Mother to Child Transmission

Around ninety percent of the more than 4 million children around the world who have died of AIDS-related illness contracted HIV from their mothers. UNICEF is one of the focal agencies in the UN system for action to prevent mother-to-child transmission – the chain of infections from male partner to mother to child.

Mother-to-Child Transmission

In developing countries, without preventive interventions, a child born to an HIV-positive mother has roughly a 25-35% chance of being infected with HIV during their first two years, according to the most recent estimates. Mother-to-child transmission can occur during pregnancy, during delivery and during breastfeeding (the virus is often present in infected mothers' breastmilk). Studies indicate that inappropriate infant feeding carries the greatest risk of transmission.

WHO estimates that 25% of children infected in this way will die before age one, 80% before age five.

Several factors influence the likelihood of transmission from an HIV-infected mother to an infant, including the health status of the mother, duration of labour, modes of infant feeding and access to preventive anti-retroviral drugs.

UNICEF and Prevention of Mother-to-Child Transmission

In East Asia and the Pacific, UNICEF is helping to develop comprehensive prevention of mother-to-child transmission (PMCT) services in several countries where HIV infection rates among pregnant women are high. UNICEF emphasizes designing programs that work in low-resource settings.

Educating young women about HIV/AIDS helps them protect themselves – and their families

In some places, new UNICEF-supported PMCT programs serve as useful initial entry points for larger HIV/AIDS prevention and care responses, such as behaviour development and change communications/Lifeskills and community-based care and support, which command the bulk of UNICEF budget and technical assistance.

A comprehensive PMCT program:

  • Protects girls and women of reproductive age from becoming infected with HIV
  • Develops and strengthen reproductive health services that are accessible and cater to the needs of men, women and youth.
  • Integrates voluntary confidential HIV counselling and testing in Maternal and Child Health/reproductive health services.
  • Offers the following interventions:
    • Prophylaxis with a short course of antiretroviral drugs for women who are known to be HIV-positive
    • Counselling on safe infant feeding
    • Counselling on family planning, and provision of services
    • Care and support to HIV-positive mothers and their children.

Prevention Strategies

Protecting Women

In East Asia and Pacific, many women need to be empowered to take control of their sexual and reproductive health, not just in the area of HIV/AIDS prevention. Relevant information on their sexual and reproductive health should be made available and accessible to all women and girls.

UNICEF supports a range of Lifeskills-based communication activities that aim to provide women with information and to develop skills in HIV/AIDS prevention, from the Friends Tell Friends factory workers' peer education program in Lao PDR to the INTHANOU HIV/AIDS Hotline and promotional TV spots in Cambodia. UNICEF also supports communication activities that encourage male partners to "love responsibly".

Voluntary Confidential Counselling and Testing

Voluntary confidential counselling and testing (VCCT) for HIV allows one-to-one discussion with potential mothers and their partners (with the consent of the women) to provide a firm basis for important decisions about pregnancy, infant feeding, how to take care of their health and to live positively.

UNICEF supplies HIV testing kits and supports counsellor training within VCCT services in several East Asia and Pacific countries. Although UNICEF support to VCCT is primarily in mother and child health services, UNICEF also supports VCCT in youth reproductive health services.

Anti-retrovirals for PMCT

Short courses of antiretroviral drugs during pregnancy, delivery and post-delivery reduce the risk of mother-to-child transmission. UNICEF is procuring supplies of the antiretroviral nevirapine for PMCT pilot programs in Myanmar, Cambodia and Papua New Guinea, in order to get the programs running as quickly as possible. This will be linked with donations from pharmaceutical companies when the countries are ready to take their PMCT programs up to national scale.

A still from the UNICEF-supported TV spots aired in Cambodia to promote new VCCT services

Infant Feeding Options

UNICEF, WHO and UNAIDS publish joint policy guidelines on infant feeding to help governments design their own policies, appropriate to their local situations. Necessary technical assistance is also provided to train counsellors on infant feeding options in the context of HIV/AIDS.

PMCT and Rights

Issues surrounding women's reproductive health and reproductive health care are extremely sensitive in some parts of the region, but the human rights message is clear: every woman has the fundamental right to decide whether to have children, whether to find out their HIV status, and how best to feed their infant. States have a duty to see that they are provided with relevant information and support with services in their respective local context.

All children, regardless of their own or their parents' HIV status, have the right:

  • to education,
  • to care in a family or in another appropriate family-like environment,
  • to the best available health care,
  • to freedom from discrimination,
  • to be protected from abuse, and
  • to an adequate standard of living

Children of HIV-positive Mothers

UNICEF supports a range of programs aimed at strengthening vulnerable families and communities, alongside activities more specifically targeting children affected by HIV/AIDS – both those who are HIV positive and those who are not.

More information about UNICEF and children affected by HIV/AIDS can be found in the UNICEF regional publication Securing a Future.

The UN Regional Taskforce

UNICEF coordinates the UN Regional Taskforce on Mother-to-Child Transmission, which brings together UN, government, NGO and international organizations from the most-affected countries in South Asia, Southeast Asia and the Pacific.

The Taskforce facilitates technical exchange and experiences sharing of emerging PMCT programs and responses to challenging issues like provision of ARVs, integration of VCCT into existing MCH services and of infant feeding options. The Taskforce provides an electronic data dissemination service and regular technical updates.

A report on the Regional Taskforce (pictured right) is available from UNICEF.

Snapshot: Country Progress

Thailand

Thailand has the most established nation-wide PMCT program in East Asia and the Pacific, and has provided important lessons for the region and for the world. Through the Technical Cooperation among Developing Counties program, UNICEF Thailand hosts frequent international study tours and training/workshops on PMCT.

Cambodia

UNICEF is supporting development of pilot PMCT projects in two sites, integrating PMCT services into the antenatal care services of the public hospital in Battambang province and in Phnom Penh. UNICEF is also supporting general VCCT services in six sites in high HIV prevalence areas. These services are increasingly utilized by young people aged 15-25.

Myanmar

UNICEF is supporting pilot PMCT activities in the five high-prevalence townships, with a focus on community-level services. Linking PMCT with women's health projects, kits for HIV testing and nevirapine, emergency obstetric care instruments for township hospitals and clean delivery kits for community midwives were provided. UNICEF also assisted in developing and implementing a PMCT counselling training package for primary health care providers, auxiliary midwives and hospital nurses in these townships in early 2001.

Papua New Guinea

In 2000, 9% of reported HIV/AIDS infections in PNG were in children who contracted HIV from their mothers. Following a UNICEF-supported needs assessment on PMCT and care and support for children affected, the National AIDS Council has now identified four hospitals for pilot implementation with UNICEF support. At present, training manuals for PMCT counsellors are being developed for use in later UNICEF-supported training of counsellors.

For more information on country-level activities, see the individual country reports.