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This analysis models the potential benefits and costs of adding family planning to national strategies for achieving universal access to programs to prevent mother-to-child HIV transmission.We assume a service delivery perspective and estimate the cost-effectiveness of programs to reduce the number of HIV-infected children through using antiretroviral prophylaxis to prevent perinatal transmission, and of family planning programs to avert additional infant infections not already averted by antiretroviral prophylaxis, as well as of family planning to reduce the number of total unintended births to women living with HIV. Data are presented from the 139 countries included in the 2008 Annual United Nations Joint Programme on HIV/AIDS Report, although the main results are for the 14 countries with the largest number of HIV-infected pregnant women.Programs to prevent perinatal HIV transmission would, if accessed by all women in need with the most efficacious antiretroviral regimen available, prevent over 240 000 infant HIV infections in the top 14 countries (over 300 000 globally) at an estimated cost of over $131 million ($208 million globally). However, almost 72 000 infant HIV infections would still occur in the 14 countries (over 90 000 globally) that could have been averted by preventing unintended pregnancies at a cost of only about $26 million (over $33 million globally). If all unintended births (whether or not resulting in HIV-infected children) to HIV-positive women were prevented with family planning, the cost per birth averted would be $61 in the 14 countries ($63 globally).This analysis suggests that national strategies should adopt a comprehensive approach to preventing mother-to-child transmission and thus focus on preventing perinatal HIV transmission as well as unintended pregnancies. Family planning is cost-effective for preventing HIV transmission and unintended pregnancies and will also reduce infant and maternal mortality and result in fewer orphans.