As we have recently noted actual use of insecticide treated bednets (ITNs) by pregnant women in malaria endemic countries is not meeting targets.Â In addition to tracking general coverage, we have reviewed Demographic and HealthÂ or Malaria Indicator Survey (DHS/MIS) data showing that even in households that own nets, pregnant women may not be using them.
Now we need to take a step back and examine our indicators in light of the need to protect women fully. Two issues arise. First in the context of universal coverage, all women in a household should have access to sleeping spaces that have nets.Â Women need strength before they become pregnant, especially younger ones who may be experiencing their first pregnancy.Â Nets are one means of ensuring that women do not enter pregnancy already in an anemic state.
The second issue is pragmatic. Since a woman may not know for sure that she is pregnant in the early days and weeks of her pregnancy, she benefits from already being protected from malaria by nets that should have been provided through universal coverage. Intermittent preventive treatment can not be used with current drugs in the first trimester, so nets are the most important preventive measure during that time.
Even if a woman suspects she is pregnant, it is considered in many places culturally inappropriate for her to publicly announce or take public actions (like attending antenatal care) that let people know she is pregnant. If she waits in a culturally appropriate manner until ‘it shows’, she and the unborn child would have already been exposed to life threatening malaria infections. Universal coverage of nets prior to pregnancy maintains both the woman’s confidentiality and health.
To date few of the recent DHS/MIS have reported on net use by women of reproductive age (15-45 years) in general. The graph here shows a similar pattern for this group as observed for pregnant women. Problems of both access and use persist.
Because of the protection offered by ITNs in the earliest stages of pregnancy, it is extremely important not only for malaria endemic countries to undertake and maintain universal coverage that will reach women, but also track this as an important indicator of program success.