Research shows that integrating family planning and HIV services is an effective strategy for increasing access to contraception among women with HIV who who wishes to avoid or delay pregnancy and reduce HIV infections in children worldwide.
Global commitments to eliminate new HIV infections in newborns recognises that preventing unintended pregnancies among women with HIV is essential to achieving this goal.
Yet, Nigeria is among countries where a number of health systems obstacles are hindering achievement of effective, sustained large scale delivery of integrated family planning and HIV services.
Despite that the country is signatory to the global commitments, substantial shortcomings exist in translating this policy support into widespread practice.
This is just as research has proven PMTCT as a better strategy in paediatric HIV management as the new antiretroviral treatment (ART) is still at the pilot stage in the country.
Unfortunately, programmes to prevent mother-to-child transmission of HIV continue to be implemented and evaluated as a narrow set of interventions that typically begins in antenatal care, after a woman is already pregnant.
This is one of the reasons for the growing numbers of HIV infections and deaths among Nigerian newborns and children.
The National AIDS and STIs Control Programme (NASCP) reports that 409 and 833 Nigerian babies were HIV positive in 2020 and 2019 respectively.
Sadly, in 2018, the country also recorded 808 HIV positive babies, while the figure was 1,359 in 2017.
Also, more than 47 children and adolescents died every day from AIDS-related causes across the country in 2018, according to a global snapshot on children, HIV and AIDS, the United Nations Children Fund (UNICEF) reports.
The reasons are not far-fetched. Low access to antiretroviral treatment and limited prevention efforts are the leading causes for these deaths, with only 54 percent of children aged 0-14 living with HIV globally in 2018 – or 790,000 children – receiving lifesaving antiretroviral therapy.
Voluntary family planning to enable women and couples to determine the timing and spacing of their pregnancies has long been recognised as a basic human right.
Sadly, data suggest that women living with HIV experience high rates of unmet need for family planning and unintended pregnancies.
Many studies confirm the contributions of family planning to global health and development, including achievement of the Sustainable Development Goals(SDGs).
In 2012, the groundbreaking London Summit on Family Planning galvanised support for the far-reaching benefits of family planning, leading funders, government leaders and other partners to commit to expanding access to contraception and rights-based family planning services to an additional 120 million women and girls.
For women and couples living with HIV who do not wish to become pregnant, family planning offers the added benefit of helping prevent mother-to-child transmission of HIV (PMTCT).
In 2003, the World Health Organisation(WHO) and its partners conceptualised a comprehensive framework for PMTCT consisting of certain core elements.
These include, primary prevention of HIV among women of childbearing age; prevention of unintended pregnancies among women living with HIV and prevention of transmission from HIV-infected women to their infants.
The fourth element is the provision of treatment, care and support to HIV-infected women and their children and families
Ten years later, this four-element strategy continues to provide the foundation for current global commitments to eliminate new pediatric HIV infection.
These include the Global Plan Towards the Elimination of New HIV Infections Among Children By 2030 and Keeping Their Mothers Alive. The centrality of family planning to MTCT elimination is clearly articulated in both of these commitments.
To achieve this goal, prevention of unintended pregnancies among women with HIV must be elevated as a programmatic priority in Nigeria.
While the importance of family planning to achieving the end of new pediatric HIV infection is recognized in relevant policy statements, few PMTCT programs have increased access to contraception for HIV-infected women and couples who do not wish to become pregnant.
A shift in how PMTCT programmes are conceptualised, implemented and evaluated is needed to better address the contraceptive needs of HIV-infected women and accelerate progress toward ending new pediatric HIV infection.
More widespread implementation of evidence-based approaches to integrating family planning and HIV services can enhance the contribution of family planning to ending pediatric HIV.
However, PMTCT and other HIV service delivery implementers, policymakers, and funders must also implement and report on family planning interventions as a routine component of their programs. Transforming services in this way will help HIV-infected women and couples achieve their desired timing and number of children and, in turn, produce gains on both reproductive health outcomes and elimination of pediatric HIV.
Those who want to become pregnant can be supported to plan for safer conception and access ART services to reduce the risk of HIV transmission from mother to child. Those who do not wish to become pregnant can be supported to access and use contraception.
By strengthening family planning programmes for all women, and better integrating family planning and HIV services, progress toward ending new pediatric HIV infections will be accelerated.
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