“They haven’t asked me. I haven’t told them either”: fertility plan discussions between women living with HIV and healthcare providers in western Ethiopia

Abstract

Background: Despite the importance of women living with HIV (WLHIV) engaging in fertility plan discussions with their healthcare providers (HCPs), little research exists. This study explored perceptions surrounding fertility plan discussions between WLHIV and their HCPs in western Ethiopia, from the perspectives of both women and providers. Methods: Thirty-one interviews (27 with WLHIV and 4 with HCPs) were conducted at four healthcare facilities in western Ethiopia in 2018. Data were transcribed verbatim and translated into English. Codes and themes were identified using inductive thematic analysis. Results: There was a discordance between HCPs and WLHIV's perception regarding the delivery of fertility plan discussions. Only nine of the 27 WLHIV reported they had discussed their personal fertility plans with their HCPs. When discussions did occur, safer conception and contraceptive use were the primary focus. Referrals to mother support groups, adherence counsellors as well as family planning clinics (where they can access reproductive counselling) facilitated fertility discussions. However, lack of initiating discussions by either HCPs or women, high client load and insufficient staffing, and a poor referral system were barriers to discussing fertility plans. Where discussions did occur, barriers to good quality interactions were: (a) lack of recognizing women's fertility needs; (b) a lack of time and being overworked; (c) mismatched fertility desire among couples; (d) non-disclosure of HIVpositive status to a partner; (e) poor partner involvement; (f) fear of repercussions of disclosing fertility desires to a HCP; and (g) HCPs fear of seroconversion.

[Retracted] The Fertility Status of the Married People Living with HIV/AIDS in China

“…e study showed that most PLHAs and their partners had the same desire to have children [14]. Couples considered their own and their spouse's health and marital satisfaction when making reproductive decisions [15]. Preexposure prophylaxis, male circumcision, and ovulation monitoring could effectively reduce the spouse's risk of condom-free sex and HIV infection during pregnancy [16], and medically assisted reproductive technology could be used when it is necessary to reduce the risk of the partner and HIV infection.…”

Family Planning Experiences and Needs of Young Women Living With and Without HIV Accessing an Integrated HIV and SRH Intervention in Zimbabwe-An Exploratory Qualitative Study

“…Therefore, in the context of HIV care, where individuals are seen repeatedly, there is an opportunity to develop such relationships. Discussions about family planning and fertility discussions could be layered onto such foundational relationships with providers within integrated HIV and SRH services ( 18 – 20 , 49 , 50 ). Additionally, provider support for women to select only the services that they wanted, including choosing not to take up certain options enables them to exercise agency.…”

“…Concerns about drug-drug interactions and viral load being a determinant for eligibility to use contraceptives limited their perceived contraceptive options. Studies have shown that HIV providers have not always been confident in their knowledge to effectively provide quality family planning counseling for young WLHIV ( 18 , 32 – 34 , 49 , 58 ). Mixed messages from providers and subsequent incorrect comprehension may result in WLHIV discontinuing either ART or contraception.…”

“…Organizations and international bodies have created guidance materials to describe these interactions and provide a reference for service provision ( 16 , 17 ). However, the limited data, clarity, and education on these interactions ( 15 ) adds additional complexity to the provision of HIV and family planning counseling, and further deters the provision of family planning within HIV programs ( 18 – 20 ).…”

“…Additionally, a review on the SRH needs of YPLHIV in low and middle-income countries found a paucity of clear policies to guide the provision of their SRH services ( 35 ). For young people who acquired HIV vertically, barriers include navigating the transitions from pediatric HIV programs where there are low/no exposure to sexual and reproductive health (SRH) services, to adult/youth HIV programs that may not recognize the need to introduce YPLHIV to SRH services ( 18 , 19 , 29 , 36 ). A study in Uganda found that for these young people, there were no policies for youth-friendly transition clinics, and poor institutional and provider abilities to meet the SRH needs of YPLHIV ( 37 ).…”