Psychosocial correlates of patient–provider family planning discussions among HIV-infected pregnant women in South Africa

Abstract

Patient–provider family planning discussions and preconception counseling can reduce maternal and neonatal risks by increasing adherence to provider recommendations and antiretroviral medication. However, HIV-infected women may not discuss reproductive intentions with providers due to anticipation of negative reactions and stigma. This study aimed to identify correlates of patient–provider family planning discussions among HIV-infected women in rural South Africa, an area with high rates of antenatal HIV and suboptimal rates of prevention of mother-to-child transmission (PMTCT) of HIV. Participants were N=673 pregnant HIV-infected women who completed measures of family planning discussions and knowledge, depression, stigma, intimate partner violence, and male involvement. Participants were, on average, 28 ± 6 years old, and half of them had completed at least 10–11 years of education. Most women were unemployed and had a monthly income of less than ~US$76. Fewer than half of the women reported having family planning discussions with providers. Correlates of patient–provider family planning discussions included younger age, discussions about PMTCT of HIV, male involvement, and decreased stigma (p < 0.05). Depression was indirectly associated with patient–provider family planning discussions through male involvement (b = −0.010, bias-corrected 95% confidence interval [bCI] [−0.019, −0.005]). That is, depression decreased male involvement, and in turn, male involvement increased patient–provider family planning discussions. Therefore, by decreasing male involvement, depression indirectly decreased family planning discussions. Study findings point to the importance of family planning strategies that address depression and facilitate male involvement to enhance communication between patients and providers and optimize maternal and neonatal health outcomes. This study underscores the need for longitudinal assessment of men’s impact on family planning discussions both pre- and postpartum. Increasing support for provision of mental health services during pregnancy is merited to ensure the health of pregnant women living with HIV and their infants.

Fertility intentions of prenatal and postpartum HIV-positive women in primary care in Mpumalanga province, South Africa: a longitudinal study

“…Furthermore, the study found an association between discussing family planning with a health care provider and fertility intentions, as in previous research. 60 These findings have been confirmed in several other studies, 5 , 6 and show the importance of the South African Department of Health guidelines in helping facilitate the initiation of discussions about fertility intentions by health care providers with PLHIV. In contrast, family planning knowledge and participation in an enhanced PMTCT intervention, which included information on family planning, were associated with decreased fertility intention.…”

“…Surprisingly, IPV during the perinatal period, unplanned pregnancy, time since HIV diagnosis, and depression (analysis not shown) were not associated with fertility intentions, contrary to previous research. 60 Future research should examine the relative trade-offs in reproductive decision making among this vulnerable population.…”

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

“…In one study, however, in rural Mpumalanga, only a quarter of HIVinfected women had discussed family planning with their providers. [73] There are substantial drug interactions between efavirenz and Implanon, considerably reducing drug levels of etonogestrel, the active drug in Implanon. [74][75][76] Interactions between efavirenz and Jadelle appear even more pronounced than with Implanon.…”

Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda

“…The literature on HIV and FP integration includes interventions targeting providers [9][10][11][12], HIV+ patients [13][14][15], and discordant couples [16,17] as well as efforts to enhance male involvement [18][19][20]. In heterosexual populations with a high prevalence of HIV, an important target audience for HIV and FP services is couples who can benefit from joint services [21][22][23].…”