ITNs – pregnant women or all women?

Providing an insecticide treated bednet (ITNs) for all pregnant women as early in pregnancy as possible is a key malaria control strategy that not only protects the woman from malaria but improves birth outcomes and child survival. Ideally ITNs for pregnant women should be a routine service provided through antenatal care (ANC) since in many countries over 80% of pregnant women attend ANC at least once.

pregnant-women-should-get-itns-as-part-of.jpgA major problem in achieving this goal is that in many malaria endemic communities, pregnant women who do attend ANC do not register until well into their third trimester after many months of exposure to malaria transmitting mosquitoes. At the same time, campaigns to distribute ITNs in the community usually target children under 5 years of age, not pregnant women.

A number of social and cultural factors explain poor access and timely acquisition of ITNs by pregnant women. In some cases pregnancy is considered normal and thus there is no need to register early for ANC. Pregnant and unmarried teens,who are among the most vulnerable to the effects of malaria in pregnancy (MIP), are often embarrassed to register and thus make their pregnancy publicly known.[1,2] ANC requires payments in some countries, and even when free, attendance at ANC has indirect economic costs when women miss work.

Poor service quality is another issue that keeps many women from attending ANC early or often. Finally a cultural issue that has been documented in many countries, is the reluctance of revealing one is pregnant until ‘it shows’ due to fears that jealous or evil people may curse or damage the pregnancy.[3-6]

One solution to this problem of ensuring that pregnant women get and sleep under ITNs is to give all women of reproductive age an ITN. This would make access easier and would also avoid any embarrassments or cultural fears that would come from singling out a pregnant women for a net. The Global Fund has created the capacity to distribute ITNs to over 30 million people by mid-2007. This ITN capacity should be extended to include all women.

References:

  1. Sow F. To be a woman in Africa. On the danger of being a mother. Mortality [Article in French] Vivre Autrement. 1994 Oct:13-4.
  2. Magadi MA, Agwanda AO, Obare FO. A comparative analysis of the use of maternal health services between teenagers and older mothers in sub-Saharan Africa: evidence from Demographic and Health Surveys (DHS). Soc Sci Med. 2007; 64(6): 1311-25.
  3. Ndiaye P, Dia AT, Diedgiou A, Dieye EH, Dione DA. Socio-cultural determinants of the lateness of the first prenatal consultation in a health district in Senegal [Article in French] Sante Publique. 2005; 17(4):531-8.
  4. Morse JM. Cultural variation in behavioral response to parturition: childbirth in Fiji. Med Anthropol. 1989; 12(1): 35-54.
  5. Beninguisse G, De Brouwere V.Tradition and modernity in Cameroon: the confrontation between social demand and biomedical logics of health services. Afr J Reprod Health. 2004; 8(3): 152-75.
  6. Chapman RR.Chikotsa–secrets, silence, and hiding: social risk and reproductive vulnerability in central Mozambique. Med Anthropol Q. 2006; 20(4): 487-515.

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