Factors associated with desire for children among HIV-infected women and men: A quantitative and qualitative analysis from Malawi and implications for the delivery of safer conception counseling

Abstract

Improved health outcomes have resulted in people with HIV facing decisions about childbearing. We sought to understand factors associated with desire for a child among men and women in Malawi. HIV-infected men and women ages 18-40 were invited to participate in a brief interview about fertility desires. Single variable logistic regression was used to evaluate factors associated with the outcome of fertility desire. Additionally, multiple logistic regression was used to assess the relationship of all the factors together on the outcome of fertility desire. In-depth interviews with women were performed to understand experiences with reproductive healthcare. A total of 202 brief interviews were completed with 75 men (37.1%) and 127 women (62.9%), with 103 (51.0%) of respondents desiring a child. Being in a relationship (OR 3.48, 95% CI: 1.58 to 7.65, p = 0.002) and duration of HIV more than two years (OR 2.00, 95% CI: 1.08 to 3.67, p=0.03) were associated with increased odds of desire for a child. Age 36-40 years (OR 0.64, 95% CI: 0.46 to 0.90, p = 0.009) and having a living child (OR 0.24, 95% CI: 0.07 to 0.84, p=0.03) were associated with decreased odds of desire for a child. Seventy percent of women (n=19 of 27 respondents) completing semi-structured interviews who responded to the question about decision-making reported that their male partners made decisions about children, while the remainder reported the decision was collaborative (n=8, 30%). Eighty-six percent of women (n=36 of 42 respondents) reported no discussion or a discouraging discussion with a provider about having children. HIV-infected women and men in Malawi maintain a desire to have children. Interventions are needed to integrate safer conception into HIV care, to improve male participation in safer conception counseling, and to empower providers to help patients make decisions about reproduction free of discrimination and coercion.

Influences in fertility decisions among HIV-infected individuals in Lilongwe, Malawi: a qualitative study

“…Despite these limitations, we believe our findings identify key areas of focus for interventions in fertility discussions within relationships with an HIV-infected partner. Additionally, this study complements other studies conducted in sub-Saharan Africa and their findings on the fertility desires of HIV-infected men and women 23 24…”

Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning

“…46 Discussion of safer conception strategies with providers early in HIV care with male participation may reduce potential HIV transmission risk from these missed opportunities. 17 Couples with HIV-infected men need to be counseled on safer conception strategies that support fertility goals of both partners while minimizing HIV risk to the woman. Provider-initiated safer conception counseling for HIV-serodiscordant couples may also provide an important entry point for addressing other issues in this population, such as male involvement in antenatal care and PMTCT.…”

“…However, most studies to date investigating fertility intentions and decisions among people affected by HIV focus on individual-level determinants rather than discourse of fertility decision-making of the couple as a unit. [15][16][17] Crankshaw et al (2012) developed a framework adapted from the Information-Motivation-Behavioral Skill Model of HIV Preventative Behavior describing elements of conception-related HIV risk behaviors among HIVserodiscordant couples. 18 The framework outlines individual, couple, and structural-level domains that collectively shape peri-conception transmission risk for HIV-serodiscordant couples who wish to conceive.…”

Reproductive desires of men and women living with HIV: implications for family planning counselling

“…This research provides evidence for advocacy for the integration of HIV and SRH services for PLHIV as part of primary health care services (Bekker et al, 2011;Cooper et al, 2009;Kawale et al, 2013;Mantell et al, 2009;Myer et al, 2007;Osman, 2011;Sarnquist et al, 2013;Smith and Mbakwem, 2010).…”

“…Because of the risks involved, health care workers tend to encourage PLHIV to use condoms and discourage them from having unprotected sex and having children (Cooper et al, 2007;Kawale et al, 2013;Mantell et al, 2009). The lack of appropriate family planning services for women living with HIV (Alkema, 2013;United Nations Children's Fund, 2013) has resulted in high levels of unplanned pregnancies.…”