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Abstract
Introduction: Motherhood among women living with HIV/AIDS is considered perilous in most of the countries of
Sub-Saharan Africa.
Objectives: To analyse womens compliance to biomedical norms recommended to reduce the risk of mother-to-
child transmission of HIV during pregnancy and childbirth in the rural province of Maputo.
Methodology: A qualitative study was performed, consisting of in-depth interviews and focus group discussions
with women who had become mothers, in-depth interviews with community health workers and semi-structured
interviews with mother and child health nurses. We used Bourdieus theory of practice as a guiding framework to
analyse the data.
Results: Our findings showed that participants complied with some recommended biomedical norms to reduce
the risk of mother-to-child transmission of HIV, such as subsequent antenatal visits, adherence to antiretroviral
therapy and childbirth at the health facility. However, they did not comply with the timing of the first antenatal care,
use of modern health care system to treat illness episodes and use of condom during pregnancy.
Conclusion: The study results suggest that compliance to the recommended prevention of mother-to-child
transmission is the result of complex interactions in which participants rely on knowledge and resources within both
the family and community and the modern health care system. Awareness among health care workers of pregnant
womens perspectives as well as an adequate education about the timing of the first antenatal care and the benefits
of antenatal care in both the health facility and community could thus enable to improve prevention of mother-to-
child transmission of HIV.
Keywords: Antenatal care; Experience of pregnancy; HIV HIV infected women also face stigma and discrimination in their
positive women; Mozambique communities, contributing to a limited or lack of access to
adequate health services and stress [7].
Introduction Several studies [8,9] reported that mother-to-child transmission
(MTCT) of HIV occurs during pregnancy, labour and breastfeeding.
The journey to motherhood among pregnant women living with
When HIV pregnant women follow the prescribed PMTCT, the
HIV/AIDS is considered perilous in most of the countries of Sub-
transmission is almost eliminated [10]. However, lack of coverage and
Saharan Africa. Carrying a pregnancy implies to follow biomedical
follow-up of antenatal care (ANC) influence the effectiveness of PMTCT
norms recommended by campaigns on prevention of mother-to-child
in developing countries [11]. Moreover, this process requires early
transmission (PMTCT) of HIV. These recommendations consist of
adherence and compliance to several biomedical norms that are often
attending first antenatal care from the first trimester of the pregnancy
conflicting with social norms at community level.
[1], as well as adherence and compliance to antiretroviral therapy
(ARTs) to prevent transmission of HIV during the pregnancy, as ANC plays a critical role in the health of pregnant women regardless
recommended by the World Health Organization [2] and the Ministry of of their HIV status. It is a key entry point to receive preventive health
Health of Mozambique [3,4]. Moreover, women are recommended to services such as nutritional support, prevention and treatment of several
give childbirth at a health facility, to adhere to ARTs for the new-born, to diseases (malaria, tuberculosis, tetanus, toxic immunization)
practise exclusive breastfeeding in the first six months of life [2,5] and to [1]. Moreover, women receive counselling about postpartum care for
adhere to lifelong ARTs for their own health [6]. However, themselves and their new-born and child spacing. Among women
Clinics Mother Child Health, an open access journal Volume 13 Issue 3 1000246
ISSN:2090-7214
Citation: Cuinhane CE, Coene G, Roelens K, Vanroelen C (2016) Understanding HIV Positive Womens Experiences with Antenatal Care in
Rural Maputo Province, Mozambique. Clinics Mother Child Health 13: 246. doi:10.4172/2090-7214.1000246
living with HIV, ANC enables access to ARTs to early prevent MTCT
[12,13], counselling about benefits of giving birth at a health facility,
safe practices of breastfeeding and early postnatal care [2].
maternity clinic. This model consists of offering both mother and child
breastfeeding [3]. Late ANC may result in high risk of MTCT of HIV,
and not all women attending the 4 ANC visits give birth in a health
facility. In Sub-Saharan Africa, in 2014, only 49% of women reported
at least four ANC visits and only 52% of childbirths were attended by
skilled health personnel [16]. In 2011, the Demographic Health Survey
(DHS) at a national level showed that in Mozambique, 91% of women
attended at least one ANC, 51% attended 4 ANC visits, and 55% gave
women living with HIV. Therefore, the objective of this study was to
Divorced/Widow
Data analysis
A thematic analysis approach was applied to obtain the key themes
Number of Children
emerging from the data. The analysis involved five stages. First,
interviews were transcribed and then translated from Portuguese to
2-Jan
English. Second, each transcription was read more than once, and
initial codes were generated. Third, the codes were used to identify and
search different themes across the data. Fourth, the identified themes 4-Mar
were revised according to the research objectives, and final themes
were defined. Codes and themes emerging from the data set were 6-May
discussed and approved by all researchers involved in this study. The
last stage of thematic analysis consisted of producing a report of the
Occupation
research outcomes. Moreover, a statistic package for Social Sciences
Factor worker
Farmer
Housemaid
Own business/sale Table 1: Demographic participants of the study participants.
