08 June 2010
It has been noted in some countries that women living with HIV have been forced or feel pressured by healthcare workers to have abortions. Positive women may choose to have an abortion because they are misinformed about the possible impact of a pregnancy on their health and that of their child or they may be told that the risks of perinatal transmission are high.
Such misconceptions can be heightened by health workers who promote a view that women with HIV should not have children. However, positive women should never be pressured by their partners, families or health workers to have an abortion as this is a violation of their human rights.
The limited research data available suggest that women living with HIV/AIDS have an increased risk of miscarriage (also called spontaneous abortion) and stillbirths (WHO). However, many women living with HIV/AIDS lack access to safe post abortion care services.
Research shows that women living with HIV have unwanted pregnancies for many of the same reasons that HIV negative women do, including pregnancies from rape and incest and the desire not to bring a child into a situation of ongoing domestic violence. Some women have achieved their desired family size or do not feel they have the economic resources to care for another child.
A positive HIV status may also cause women to reject pregnancy for new reasons. Some women need to spend their restricted incomes on accessing medications and treatments for their own family and perhaps other family members’. Some women believe that a pregnancy could have a negative impact on their health or they fear infecting a child with HIV.
In some situations, HIV positive women have been denied safe abortion care or have been asked to agree to sterilization in order to access abortion services. This is a violation of their rights to unbiased health care.
Clinical research regarding provision of abortion care to HIV positive women is almost nonexistent. We do not yet know whether complications of unsafe abortions differ between HIV positive women who are asymptomatic, immunocompromised and not receiving antiretroviral drugs (ARVs) and women who are taking ARVs.
And we do not yet know if women living with HIV respond to surgical and medical abortion methods differently than HIV negative women.
Women living with HIV/AIDS are prone to septicaemia and may be particularly at risk of complications, so that preventing unintended pregnancies and unsafe abortion is essential for improving the health of these women. Ensuring that safe abortion is available and accessible to the full extent allowed by law to women living with HIV/AIDS who do not want to carry a pregnancy to term is essential to preserving their reproductive health.
Laws should also be enacted to ensure women’s reproductive and sexual rights, including the right of independent access to reproductive and STD health information and services and means of contraception, including safe and legal abortion and the freedom to choose among these, the right to determine number and spacing of children, the right to demand safer sex practices and the right to legal protection from sexual violence, outside and inside marriage, including legal provisions for marital rape.
To make an informed decision about whether to continue with the pregnancy or have an abortion, women living with HIV/AIDS need to know the risks of pregnancy to their own health, the risks of transmission of HIV to their infant and the effectiveness and the availability and cost of antiretroviral drugs for treating HIV infection and for preventing HIV infection among infants as well as the potential toxicity of such drugs.
They also need to know the side effects and risks of the abortion procedures available. The woman should make the final decision to terminate a pregnancy.
There is a need for improved policy formulation and service provision that include stronger linkages between HIV/AIDS and reproductive health services.