People living with
HIV have been doing their best in order to survive since there is no cure at
the moment. However, it has been debatable whether it would be right for women
to make the decision to do abortion knowing that the baby would be born with
HIV. Besides the medical reason of passing on the disease to the child, there
have been sociocultural factors that have influenced mothers to make the
decision that they have made. Although there should be a right for women to
make the decision for their future and their offspring, there should be some
prevention to reduce the spread of HIV and the death toll from the disease
through education.
According to the
World Health Organization, the HIV prevalence rate from 2000-2009 in India was
slightly above the regional average (WHO 27). This meant that there is still a
high toll of death occurring among those with HIV and also those carrying the
disease. There are several of reasons to the high statistics for India. One is
that the prevention to HIV may not be as developed as other developed countries
to educate the people. Second, there are particular areas in India with “Higher HIV rates in the northeastern
states of Nagaland and Manipur are attributed to high intravenous drug use in
the region. The other three high prevalence states are all located in south and
central India” (Van Hollen). Lastly, the people may not have been aware
of their HIV status or decided to give birth regardless of them being positive.
The following medical anthropology journal discusses about some of the
sociocultural factors more in depth to explain the statistics.
The article
examined the women from Tamilnadu,
India who were dealing with the issue of whether to continue to bear
children even though the women were HIV positive or to abort the baby that they
were pregnant with. There were several factors that influenced their decisions
which were Christianity, positive network, social background, etc. In general,
the social responses to HIV status were hard on women than men. “The assumption
is that someone with HIV has engaged in “illegal sex” (i.e., any sex that
occurs out of wedlock) and is therefore to be blamed for having this disease… women
tend to be blamed for “illegal sex” more often than men… Not only are
they blamed for their husbands' deaths but they must also suffer the added
indignity of having the stigma of their HIV + status exacerbated by
the stigma of being a widow” (Van Hollen). The
society’s reaction to people, especially women, with HIV is pretty harsh, which
makes them to discourage child birth. As mentioned in the class, “…values,
beliefs, and perceptions of the world that lie behind people’s behavior, and
which are reflected in their behavior” (Week 5-1 Lecture). There are pressures
for women to choose the option of abortion and many are choosing this option.
However, one such factor that prevents women from going through abortion was
faith in Christianity.
Those
who believed in Hindu, abortion was not a problem, however in a Christian view,
abortion was unacceptable. The rate of suicide was also high for women when
finding out about their HIV status, but one woman said, “It was only Bible reading that prevented
me from committing suicide [after discovering HIV status]. The Bible gave me
strength and hope” (Van Hollen). Depending on how women viewed HIV as a believer, they would
either take it as an unavoidable disease or a hope for them to save their
pregnancy and to live with it. Along with this positivity, there were groups of
people what they called “Positive Network” that further supported mothers with
HIV.
The
Positive Network was encouraging mothers to give birth, just like any other
normal mothers, except to take extra care and early treatments. The group
emerged in the “mid-1990s
as these people organized to combat the extreme forms of stigma and
discrimination that they faced at home, in the workplace, and in medical
institutions” (Van Hollen). Though it
was not guaranteed for the mother and the child’s future would become a
long-term, the Positive Network spread the awareness of the need for them for
prevention of further progress of HIV. This was beginning to create an environment
that women who are HIV positive can bear children and that even after birth,
the mother and the child can pursue to live life like others. However, there
were still some downsides when it came to focusing women in poverty and
suffering from HIV at the same time.
Most women living in poverty were at risk
for HIV than women in a higher status. “Poverty curtails access to health care,
nutrition, and education and may contribute to high rates of migration as well
as drive people into sex work and/or substance abuse, all of which place people
at risk for HIV” (Van Hollen). Women
have worked like sex slaves and in the process, some may have “unwanted” child
in the process, which also leads to abortion in a more acceptable way than a
married woman, who would try to avoid abortion as much as possible. Depending
on all the circumstances of these women in HIV, most women chose not to do
abortion when taking HIV as just another addition to live with while the other
women, feeling hopeless about the condition, chose to abort the baby or commit
suicide when unable to endure the society’s perception of this particular group
of women.
When comparing the work of this
ethnographer and the Global Health Watch 3 report, there is actually some overlapping
approaches about what to do in order to prevent HIV from increasing. The
ethnographer Van Hollen mentioned with (1) increased access to early prenatal care, (2) PPTCT
services that provide women with information and options with regard to making
informed reproductive decisions and that provide treatment without
discrimination, and (3) access to free ART treatment…it may be possible to
envision a future in which these women's decision” (Van Hollen). She was
a bit more optimistic and about the care and the education that will be further
provided in India as well as their right to not abort the baby if willing to
take care of its responsibility. In Global Heath Watch 3, the document also
mentioned a similar approach. It mentions that “They
(the CHWs) are trained to monitor growth and development in children, to care
for people living with HIV, to distribute family planning supplies, to treat
certain diseases such as malaria and pneumonia, and to refer sick patients to
the nearest health facility… These CHWs help ease the burden on family members
by taking responsibility for caring for people in the late stages of any
disease. Their care also reduces the number of dying patients brought to the
hospital” (Global Health Watch 3 53). They both strive the alleviate some of
the difficulties the HIV patients would face and programs that would help out
the low status people to receive the treatments that they too deserve. The only
slight difference would be that the Global Health Watch 3 did not mention much
about the women’s right to do abortion. It was just a general statistic that
did not quite show all the variables that accounted into the rate.
In a conceptual
perspective, examining the issue through the medical anthropology concepts
helped me understand that there were more things to HIV or abortion, but that
the sociocultural factors played a huge role in making the statistics on the
WHO and the women’s complex decisions. Some of the well-known causes for HIV
would be through the sex work that the women went through as a business, but
religion playing a role did not at first come into my mind. The woman,
who was once considering abortion, completely changed her mind after being
converted to a Christian. Even though there was the risk of giving birth to a
child who would have to deal with the illness, the hope that she received
through the faith was in a way prevented suicide or abortion. However, it also
became a part of the statistic that shows the rise in people with HIV.
From a practical
perspective, it would be nice to see more emphasis on educating people,
especially those in poverty, to be aware of HIV and some of the options that
they can take if pregnant with a baby who is bound to contract HIV as well. It
is important to give the right for women to decide whether they want to give
birth to a baby that is bound to live with the illness or to do abortion to
prevent giving birth to another child with HIV, but in a global health sense,
it is more important to figure out ways that can try to treat and prevent HIV,
or even before, at its earliest stage.
All in all, the
connection between HIV and childbearing had various sociocultural components
that explained the high rates of HIV and abortion as well. Due to some of the
desires of wanting to be a mother, religious beliefs against the idea of
abortion, and even social background, there had been some ups and downs to
contributing to the statistics of India’s HIV rate. Though the rate of the HIV
have been high, it was important to recognize that it also had a human right
for both the mother and the newborn to live their own life with what they had
and to live a life just like any other people, but with extra care and
treatments. Also by getting educated early enough, the people would be able to
prevent HIV and abortion as much as possible, especially in regions that lack
such resources and high risk HIV regions.
References:
Global Health Watch 3 (2011): 1-391. Print.
Van Hollen, Cecilia. "Navigating HIV, Pregnancy, and Childbearing in South India: Pragmatics and Constraints in Women's Decision Making." Medical Anthropology 26.1 (2007): 7-52. Print.
Week 5-1's Lecture
World Health Organization 2012
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