When Saroj Chakravarty (23) first came to know she was HIV-positive, she was seven months pregnant. Like her, Savita Sinha (19) too discovered she was infected only in the sixth month of pregnancy. And Saima Khatoon (23) was in the first trimester of hers. All three women chose to keep their unborn child.
Despite established medical opinion that there is a high risk of mother-to-child transmission (MTCT) of the disease, first-time mothers rarely terminate their pregnancy. In some cases that determination might be born of sheer ignorance, as in Khatoon's case - she thought being HIV-positive was 'just another illness', and even breast-fed her son for two years, in the process increasing his chances of contracting the virus manifold. In some other cases, as with Chakravarty, the discovery comes too late to terminate the pregnancy without significant risk to the life of the mother herself.
Dr Urmila Singh, Professor at the Department of Obstetrics and Gynecology at the Chattrapati Shahuji Maharaj Medical University (CSMMU) says, "Depending on which trimester of pregnancy an HIV-positive mother approaches us, we counsel her to consider adoption instead. But no one can take away a woman's right to be a mother. One of the precautions we take is to go in for a caesarian delivery to limit the loss of blood. There is greater need for follow up in such cases. For instance we have to ensure that the mother does not breast-feed her child. And if that is happening, top feed should never be mixed with the mother's milk."
According to an UNAIDS paper on the Prevention of MTCT (see here) "In recent years, projects to prevent mother-to-child transmission in resource-limited settings have primarily focused on provision of single-dose intrapartum and neonatal nevirapine, which cuts the risk of HIV transmission by more than 40 per cent."
• Surviving a battle every day Figures put out in 2009 by the National AIDS Control Organisation (NACO), the highest body for implementation of HIV-AIDS related programs in India, say that the chances of MTCT are 5-10 per cent, even in cases where the mother has her delivery in a hospital and the child is given the necessary medicines. During normal labour and delivery these chances increase to 10-15 per cent, while breast-feeding gets these figures to jump to 20-25 per cent.
But such figures made little difference to Chakravarty, a resident of Nawabganj, an outer fringe of Lucknow. "I had been married for eight years and this was my first child. Though it came as a huge shock to me, there was no question of an abortion", she says. Her son, Moni is nine months old now and Chakravarty will not know the status of her son till he is at least 18 months old. Till then she will swing between fear and hope.
Khatoon was luckier. Her 4-year-old son is negative. Her husband Afzal died a year ago, aged 28. He was a skilled zardozi embroidery artisan and had worked in Mumbai and Goa for a number of years before getting back to his family in Lucknow. Khatoon says that though she was tested twice at the government hospital, there was no counseling offered. "The only information I got was from television. And I did not think at all of the seriousness of the situation. Had I, perhaps I would not have had my child", she says. She is supported by her in-laws and her brother but wishes to do some work of her own.
Sonia Singh (30) lost her husband Sundar Singh, who owned a shop in Mumbai, four years ago after 10 years of marriage. Her husband had been suffering from low haemoglobin, as well as tuberculosis and epilepsy. The only time he was prescribed an HIV test, he died before the results were out, showing he was a carrier of the virus. Her son, who is now in class six, is also positive. Singh, under immense financial pressure, refuses to leave her marital home. "My husband and his brothers had a shop, the income from which was divided amongst them. If I leave, who will fight for my son's rights?" she asks. Her brother pitches in with some help but she says she can barely make ends meet.
Sinha also lost her daughter (now two and negative) to her husband, who forced her out of her marital home after her positive status was known. She is unsure how she could have been infected, and has made her peace with the fact that at least with her husband her daughter is ensured a decent upbringing, something she will be unable to offer with the Rs.2500 she earns as a counselor in the voluntary sector. "I still hope to make up with my husband some day for the sake of my daughter. And also to block any chances of a remarriage for him", her voice trails off. Sinha knows that after her mother is gone, there will be no one to care for her at her parental home.
Dr Saurabh Paliwal, counselor at the Anti Retroviral Therapy Centre (ART) at CSSMU says, "Most positive people have little reason to look at life with hope. Often a child is the only source of joy for such people."
Dr Rekha Sachan says that of the 100 outdoor patients she examines every day at the CSSMU outdoor patient department, "at least one is HIV positive". She adds that if the CD4 count (a measure of how well the immune system of a person is functioning) is healthy, there is greater foetal risk rather than danger to the mother. "There are greater efforts and greater care required. But we have sent back healthy mothers and babies. Motherhood is a joy and no woman can be denied it, except in extreme cases".
The debate on whether HIV-positive women should become mothers is far from concluded. But there seems to be some kind of consensus that given the advances in medical science, and with greater care and support, such women should not be denied the happiness motherhood brings.