Reproductive aspirations, contraception use and dual protection among adolescent girls and young women: the effect of motherhood and HIV status

Abstract

Introduction There is a growing interest in adolescent motherhood and HIV among policymakers and programme implementers. To better shape services and health outcomes, we need evidence on reproductive aspirations and contraception use in this high‐risk group, including the effect of motherhood and HIV status. We report data from a large survey of adolescent girls and young women conducted in a mixed rural‐urban district in South Africa. Methods Quantitative interviews were conducted with 1712 adolescent girls and young women (ages 10 to 24): 336 adolescent mothers living with HIV (AMLHIV), 454 nulliparous adolescent girls living with HIV (ALHIV), 744 HIV‐negative adolescent mothers (control adolescent mothers) and 178 HIV‐negative nulliparous adolescent girls (nulliparous controls) in 2018 to 2019. Standardized questionnaires included socio‐demographic measures, reproductive health and contraception experiences. Reproductive aspirations were measured as the number of children participants wanted to have. Dual protection was computed as use of both hormonal and barrier contraception or abstinence. Multivariate logistic regression and marginal effects models in STATA 15 were used to test associations between HIV status, adolescent motherhood and outcomes of reproductive aspirations, contraception use and dual protection, controlling for covariates. Results and discussion Nearly 95% of first pregnancies were unintended. Over two‐thirds of all participants wanted two or more children. Hormonal contraception, condom use and dual protection were low across all groups. In multivariate regression modelling, ALHIV were less likely to report hormonal contraception use (aOR 0.55 95% CI 0.43 to 0.70 p ≤ 0.001). In marginal effects modelling, adolescent mothers – independent of HIV status – were least likely to report condom use at last sex. Despite higher probabilities of using hormonal contraception, rates of dual protection were low: 17.1% among control adolescent mothers and 12.4% among AMLHIV. Adolescent mothers had the highest probabilities of not using any contraceptive method: 29.0% among control mothers and 23.5% among AMLHIV. Conclusions Among adolescent girls and young women in HIV‐endemic communities, reproductive aspirations and contraceptive practices affect HIV risk and infection. Tailored adolescent‐responsive health services could help young women plan their pregnancies for when they are healthy and well‐supported, and help interrupt the cycle of HIV transmission by supporting them to practice dual protection.

Psychosocial interventions for improving engagement in care and health and behavioural outcomes for adolescents and young people living with HIV: a systematic review and meta‐analysis

“…Our meta‐analysis showed limited effectiveness for improving outcomes related to sexual risk behaviours and knowledge. This is an important finding, especially given the intertwined risks of early, unintended pregnancy and secondary HIV transmission, especially in sub‐Saharan Africa [108,109]. Sexual risk behaviours in AYPLHIV have been found to be driven by a combination of individual, relationship, family, community and structural factors [110,111].…”

Sexual and reproductive health and rights of “last mile” adolescents: a scoping review

“…Sample populations included refugees from Sudan, the Democratic Republic of Congo, Somalia, Burundi, Iraq and Bhutan. n/a n/a Toska et al, 2020 63 Quantitative, Cross-sectional 10–24 Females South Africa Mixed Random and purposive Tumwesigye et al, 2013 64 Quantitative, Cross-sectional 15–24 Males and females Uganda Mixed Multi-stage cluster Wado et al, 2020 65 Scoping review 10–19 Males and females Sub-Saharan Africa n/a n/a Wong et al, 2017 66 Qualitative, Cross-sectional 11–19 Males and females China Rural Purposive Ziraba et al, 2018 67 Quantitative, Cross-sectional 12–23 Females Kenya Urban Random a At the time of this study, participants’ age varied from 18 to 35 years; however, their adolescent experiences were explored. b Age-disaggregated data for adolescents available.…”

Factors associated with pregnancy uptake decisions among seropositive HIV people receiving antiretroviral therapy in sub‐Saharan Africa: A systematic review

“…The studies recruited participants from various backgrounds including eligible HIV‐infected women (Adeleye et al, 2019 ; Atukunda et al, 2019 ; Iliyasu et al, 2019 ; Remera et al, 2017 ), new mothers living with HIV (Cuinhane et al, 2018 ), HIV‐positive women between the ages of 15 and 44 years (Mekonnen & Enquselassie, 2017 ; Muthelo et al, 2020 ), adolescents aged 15–19 who were aware of their HIV status prior to the survey (Okawa et al, 2018 ; Toska et al, 2020 ), HIV clients in serodiscordant relationships (Nakiganda et al, 2018 ; Wagner et al, 2021 ), and also, women who were non‐pregnant, non‐menopausal, aged 18–49 and diagnosed as HIV seropositive (Arikawa et al, 2020 ). The sampling methods were systematic sampling (Adeleye et al, 2019 ; Iliyasu et al, 2019 ), non‐probability sampling technique of purposive sampling (Arikawa et al, 2020 ; Cuinhane et al, 2018 ; Mekonnen & Enquselassie, 2017 ; Muthelo et al, 2020 ), convenience sampling (Okawa et al, 2018 ), stratified sampling (Toska et al, 2020 ; Wagner et al, 2021 ), and survey (Nakiganda et al, 2018 ) while in others, eligible participants were women living with HIV (more than 18 years), admitted in a postnatal ward within 5 days postpartum regardless of pregnancy outcome (Atukunda et al, 2019 ). All the studies used primary data except two that used data collected by other institutions (Mekonnen & Enquselassie, 2017 ; Nakiganda et al, 2018 ).…”