Unmet Need for Family Planning, Contraceptive Failure, and Unintended Pregnancy among HIV-Infected and HIV-Uninfected Women in Zimbabwe

Abstract

BackgroundPrevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe.MethodsWe analyzed baseline data from the evaluation of Zimbabwe’s Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased) born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use.ResultsOf 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1%) reported that their births were unintended; of these women, 1,477 (47.8%) and 1,613 (52.2%) were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01). After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy.ConclusionsUnmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions.

Demand for Modern Family Planning among Married Women Living with HIV in Western Ethiopia

“…However, when compared to studies from the HIV positive women, our results are consistent with unmet need among married women in Zimbabwe (16%) [17],higher than reports from prior demographic and health surveys in Kenya [18] but lower than findings from Uganda [19]. We also found higher rates of modern family planning (combination methods used 32%), compared to a previous report from Lesotho, which documented 6% in a similar population [20].…”

HIV status, fertility intentions, and contraception in the era of expanded access to antiretroviral therapy: A case study of rural Mozambique

“…In fact, in some countries contraceptive prevalence has recently stagnated and even declined, and unmet need for family planning in the region remains highest in the world (Cleland, Harbison, & Shah, 2014), with less than half of sub-Saharan women who said that they would like to stop or postpone childbearing using contraception (Sedgh, Hussain, Bankole, & Singh, 2007). As a result, unintended pregnancies are common (McCoy et al, 2014; Singh, Sedgh, & Hussain, 2010), compromising the health and well-being of women, children, and families.…”

Effect of HIV status on fertility desire and knowledge of long-acting reversible contraception of postpartum Malawian women

“…Unintended pregnancy was common in our population, in which half of HIV-infected participants reported that their last pregnancy was unintended. Unintended pregnancy was also higher among HIV-infected women in Zimbabwe (McCoy et al, 2014), while most recent pregnancy intentions of postpartum women in South Africa and Swaziland did not differ by HIV status (Warren, Abuya, Askew, & Integra, 2013). Most of our HIV-infected women also did not want to have more children.…”