Traditional Birth Attendants Help HIV-Positive Women Deliver Uninfected Babies

Preventing mother-to-child transmission (PMTCT) of HIV remains a challenge in Haiti since most institutions providing maternal health care are not equipped to perform deliveries. (A key drug to prevent the transmission of HIV is administered during labor and delivery.) In the North Department, a USAID-funded clinic helps HIV-positive pregnant women receive the full package of services that their status requires.

The story of Guise Paulne’s (name changed to protect her privacy) illu-strates the success of these efforts. At her first prenatal visit during her second pregnancy, Guise tested HIV-positive. The baby’s father’s HIV status is unknown (he has refused testing) and their first baby (four years old) is in apparent good health, but Guise understood the seriousness of this situation.[Integration between community-based and institutional services helped Guise learn her HIV status at a prenatal visit, and receive treatment from her chosen traditional birth attendant to prevent transmission of HIV to her unborn child. Photo by MSH staff.]Integration between community-based and institutional services helped Guise learn her HIV status at a prenatal visit, and receive treatment from her chosen traditional birth attendant to prevent transmission of HIV to her unborn child. Photo by MSH staff.

Like most women in Haiti, Guise chose to have her baby at home. Unlike many of those women, Guise has an advantage: her mother is a traditional birth attendant (TBA, or matrone) who has worked with the USAID-supported clinic for years. Guise was closely monitored by the clinic and chose her mother to be her “buddy” from the first prenatal visit through delivery and her entire PMTCT treatment.

Guise’s mother is well informed about HIV transmission and was very con-scious of the role she was called to play. She remained committed throughout Guise’s pregnancy and helped Guise to attend all of her ap-pointments and to take her prophylactic medication properly.

On the day of the birth, the mother-matrone had the necessary equip-ment on hand, remained faithful to the service guidelines, administered the medication properly, and led her daughter through a successful birth. The next day, she proudly presented her new grandchild for care at the clinic.

With support from the American People through the SDSH Project, Hai-tian institutions are adopting innovative approaches to help all HIV-positive pregnant women benefit from preven-tion of mother-to-child HIV transmis-sion (PMTCT) programs. Traditional birth attendants are trained to provide PMTCT care, including HIV prophylaxis to infants during their first 18 months. (The attendants are especially important in rural areas where facilities are scarce.) The program also provides subsidies to HIV-positive women re-ceiving services from these matrones.


Deeply rooted in traditional practices, this story is an example of suc-cessful integration of community- and facility-based services. This family—infected and affected by HIV—benefitted from the tradition and comfort of having the mother-matrone help deliver a child, but they also benefitted from the HIV-prevention resources of the clinic’s program.

And the health system, unable to serve the entire population through facilities, is able to collaborate with community agents to reach Haitians who might otherwise not receive the care they need and deserve. Working together, these forces are helping prevent new HIV infections among newborns.

 

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