A new approach to maternal mortality: The role of HIV in pregnancy

As 2015 quickly approaches, we have been made increasingly aware of our progress toward the Millennium Development Goals (MDGs). Some remarkable progress has indeed been made. However, one MDG has been particularly recalcitrant to progress: MDG 5, namely, improving maternal health. Few countries are on track to achieve the first part of MDG 5's goals, reducing maternal mortality by 75%. Sub-Saharan Africa is in the most dire position, with a regional maternal mortality rate of 640 maternal deaths out of 100,000 live births, and a decline rate of merely 0.1% per year. This paper argues that greater provisions for HIV-specific services in young women of reproductive age could have a major impact on the global maternal mortality rate, especially in places like sub-Saharan Africa, where both HIV rates and the maternal mortality ratio are high. I demonstrate that only an integrative approach to the twin challenges of HIV and maternal mortality can help reduce devastatingly high rates of maternal deaths worldwide, especially in sub-Saharan Africa. The paper re-envisions the MDGs not as independent tasks but as related, cohesive issues for which a holistic approach is needed. Through careful review of the peer-reviewed literature, specific recommendations are offered, including: lifelong ART for pregnant women in sub-Saharan Africa, scale-up of community and household care, preventing unwanted pregnancies, joint ownership of HIV and maternal health clinics with integrated services, and educating international donors about the benefits of integrated, horizontal health programs.