The third major mode of HIV transmission is mother-to-child transmission during pregnancy, labor and childbirth, or with breastfeeding. Without access to therapies known to decrease risk, perinatal transmission occurs in 25–45% of pregnancies where the mother is HIV-infected. The risk of HIV transmission from traditional practices, such as female circumcision, ear piercing, tattooing or ritual scarification with shared and non-sterile or non-disinfected instruments, is unknown.