Effect of HIV status on fertility desire and knowledge of long-acting reversible contraception of postpartum Malawian women

Abstract

The objectives of this study were to describe the most recent pregnancy intentions and family planning preferences of HIV-infected and HIV-uninfected postpartum Malawian women, and to assess whether HIV status is associated with fertility desire and knowledge of intrauterine contraception (IUC) and the subdermal contraceptive implant. We conducted a cross-sectional analysis of the baseline characteristics of Malawian women enrolled in a prospective cohort study assessing postpartum contraceptive uptake and continuation. Women at a government hospital completed a baseline survey assessing reproductive history, family planning preferences, and knowledge of IUC and the implant. We used Pearson's chi-square tests to compare these parameters between HIV-infected and HIV-uninfected women. Modified Poisson regression was performed to assess the association between HIV status and fertility desire and knowledge about IUC and the implant. Of 634 postpartum women surveyed, HIV-infected women were more likely to report their most recent pregnancy was unintended (49% versus 37%, p=0.004). Nearly all women (97%) did not want a child in the next two years but HIV-infected women were more likely to desire no more children (adjusted PR: 1.59; 95% CI: 1.33, 1.89). HIV-infected women were also less likely to know that IUC (adjusted PR 0.72; 95% CI: 0.61, 0.84) and the implant (adjusted PR 0.83; 95% CI: 0.75, 0.92) are safe during breastfeeding. Postpartum women strongly desire family spacing and many HIV-infected postpartum women desire no more children, suggesting an important role for these long-acting methods. Education about the efficacy and safety of IUC and the implant particularly during breastfeeding may facilitate postpartum use.

Reproductive intentions and family planning practices of pregnant HIV-infected Malawian women on antiretroviral therapy

“…On one hand, HIV-related concerns have been described as deterrents to childbearing, stemming from poor health, fears of pregnancy’s negative effects on health, and anxiety of HIV transmission (Chen, Philips, Kanouse, Collins, & Miu, 2001; Cooper et al, 2007; da Silveira Rossi, Fonsechi-Carvasan, Makuch, Amaral, & Bahamondes, 2005; Kirshenbaum et al, 2004). Consistent with this trend, postpartum HIV-infected Malawian women at the same hospital were more likely than their HIV-uninfected counterparts to report unintended pregnancy and decreased future fertility desire (O’Shea et al, 2015), while knowledge of HIV-infected status also decreased fertility desire among nonpregnant Malawian women (Hoffman et al, 2008). However, those with fewer living children and positive subjective health reported increased fertility intentions, which is consistent with other studies in sub-Saharan Africa (Loko et al, 2005; Nebie et al, 2001).…”

“…HIV-infected women in the region have previously reported experiencing pregnancy while using contraception. One third of HIV-infected postpartum Malawian women reported using contraception before their most recent pregnancy, with the most popular methods being condoms, followed by injectables and oral contraceptives (O’Shea et al, 2015). Half of HIV-infected pregnant Zimbabwean women also reported using contraception prior to their current pregnancy (McCoy et al, 2014).…”

“…However, data were collected prior to the initiation of Option B+ in Malawi, and the fertility desires of women may have changed following nationwide implementation of the new policy. In a recent study of postpartum Malawian women, HIV-infected women were more likely than their HIV-uninfected counterparts to desire no further children (O’Shea et al, 2015). ART status was not measured in this study, however, and the association between ART and fertility desire among HIV-infected women remains largely unknown in the Option B+ era.…”

Patterns of Contraceptive Adoption, Continuation, and Switching after Delivery among Malawian Women

“…This study involves a secondary analysis of data from a prospective cohort study of postpartum Malawian women (S1 data) [6]. At the beginning of this prospective study, women were recruited from the postpartum unit of Bwaila Hospital, a government district hospital in Lilongwe, Malawi, with over 14,000 deliveries per year.…”

Contraceptive use and preference of HIV infected pregnant women living with HIV-negative partners in the central region of Cameroon: a cross sectional survey

“…In 2014, women living with HIV in SSA accounted for 58% of the total number of PLHIV and among pregnant of them, more than 32% do not receive any antiretroviral therapy at least to reduce vertical transmission [1,10,11]. Additionally, evidences indicate that most of women infected with HIV living in union with HIV-negative individuals in Africa continue to desire and bear more children despite their HIV status [8,[12][13][14][15][16][17][18]. Despite the widespread acceptance of family planning services (FPS) is high in some low income countries, the use of contraceptive methods still remains lowest in most of SSA countries including Cameroon [9,16,[19][20][21].…”