There is a consensus among a range of bodies, such as the WHO, UNFPA, International Planned Parenthood Federation (IPPF) and UNAIDS (2005:11) that HIV and sexual reproductive health (SRH) are closely related or linked. Such a consensus is a function of the view that the majority of HIV infections are sexually transmitted or related to pregnancy, childbirth and breastfeeding. It is for this reason that the
international community claims that the MDGs can only be achieved if universal access to SRH and HIV care are promoted (UNFPA, WHO & IPPF 2012:1). The latter requires linkages at policy level, strengthening of health systems and provision of access to comprehensive and integrated SRH and HIV services (UNFPA, WHO & IPPF 2012:1). The benefits of integrating or linking SRH and HIV are wide ranging, and examples of these include improved access to and uptake of HIV and SRH services; improved coverage of underserved, vulnerable and key populations; improved quality care and decreased duplication of efforts; and better utilisation of scarce resources for health.
The provision of integrated SRH and HIV services could have an important influence on maternal, newborn and child health interventions as it can improve efficiencies, and reduce duplication of efforts (Bhutta, Cabral, Chan & Keenan 2012:S13). Thus, the integration of these services has been widely promoted, particularly in resource-poor countries because of its potential to increase uptake of SRH and HIV services (Warren 2015:19). It is for this reason that a number of developing countries, such as Botswana, South Africa, and Swaziland are integrating SRH and HIV services (IPPF, UNFPA & WHO 2014:6–7). Taking the Kingdom of Swaziland as an example, one major success of such integration is the linkage of PMTCT of HIV programmes into SRH services (KoS, MoH 2010a:1–10).
Mazia et al (2009:253) conducted a study on an integrated PNC and PMTCT programme. They investigated the quality of PNC for women and their infants who used the integrated programme. The results indicate a 20-fold increase in the number of early postnatal visits (within the first three days after birth) as well as a significant increase in the competence of health workers related to postnatal examinations and the general care of mothers and babies. The percentage of women breastfeeding within one hour of delivery increased by 41% in HIV-positive mothers, while co-trimoxazole prophylaxis for HIV-exposed infants increased by 24%. These outcomes enabled the present researcher to examine the competencies of midwives during the provision of immediate PNC to mothers and their infants in Swaziland.
Lemly, Mandelbrot, Meier, Firtion, Matheron, Jeantils and Scott (2007:346) examined factors related to attendance and adherence to medical appointments after childbirth among HIV-infected women in France. The study took the form of an observational cohort in four hospitals in Paris. The strength of the study was its ability to record
people’s behaviour and events directly. In contrast, the vulnerability to prejudices, attitudes and values of the observers were the weakness of the study (Polit & Beck 2008:321). The results showed that 75% had regular attendance, 14% had irregular attendance and 18% had no attendance. The prescription of ARV combination therapy during pregnancy was significantly related to regular postnatal attendance (Lemly et al 2007:346). About 47% of the respondents continued to attend regular paediatric appointments. This means that the provision of ARV medication was a motivating factor for mothers to attend PNC services. This was good as it may result in early identification of maternal and neonatal complications, such as sepsis. Furthermore, the study revealed that communication between the healthcare providers and mothers in the postnatal period gave rise to an increase in postnatal appointment attendance and adherence to appointments. This finding influenced the researcher to include a question on interaction of midwives and mothers during the PNC in the current study.
Warren, Mwangi, Oweya, Kamunya and Koskei (2009:24) assessed changes in the quality of care following the introduction of a new postnatal care programme in Kenya. The study population was healthcare providers and postpartum women. A pre-post intervention cross-sectional design was used to assess changes in the quality of counselling and care following the introduction of the postnatal care programme. Respondents were purposefully selected. Direct observation of client-provider interactions were used to measure the quality of PNC. The results of the study showed an increased mean score for counselling on infant danger signs (0.24–1.39) and infant feeding (1.33–2.19). These findings indicated that a significant number of neonatal deaths were averted because of early identification of danger signs, like infections and fever. The findings also indicated the need for mothers to be educated on these danger signs given newborns sometimes die of the same. The provision of such education will enable mothers to take their babies to a health facility early if they notice any danger signs. The study further showed an increase in the total quality index of PNC for newborns from 3.337 to 6.45 and an increase in maternal index from 3.4 to 8.7 (Warren et al 2009:27). The provision of education to mothers on danger signs could lead to the reduction of maternal deaths by 75% and child mortality by two thirds as stated in the targets of the MDGs (Warren et al 2009:27).
The strengths of the study were that it yielded evidence of multiple predictors and outcomes. The observation directly captured the respondents’ behaviours and events.
However, the weaknesses of the study were the high possibility of distorted behaviour of the respondents, and the vulnerability to observer bias. The study findings enabled the researcher of the current study to evaluate the knowledge and practices of midwives during the provision of immediate PNC rendered to mothers and their infants. Moreover, the key indicators for essential newborn care and counselling on maternal health helped the researcher to revise the questionnaires used in the present study.