Clinics Mother Child Health, an open access journal Volume 13 Issue 3 1000246
ISSN:2090-7214
Citation: Cuinhane CE, Coene G, Roelens K, Vanroelen C (2016) Understanding HIV Positive Womens Experiences with Antenatal Care in
Rural Maputo Province, Mozambique. Clinics Mother Child Health 13: 246. doi:10.4172/2090-7214.1000246
Clinics Mother Child Health, an open access journal Volume 13 Issue 3 1000246
ISSN:2090-7214
Citation: Cuinhane CE, Coene G, Roelens K, Vanroelen C (2016) Understanding HIV Positive Womens Experiences with Antenatal Care in
Rural Maputo Province, Mozambique. Clinics Mother Child Health 13: 246. doi:10.4172/2090-7214.1000246
the belly was visible. () I waited until the belly was visible, and I went
back to the health facility at four months [16 weeks]. (20 years, 1 child,
Namaacha).
time for the first ANC. Some participants with unknown HIV status
prior to the pregnancy reported that they would have attended the first
ANC earlier if they had known they were HIV positive prior to the
pregnancy. Moreover, other participants delayed the first ANC because
they were feeling lazy and did not want to get tired to go to the
Characteristics of participants
Age range
18-24
25-34
35-39
Educational Level
None
Marital Status
Single
Divorced/Widow
Number of Children
2-Jan
4-Mar
Occupation
Factor worker
Farmer
Housemaid
Own business/sale
Student
Teacher
Table 2 presents the gestational age of the participants at the first age at the first ANC was 8 weeks and the latest was 28 weeks. Most
ANC according to their social characteristics. The earliest gestational participants attended the first ANC between 13-24 weeks, regardless of
Clinics Mother Child Health, an open access journal Volume 13 Issue 3 1000246
ISSN:2090-7214
Citation: Cuinhane CE, Coene G, Roelens K, Vanroelen C (2016) Understanding HIV Positive Womens Experiences with Antenatal Care in
Rural Maputo Province, Mozambique. Clinics Mother Child Health 13: 246. doi:10.4172/2090-7214.1000246
Page 6 of 9
Characteristics of participants
Age range
18-24
25-34
35-39
Educational Level
None
Student
(7-9 years)
Teacher
Secondary education completed
5-6
Practices of pregnancy care
This section describes womens practices regarding disclosure of
Occupation
HIV status to the partner for women who knew their HIV positive
status for the first time at the ANC, adherence to ARTs, use of
Factor worker
condom and management of illness episodes during pregnancy.
Farmer
Housemaid
Clinics Mother Child Health, an open access journal Volume 13 Issue 3 1000246
ISSN:2090-7214
Citation: Cuinhane CE, Coene G, Roelens K, Vanroelen C (2016) Understanding HIV Positive Womens Experiences with Antenatal Care in
Rural Maputo Province, Mozambique. Clinics Mother Child Health 13: 246. doi:10.4172/2090-7214.1000246
Page 7 of 9
Clinics Mother Child Health, an open access journal Volume 13 Issue 3 1000246
ISSN:2090-7214
Citation: Cuinhane CE, Coene G, Roelens K, Vanroelen C (2016) Understanding HIV Positive Womens Experiences with Antenatal Care in
Rural Maputo Province, Mozambique. Clinics Mother Child Health 13: 246. doi:10.4172/2090-7214.1000246
nurses advised pregnant women to attend the first ANC when the belly
first ANC visit after this period. Moreover, social norms, such as
positive status, lack of knowledge about the recommended time for the
first ANC, lack of money for transport, and the perception of the ANC
as an exhausting process. Early ANC was associated with availability
and access to resources, such as health facility to treat the perceived
symptoms of illness, advice from the partners who knew their HIV
positive status and advise of MCH nurses on timing of the first ANC.
This result is in line with previous studies in Sub-Saharan Africa [18].
Limitation
Page 9 of 9
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Clinics Mother Child Health, an open access journal Volume 13 Issue 3 1000246
ISSN:2090-7214