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Gender and HIV/AIDS: Prevention of Mother-to-Child-Transmission (PMTCT) and paediatric treatment

Gender and HIV/AIDS: Prevention among young people

 

Gender and nutrition

© UNICEF/NYHQ2009-0200/Ysenburg
Women and children queue for food aid distributed by the Kenya Red Cross in Korogocho, a slum area of Nairobi, Kenya.

The health of a child is inextricably linked to the health and nutritional status of the mother. An under-nourished woman will give birth to a baby with low birth weight, causing the cycle of under-nutrition and poor health to continue.

In the Eastern and Southern Africa region (ESAR), approximately 14 percent of infants weigh less than 2.5 kg at birth, 26 percent of all children under the age of five are underweight, and 45 percent suffer from stunted growth, often resulting in irreversible physical and mental deficiencies later in life. Under-nutrition contributes to up to 50 percent of all cases of child mortality.

Key issues

Poor nutrition in girls and women is not only the result of inadequate quantities and quality of food, but also of nutrition insecurity, which can have many causes:

  • limited access to quality healthcare services;
  • deficits in environmental health;
  • lack of safe water, sanitation and hygiene;
  • and unsafe food preparation practices.

During adolescence, girls’ risk of anemia and iron deficiency increases due to quick growth and menstruation, often further enhanced by malaria and parasitic infections. Iron deficiency and anemia slow growth and increase fatigue, leading to lower performance in school.

During pregnancy, anemia increases the risk of complications and is also a main cause of maternal death. ESAR has one of the highest maternal mortality ratios in the world with some 80,000 women in the region dying every year from causes related to pregnancy and childbirth.

If a woman’s nutritional status is poor at conception and if she does not gain sufficient weight during pregnancy, she will most likely give birth to a low birth weight baby. Her child may never catch up in terms of growth and, as an adult, will run an increased risk of chronic illness such as heart disease and diabetes.

Low levels of exclusive breastfeeding further contribute to morbidity and mortality among children. In ESAR only 40 percent of babies are exclusively breastfed during the first six months, despite the fact that breast milk is the best form of nutrition for infants and significantly reduces the risk of diarrhoea, acute respiratory infection and other child killers. A woman may fail to breastfeed exclusively due to inadequate support from her partner or family, or because of labour burdens, or as a result of the aggressive promotion of formula as a breastmilk substitute.

Nutrition further has a direct impact on the health status of people living with HIV and AIDS. HIV increases people’s energy requirements, while reducing their appetite. As a result, HIV-positive people are more likely to be malnourished, and therefore need specific support in terms of nutrition. In the region, HIV prevalence among girls and young women is two to four times higher than among boys and young men. Because of stigma and the fear of being rejected by their families, women often refrain from getting tested or disclosing their HIV status, thus limiting their chances of getting treated when they become malnourished.

Decisions related to nutrition also play a key role in preventing mother-to-child transmission (PMTCT) of HIV. According to the latest guidelines issued by the World Health Organization (WHO), when breastfeeding is judged to be the safest infant feeding option for HIV-positive mothers, it must be accompanied by antiretroviral treatment (ART). Research has shown that mixed feeding without ART increases the risk of transmission.

© UNICEF/NYHQ2009-1932crop/Nesbitt
A mother feeds her six-month-old son in their home in Lusaka, Zambia.

Gender inequality: Gender inequality is an important underlying cause of women’s under-nutrition and is further exacerbated by poverty and lack of access to resources. In many cultural settings in the region, boys and men traditionally eat first, and girls and women eat the leftovers. When food is short, this can mean females have very little, or nothing at all, to eat. Because of gender norms, women often also have limited access to and control over resources and may therefore be excluded from household decision-making

Integrated approaches to improving infant and young child feeding in Kenya:

Between 1993 and 2003, the exclusive breastfeeding rate for children under 6 months in Kenya remained very low at 13 percent. The Government with UNICEF support established a comprehensive infant and young child feeding (IYCF) programme in 2007, including legal reform and training materials for maternity wards and communities. In 2008, 25 percent of all health and nutrition service providers and community health workers were trained in IYCF counselling. Messages on the benefits of exclusive breastfeeding were broadcast nationwide. By end 2008, the exclusive breastfeeding rate had jumped to 73 percent among women attending antenatal care or PMTCT services.

Sources: UNICEF Kenya Country Office, ‘Annual Report 2008’ and Demographic and Health Surveys, 1993, 1998 and 2003.

In addition, while women make up the majority of the agricultural workforce in sub-Saharan Africa and produce up to 80 percent of basic foodstuffs, they have the least access to the means of production. A study conducted by the Food and Agricultural Organization (FAO) showed that agricultural productivity in sub-Saharan Africa could rise by 20 percent if women had equal access to land, seed and fertilizer. In some countries, such as in Kenya, only 5 percent of women have land tenure rights.

Without land tenure, a widow is often disposed of her land by her husband’s family, leaving her and her children destitute. Thus, empowering women promises to reap a ‘double dividend’ of both better food and nutrition security and greater economic growth.

Lack of male participation: Men’s low involvement in infant and childcare further has a negative impact on children’s nutrition. Their absence may, for instance contribute to a low breastfeeding rate.

UNICEF interventions

In order to improve children’s nutritional status,women’s nutrition needs to be addressed at all stages of the life cycle.UNICEF strongly advocates for the scaling-up of integrated interventions using a multi-sectoral approach and working closely with regional bodies such as the African Union (AU) and the East, Central and Southern Africa Health Community (ECSA). These programmes aim to prevent nutritional deprivation before and during pregnancy and through the first two years of a child’s life.

UNICEF also works to improve maternal knowledge about nutrition and feeding practices. Community health workers, lay counsellors and mother-to-mother support groups are important delivery channels to achieve this. Support for young infant feeding is complemented with interventions to address malnutrition, such as complementary feeding for stunted children, provision of micronutrients and fortified food supplements and the management of severe acute malnutrition among children. This comprehensive approach further includes improving food security for poor families through social protection schemes such as cash transfers.

UNICEF also promotes the participation of male partners in antenatal care and PMTCT to improve feeding practices, including exclusive breastfeeding.

 

 
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