midwives by conducting workshops, making presentations at meetings and conferences, and working closely with other advocacy groups.

Looking for best practices

For midwives in South Africa today, training in HIV prevention and treatment varies. Some have little training in the subject. Others have managed to gain substantial knowledge through in-service training. In spite of the challenges, some midwives are already taking the lead to manage the condition among their HIV-positive clients and to prevent the spread of the virus to those who are not infected.

The MAA, with the help of PATH, has identified several South African midwives as innovators in working with HIV-positive women. The group is documenting the practices of these “best midwives,” noting step-by-step their work. The MAA’s plan is to use the knowledge of these midwives to help train their colleagues, and to help introduce the idea of midwives as HIV experts in the care of pregnant women.

Photo: PATH/Amy MacIver.