Intergenerational impacts of maternal mortality related to HIV in South Africa

1. Intergenerational impacts of maternal mortality related to HIV in South Africa L. Knight1 and A.E. Yamin2 1. School of Public Health, University of Western Cape, South Africa 2. François-Xavier BagnoudCenter for Health and Human Rights, Harvard University, Boston, Massachusetts, United States

2. Background • Despite good access to services, South Africa still has a high maternal mortality ratio (MMR) ≈300 deaths/100,000 live births. • 2010 WHO estimates suggest 60% of maternal deaths are attributed to HIV. • HIV-infected mothers face greater risk of complications in pregnancy and childbirth compared to HIV-negative. • Maternal deaths are largely preventable. • It is important to consider the intergenerational impacts of maternal mortality, in a high HIV prevalence context, on the well-being of the surviving infant and older children. • This study aims to provide: • insight into the consequences of maternal mortality for child well-being. • a detailed account of the impacts of maternal deaths on families. • The study utilised qualitative research using in-depth interviews with family members, stakeholders and FGD with community.

3. Results Caregiving for children left behind • The primary impact is a change in primary caregiver. • In this context gender norms dictate that childcare is women’s work. • Caring for children had knock on impacts for employment and health. • Caring poses a potential human and financial burden for households: • Households nevertheless manage to rally resources in response. • Indirect social grants (old age and child support) were vital for financial security. Impact of death on infant children • Infants do not gain from acknowledged benefits of breastfeeding. • Social grants are particularly important in infancy allowing families to provide for infants. Impact of death on young children • A number of children were sickly and required care or treatment for HIV. • The emotional impacts of a mother’s death were felt more acutely by older children. • Emotional difficulties manifested in difficult behaviour and poor schooling outcomes. Impact of death on older children • Adolescence is a difficult period. • Older girls were perceived to be at risk of abuse, early sexual debut, teenage pregnancy and HIV.

4. Conclusions • Despite their important role, female caregivers were not always prepared for this responsibility. • The burden of a maternal death is a burden at household level. • Access to social grants enabled households to cope financially. • Emotional support and caregiving was harder for families to provide in the absence of a mother. • A mother’s absence is most notable as children get older and require greater emotional support, guidance and care. • The prevalence of HIV in the South African context and the risk it poses to women has knock-on effects for the children of HIV-positive women who die as a result of maternal complications. • The economic and social costs of maternal mortality provide evidence for the need to invest in maternal health. • Ensuring adequate family planning, antenatal and emergency obstetric care is critical for preventing maternal death. • Ensuring social protection and community support is key for affected children and families.