Fertility Intentions of HIV-1 Infected and Uninfected Women in Malawi: A Longitudinal Study

Abstract

This study aimed to determine changes in fertility intentions of HIV-1 infected and uninfected reproductive age women in Blantyre, Malawi. Participants were asked about their fertility intentions at baseline and at 3-month visits for 1 year. Time-to-event statistical models were used to determine factors associated with changes in fertility intentions. Overall, 842 HIV uninfected and 844 HIV infected women were enrolled. The hazard of changing from wanting no more children at baseline to wanting more children at follow-up was 61% lower among HIV infected women compared to HIV uninfected women (P < 0.01) after adjusting for other factors, while HIV infected women were approximately 3 times more likely to change to wanting no more children. The overall pregnancy rate after 12 months was 14.9 per 100 person-years and did not differ among 102 HIV uninfected and 100 infected women who became pregnant. HIV infection is a significant predictor of fertility intentions over time.

Fertility intentions of HIV-infected women in the United Kingdom

“…While a third of women decided they no longer wanted children after HIV diagnosis, nearly half of them changed their mind once they had become aware of advances in HIV management and treatment. Decreased fertility intentions associated with HIV diagnosis have also been reported in other studies in the pre-HAART era (Bedimo et al, 1998;van Benthem et al, 2000;Stephenson and Griffioen, 1996;De Vincenzi et al, 1997), and more recently in Africa, where access to HAART remains limited (Taulo et al, 2009;Yeatman, 2009). Qualitative studies have shown that childbearing intentions in HIV-infected women are affected by personal health-related concerns, fear of transmitting HIV to the child, and societal influences and stigma (Craft et al, 2007).…”

“…Studies prior to the advent of highly active antiretroviral therapy (HAART) showed reductions in live birth rates and increases in termination rates after HIV diagnosis (Stephenson and Griffioen, 1996;van Benthem et al, 2000;De Vincenzi et al, 1997), but included little information on the women themselves. Likewise, in African settings where women have limited access to antiretroviral therapy, HIV diagnosis is associated with lower fertility intentions in HIVpositive than HIV-negative women (Kaida et al, 2010;Taulo et al, 2009;Yeatman, 2009). …”

Factors affecting the HIV/AIDS epidemic: An ecological analysis of global data

“…However, in some countries where the HIV prevalence rate is high, contraceptive use is reasonably low. High rates of unmet contraceptive need and unplanned pregnancy have been reported among HIV infected women in Malawi, South Africa, and Uganda [25][26][27][28] . In Uganda, the contraceptive prevalence rate among currently married women is 24% which is very low compared to the countries Ireland (89%), Norway (88%), etc.…”

How the global call for elimination of pediatric HIV can support HIV-positive women to achieve their pregnancy intentions

“…56 Similar results have been reported from Malawi, where a study found HIV-positive women to be 61% less likely to desire pregnancy than their HIV-negative counterparts. 57 The limited evidence on HIV-positive men's pregnancy intentions generally indicates that HIV-positive men tend to want children more than their HIV-positive female counterparts. [36][37][38]52,58 More research is needed to explore men's and couples' views on pregnancy desires in the context of HIV.…”

“…60 A recent study in Malawi found that while HIVpositive women desire pregnancy less than HIVnegative women, the rate of pregnancy after one year was not different between the two groups, suggesting unmet contraceptive need, non-use or failure of a contraceptive method, or inability to negotiate contraceptive use. 57 Unintended pregnancies among HIV-positive women contribute to pediatric HIV infections because only about half of HIV-positive women worldwide receive PMTCT interventions despite the scale-up of PMTCT services in recent years. 61 For HIV-positive women who do not wish to become pregnant, prevention of unintended pregnancies through access to voluntary family planning can contribute to improving maternal health as well as reducing pediatric HIV infections.…”