The first study, led by Professor Basia Zaba at the London School of Hygiene & Tropical Medicine, found that the HIV-infected pregnant or post-partum women are eight times more likely to die than their non-HIV infected counterparts, suggesting that around a quarter of deaths in pregnancy in sub-Saharan Africa may be attributable to HIV.
While it has previously been suggested that increasing rates of maternal mortality in some sub-Saharan African countries are due to the effect of HIV, until now there has been little evidence for this as previous estimates, based on mathematical models, have shown wide variation.
This is the first empirical study to estimate the effect of HIV, and was based on data from six independently established community based studies in Malawi, Zimbabwe, Uganda, Tanzania, and South Africa.
The authors suggest that the high proportion of deaths in pregnant women with HIV may partly result from the way pregnant women have been treated for HIV in some areas; drugs were generally given to prevent mother-to-child transmission, usually made available just before delivery, when it is too late to help the mother’s survival.
The authors call for HIV and reproductive health services to be integrated with safe motherhood programmes, so that pregnant women who are infected with HIV can be can be actively encouraged to take up HIV treatment during their pregnancy.
In the second study, researchers led by Justine Hsu, conducted an analysis of official development assistance for reproductive health in 2009 and 2010. They found that less than a tenth (7%) of the total funding was spent on family planning. Around half of the total funding was spent on the prevention, care, and treatment of HIV infection for adult women.
The study is the first to look at how aid is disbursed for a comprehensive set of reproductive health activities, including treatment of sexually transmitted infections.
Lead author, Justin Hsu, said: “We found that over 50% of aid to reproductive health was spent on HIV/AIDS activities for women, in contrast to just 7% spent on family planning. A balance of aid across reproductive health activities is essential if international targets are to be met for universal access to reproductive health.”
The authors found that aid was heavily dependent on just five main donors: USA, UK, the Global Fund, United Nations Population Fund, and the World Bank, who together provided around three quarters of the total funding for reproductive health. The top recipients of aid are heavily determined by funding to HIV activities.
Overall, the analysis shows that aid appears to be largely directed to the countries that need it most, though information on domestic resources to reproductive health is still lacking and further data is needed on aid from non-profit organisations, private foundations (in addition to the Gates Foundation), and emerging donors such as China.
Co-author, Professor Anne Mills, added: “This paper highlights the importance of analysing funding in detail to understand what aspects of reproductive health are being supported. Tracking flows of money not only helps to encourage donor accountability for their stated commitments but also can improve investments in women’s health.”
• Basia Zaba, Clara Calvert, Milly Marston, Raphael Isingo, Jessica Nakiyingi-Miiro, Tom Lutalo, Amelia Crampin, Laura Robertson, Kobus Herbst, Marie-Louise Newell, Jim Todd, Peter Byass, Ties Boerma, Carine Ronsmans. Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for Analysing Longitudinal Population-based HIV/AIDS data in Africa (ALPHA). The Lancet. doi:10.1016/S0140-6736(13)60803-X
• Justine Hsu, Peter Berman, Anne Mills. Reproductive health priorities: evidence from a resource tracking analysis of disbursements of official development assistance in 2009 and 2010. The Lancet. doi:10.1016/S0140-6736(13)60762-X
London School of Hygiene & Tropical Medicine