Option B+ for every woman?

One of the projects that I work on at the Elizabeth Glaser Pediatric AIDS Foundation is a research study assessing the acceptability of option B+ among pregnant and lactating women in select sites in Malawi. In 2011, Malawi rolled out the Option B+ policy, which mandates health care workers (HCWs) to put every pregnant and lactating woman testing positive for HIV on antiretroviral therapy regardless of CD4 count and stage of pregnancy. The study excited me, and I was looking forward to learning about how the Option B+ policy has been working over the past two years.

During my second month working on the project, I saw this post on my friend’s (working in the private health sector) wall on Facebook:

“QUESTION: IN THIS DAY AND AGE ARE THERE WOMEN NOT ACCESSING PMTCT. I MEAN WHO CHOOSES NOT TO????”

This made me stop a bit to think. Prior to working on the Option B+ study, I wouldn’t have hesitated in agreeing with my friend’s post. Of course every woman should choose to access PMTCT services, why wouldn’t they? However, without preemptively sharing the findings of the study I am working on, I now consider more carefully how people in the health sector expect people to follow policies since it is for their own good, so we say. But how much publicity has the government of Malawi given to this issue I ask myself? Not only the government of Malawi, but how about the different organizations working in the field of health: have they taken the initiative to inform the public about this? I rarely hear Option B+ messages on the radio, let alone see a billboard for that around town. If these messages are scarce around town, then how about in our villages? I realized eventually that expecting women to access PMTCT in this day and age actually hinges on other factors, and these factors may force women not to actually access PMTCT.

I know Option B+ and PMTCT have advantages in promoting safe motherhood, maternal and neonatal health. I imagine myself pregnant and HIV positive and hearing a HCW tell me I have to initiate Option B+. Would l really do it I wonder? Since just by the thought I have a lot of questions in my mind still: How would my family react? How about my husband? How about my friends? What about the baby? Will it be a normal baby? Won’t it be affected negatively by the medicines? Well, I know if I had to meet a health practitioner they would explain very well and have answers to all my questions but the underlying fact is there are always questions and dilemmas that might force some women not to access PMTCT even in this day and age.

From the eyes of a person working to improve access to health I would be happy to see 100 percent PMTCT or Option B+ access, but I should also practically acknowledge that there are many questions and dilemmas surrounding these issues. I’ve learned that an individual’s health decisions can be complicated and not as straightforward as I once thought. This year, I hope to continue to listen to women’s stories, compassionately, and think twice before telling someone what I think is best for their health.