Motherhood and decision-making among women living with HIV in developed countries: a systematic review with qualitative research synthesis

Abstract

Background Women living with HIV (WLH) lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for WLH in developed countries. Methods A systematic review with qualitative research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo, and SciELO). Studies published in journals from 1995 to 2019 with qualitative data about reproductive decision-making among WLH in developed countries were eligible for inclusion. Developed country was operationalized by membership in the OECD for comparative conditions of social wellbeing and economic stability. The CASP and JBI checklists for qualitative research were used to assess study quality and methodological integrity. Thematic analysis and qualitative meta-summary techniques were used for the synthesis. Results Twenty studies from 12 developed countries were included in the synthesis. Findings were organized into 3 meta-themes from 15 themes and 45 subthemes, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, (3) Coping, resiliency, and support. Reproductive decision-making was perceived as a complex process influenced by facilitators and barriers. The facilitators helped WLH cope with their new situation to become more resilient, while the barriers made their situation more difficult to manage. Conclusion WLH encounter reproductive decision-making with knowledge deficits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support WLH. Clinicians could benefit from professional development to learn how to be authentically present for WLH, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical practice guidelines need to be tailored for the family planning and sexual health needs of WLH.

The experience of pregnancy among women living with HIV in Nordic countries: A qualitative narrative enquiry

“…Our finding that being pregnant brought a sense of normality to women living with HIV and the importance of being treated as ‘normal’ is supported by other studies. 7 , 8 , 33 – 35 The results from several meta-syntheses indicate that the burden of HIV is often associated with feelings of loss of normality, while pregnancy is perceived to be a route to being normal, making the burden of HIV easier to bear. 7 , 8 Normality in pregnancy is defined by social and cultural expectations about pregnancy; the context, and women’s feminine identity 7 , and a sense of normality seems to have a supportive, strengthening function for women living with HIV.…”

“… 7 , 8 , 33 – 35 The results from several meta-syntheses indicate that the burden of HIV is often associated with feelings of loss of normality, while pregnancy is perceived to be a route to being normal, making the burden of HIV easier to bear. 7 , 8 Normality in pregnancy is defined by social and cultural expectations about pregnancy; the context, and women’s feminine identity 7 , and a sense of normality seems to have a supportive, strengthening function for women living with HIV. 35 Hence, healthcare professionals should, regardless of their level of previous experience with HIV, focus on the ordinary aspects of pregnancy and not allow the presence of HIV to overshadow the care provided.…”

“…Women living with HIV have fertility desires similar to those of the general population. 5 , 6 Motherhood is often experienced as something positive, 7 and pregnancy is usually connected to a sense of normality and the experience of feeling whole. 8 …”

Public Opinion Leadership in Nursing Practice: A Rogerian Concept Analysis

“…Two reviewers (JE, PL) respectively screened 50% of the initial search results independently of the first reviewer (MvW). Scientific articles or grey literature were selected for full-text screening if (1) POL was a considerable focus point in the title or abstract of the selected article, (2) POL manifested itself in healthcare settings which aligned with nursing practice, (3) the concept of POL was described in OECD countries, as the concept may differ in low income countries ( Huertas-Zurriaga et al, 2021 ) and (4) a description of surrogate/related terms, antecedents, attributes, consequences or examples of POL was provided. Articles were excluded, if (1) local—or product opinion leadership (i.e., implementation processes, change management) was studied or (2) POL was mentioned, but another specific healthcare issue was the main focus, and subsequently leaders in the field were approached to reflect upon and provide their opinion on the specific healthcare issue.…”

Reproductive decision-making of Black women living with HIV: A systematic review

“… 39 , 40 This situation is even more complex since women living with HIV have to concurrently manage family pressures and community expectations when engaging in reproductive decision-making. 41 , 42 …”