Q.58 How should health workers at clinics integrate and support improved family planning by HIV-infected mothers?
Nearly all mothers, including HIV-infected women, return with their infants to child (maternal-child) health services within the first few weeks of the infant’s life. One of the key points to be covered in the first visits is to explain what family planning services are available to the mother, and to offer these services to her. In most cases, the health worker who is looking at the infant should also have been trained to check on the mother’s health, including knowledge of family planning issues. Depending on the set-up of the clinic, the same worker can offer her a family planning method, or the mother can be referred to another worker in the same clinic who can do this. The family planning method should be related to the infant feeding practice, with an emphasis on the dual protection against HIV/STIs and pregnancies afforded by condoms and on the protection afforded by exclusive breastfeeding. In all cases, the fact that family planning has been discussed, and whether the mother has accepted a method, should be recorded in a follow-up card.
HIV-infected women and mothers who are planning to become pregnant, regardless of whether they have already started ART, should be counselled on attending ANC early in the pregnancy, starting on ARVs for prophylaxis at an appropriate time and the importance of adhering to ARVs/ART throughout pregnancy.