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Saving the Lives of Mothers Worldwide

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Mother's Day is a celebration of life and reflects the importance of women to their families, communities and countries. Yet every hour, 40 pregnant women and new mothers around the world die--and seven of those 40 perish not because of a lack of emergency obstetrical care, but because of HIV/AIDS.

While a recent report in the Lancet provides news that we can celebrate--maternal mortality worldwide has dropped from 525,000 to 340,000 deaths per year between 1980 and 2008-- the report also underscores that were it not for the high prevalence of HIV/AIDS in pregnant women around the world, the maternal death rate would be almost 20 percent lower, to 280,000 deaths annually. That means that the lives of 60,000 pregnant women and new mothers are lost every year because of HIV/AIDS, particularly in eastern and southern Africa.

Globally, HIV/AIDS is the leading cause of death among women of reproductive age. Sub-Saharan Africa now accounts for over half of all maternal deaths in the world, up from 23 percent in 1980, in large part because of the rapid rise in maternal mortality beginning in the early 1990s, linked to increasing HIV infection rates in women. And in spite of global decreases, all six countries in southern Sub-Saharan Africa have experienced increases in maternal mortality, defined as death during pregnancy or within 42 days after the end of pregnancy, over the past three decades.

Reasons for the increase in maternal deaths linked to HIV/AIDS require further study, but research suggests that it may be attributable to higher rates of all-cause mortality due to this disease, an elevated rate of pregnancy-related complications in HIV-positive women (such as hemorrhage, opportunistic infections, and sepsis), the pervasive stigma that discourages women from seeking care and impedes access to services, and a shortage of safe blood for transfusions. Another contributing factor in these countries may be the limited availability of skilled birth attendants because of the burden of HIV on the health system and the AIDS-related deaths of these health care workers.

While there has been great success in preventing mother-to-child transmission of HIV, intensified efforts are needed to protect the health of HIV-positive mothers as well. Prenatal care and delivery is an entry point for women into the health care system and an opportunity to treat women who are infected with HIV. Short-course antiretroviral therapy during pregnancy and labor has proven very effective in reducing the risk of HIV spread from mother to child in both the industrialized world and in resource-poor settings. Furthermore, in the developing world, HIV-positive mothers are not often prescribed further treatment for HIV to prevent the development of AIDS. This start-and-stop therapy is not only a missed opportunity for intervention but also can lead to drug resistance, making future efforts to treat this disease in women even more difficult.

HIV/AIDS continues to cause the deaths of more than 1 million women annually, including pregnant women and those in the postpartum period. That is why we must intensify efforts to save the lives of pregnant women and new mothers, employing a comprehensive and multi-faceted approach. This strategy must involve continuing treatment of women with antiretroviral medications after they give birth, preventing HIV infection in all women and their partners before pregnancy, testing and early treatment of HIV, reducing stigma, as well as improving the economic status, educational opportunities and the empowerment of women worldwide.

The enormity of the HIV/AIDS epidemic in many countries means that addressing AIDS is central to advancing other health and development goals, including reducing maternal mortality. Therefore, addressing and funding these issues independently can lead to a fragmentation of efforts and missed opportunities. Reducing maternal mortality is a cornerstone of the Administration's Global Health Initiative (GHI), and should be coordinated with GHI's programming to eradicate AIDS including strengthening support of the President's Emergency Plan for HIV/AIDS Relief (PEPFAR) which has produced lifesaving benefits. Insufficient funding for HIV/AIDS initiatives will shortchange those who are most vulnerable, particularly women, who now represent half of all people living with HIV/AIDS worldwide. Integration of initiatives will improve results, efficiency and the effectiveness of efforts.

The saved lives of nearly 200,000 new mothers every year represent a triumph of the safe motherhood movement, but those 60,000 deaths from HIV/AIDS annually represent a tragic, preventable loss that must be redressed. So starting this Mother's Day, let's work together to deliver a world to women where twinning a focus on maternal mortality and AIDS results in a significant decline in both of these major public health problems.

Rear Admiral Susan Blumenthal, M.D. (ret.) is Senior Policy and Medical Advisor at amfAR, The Foundation for AIDS Research. She also serves as a Clinical Professor at Georgetown and Tufts University Schools of Medicine, and Chair of the Global Health Program at the Meridian International Center. She served for more than 20 years in health leadership positions in the Federal government, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, and as Chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health. Dr. Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the US Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. She is the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association.

Co-authored by Melissa Shive, a medical student at the University of California, San Francisco. She served as a Research Assistant at amfAR, The Foundation for AIDS Research in Washington DC and graduated with honors from the University of Pennsylvania.