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Women's reproductive health Women left destitute by AIDS

BMJ 1994; 308 doi: (Published 19 March 1994) Cite this as: BMJ 1994;308:789
  1. A Berger
  1. Bristol BS8 3ER
  2. Bowden, Melrose TD6 0ST
  3. Population Council, New York, NY 10017, USA.

    EDITOR, - Though women's reproductive health in the developing world undeniably depends on a country's “social, economic, and cultural pressures,”1 the profound additional influence of HIV infection and AIDS should not be forgotten. Uganda seems to be doing its best to wake up the world. With 20 years of unrest and civil war, a ruined economy, minimal healthcare equipment, a dearth of medical professionals, and a 12% prevalence of HIV infection in the adult population, Uganda may seem from the outside to have a problem too bewildering to contemplate. Yet with insight into Ugandan society it is possible to understand the problems that HIV infection presents, especially to the country's women.

    In Uganda “to die without a child is to leave without a trace.” Therefore, despite the dangers of transmission of HIV infection inherent in pregnancy, women continue to get pregnant. Ugandans are polygamous, and this poses a major problem. A man who is HIV positive may pass the virus on to several wives. In the past, if a man died his wives and children would be inherited and looked after by his brother. AIDS has changed all that. Now brothers are no longer willing to “marry” these widows for fear of catching the disease themselves. Furthermore, women work the land but do not own it. As a result, thousands of vulnerable women are being left destitute and rejected from families they were once considered part of. The extended family is breaking down. The best a woman can hope for is that her children grow up fast enough to fend for themselves and that she can make some provision for them before she too dies.

    A tenth of children under the age of 15 in Uganda have lost at …

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