Women’s health is one of the four pillars of health care in the model developed and defined by PIH's HIV Equity Initiative. Given the disparities in health that exist between sexes and the high reproductive health risks for women in developing countries, PIH has focused on women's health from our earliest years. We have also recognized that women’s health outcomes are intimately connected with the social, educational and economic disparities that exist in most countries where we work. Our comprehensive model of care for all patients seeks to address the root causes of these disparities, even as our healthcare delivery system tackles the most serious health problems affecting women by decreasing maternal mortality, reducing rates of HIV and other sexually transmitted infections, and improving access to primary health care for prevention and treatment of cardiovascular disease and other chronic killers. 

Reducing maternal mortality,
improving reproductive health

Becoming pregnant and giving birth can and should be occasions to celebrate life and hope. For millions of women in the developing world, pregnancy and childbirth must be experienced as major risks for death and disability. In Malawi, one woman out of every seven can expect to die as a result of pregnancy and childbirth, based on the average number of pregnancies and the high rate of fatal complications. In the United States, this lifetime risk of maternal death is less than one in 2,500.

Worldwide, nearly 1,600 women and more than 10,000 newborns die every day from complications of pregnancy or childbirth that could have been treated or prevented with adequate care. These needless maternal deaths – almost 600,000 per year – have left millions of orphaned children. And for every maternal death, another 20 women are injured or disabled as a result of pregnancy or childbirth—at least 10 million women every year.

Partners In Health strives to address these lethal inequalities by making women’s health care a top priority and providing access to basic services proven to lower maternal death rates: family planning, comprehensive neonatal care, adequate nutrition, and professional medical attention for childbirth and emergency complications of pregnancy. We also offer antiretroviral treatment for pregnant women living with HIV as a way both to improve their health and to prevent mother-to-child transmission of the virus during childbirth.

Family planning

Family planning is among the most effective tools for reducing maternal mortality. When women are counseled, educated, and provided with contraceptive options, they are more likely to delay childbearing, have fewer children, and reduce their risk for obstetrical complications. Nevertheless, up to 75 percent of all pregnancies worldwide are unplanned or unwanted, accounting for nearly 300,000 new pregnancies every day.

Many barriers limit women’s access to family planning methods, including gender inequality, myths, and lack of knowledge about available services. The greatest barrier for many women, particularly in poor communities, is lack of availability. Clinics are too far away, user fees are too high, and transportation costs are beyond their means. Making family planning available and affordable to the poor worldwide would reduce maternal deaths and injuries by at least 20 percent, saving the lives of more than 100,000 women every year.

Family planning is an integral part of the model of comprehensive women’s health care that was developed at Zanmi Lasante in Haiti and emphasized as one of the "four pillars" of PIH's HIV Equity Initiative. Each of ZL’s clinical sites has a full-time nurse trained in sex education and reproductive health counseling. ZL has been offering free condoms and other contraceptive methods for over 15 years. In 2003, Zanmi Lasante began training and mobilizing community health workers who specifically promote family planning and women’s health. These ajans fanm (women's health agents) travel throughout the countryside, teaching women and men about sexually transmitted infections (including HIV) and contraceptive methods, distributing condoms and oral contraceptives, and referring pregnant women and others to the clinics. This successful model is being replicated at PIH sites in Rwanda and Lesotho.

Skilled obstetric care for pregnancy and childbirth

Throughout the developing world, only 58 percent of deliveries take place with the assistance of a trained attendant. Yet potentially fatal complications occur in 15 percent of all births. Women assisted by skilled birth attendants are more likely to receive treatment for these conditions early, when the situation can still be controlled.

At Zanmi Lasante, high-quality obstetric care for pregnancy, childbirth, and emergency complications is available to all pregnant women. Each ZL site has a fully-functioning women’s health clinic staffed by a professional midwife, and four full-time obstetrician/gynecologists cover all of ZL's clinical sites. ZL also works with matrons, traditional birth attendants, to help women deliver babies at home. ZL trains matrons to identify complicated or high-risk pregnancies that need to be referred to a clinic or hospital. Together with the matrons, ZL clinicians seek to ensure that pregnant women receive the safest and most efficient obstetric care possible.

At Inshuti Mu Buzima in Rwanda, rapid scale-up of obstetric and comprehensive women’s health care has been facilitated by the support of clinicians with years of experience in rural Haiti. The nursing staff at the women’s health clinic at Rwinkwavu Hospital includes specialists trained in prenatal counseling and delivery as well as family planning. The number of women receiving prenatal care continues to grow.

Preventing mother-to-child transmission of HIV

Ninety percent of the 2.3 million children living with HIV became infected during childbirth. So did the vast majority of more than 300,000 children who die of AIDS each year before reaching the age of 5. Yet a simple and highly effective treatment for prevention of mother-to-child transmission of HIV (PMTCT) has been available in developed countries since 1994. As a result, mother-to-child transmission by HIV-positive women in rich countries has dropped from 30 percent to just 2 percent.

In 1995, Zanmi Lasante began providing antiretroviral treatment for PMTCT to HIV-positive pregnant women in rural Haiti, where 5 percent of women are living with HIV. ZL offers HIV counseling and testing to every pregnant woman seen – which amounts to about 10,000 women a year. And in special cases, ZL clinicians deliver infants by cesarean section to reduce the risk of mother-to-child transmission. Since the PMTCT program was introduced, the HIV infection rate of newborns has fallen to levels rivaling those in developing countries.

The model for preventing mother-to-child transmission developed in rural Haiti has become an essential and standard component of PIH's model of HIV prevention and care wherever we work. In Rwanda and Lesotho, PMTCT programs are integrated into comprehensive care for both mother and child. After giving birth, mothers living with HIV receive counseling and a small monthly stipend to cover basic nutritional needs and monthly travel costs to the clinic. They are also paired with an accompagnateur, a community health worker who will deliver and observe antiretroviral therapy twice daily. Because of the high risk of HIV transmission through breastfeeding, PIH advocates exclusive formula feeding for infants of HIV-positive mothers. All HIV-positive mothers are provided with education, support, equipment for preparing clean water, and formula so they can safely formula-feed their infants.