Examining the Traits-Desires-Intentions-Behavior (TDIB) Model for Fertility Planning in Women Living with HIV in Ontario, Canada

Abstract

The objective of this study was to determine the predictors of fertility behavior (i.e., trying to become pregnant) in a large representative sample of women living with HIV of reproductive age in Ontario, Canada. The Traits-Desires-Intentions-Behavior model was used to examine the key predictors of reproductive decision making and behavior. A total of 320 women living with HIV were included in the current analysis. The women living with HIV were between the ages of 18 and 52 (mean=37.23, SD=7.53), 56.4% had at least one child living in the home, over 40% identified as being of African ethnicity, and the average time since HIV diagnosis was 10.49 years (SD=5.71). In hierarchical multilevel analysis, perceived family support for trying to become pregnant, living in a large metropolitan city (i.e., Toronto), women's fertility desires, and fertility intentions were associated with fertility behavior (χ(2)9=59.97, p<0.001). As only 10.6% of participants reported engaging in fertility-related behavior, while 57.5% intended a pregnancy in the future, identifying barriers to fertility and discrepancies between intentions and behaviors can support policy programs and assist health care providers to better facilitate the fertility goals of women living with HIV.

Sexuality and Reproduction in HIV-Positive Women: A Meta-Synthesis

“…If women lack support from family members, support from health care providers may be even more important. 65 …”

“…There is a need for practical information about contraceptives, medical risks, and interventions related to the risk of HIV transmission and barriers between fertility intentions, and pregnancy seeking behavior also need to be illuminated. 65 Women actively trying to conceive intend not to talk with their provider about safer conception strategies and they expressed confusion and concern on how to conceive safely. 66 Reproductive counseling initiated by health care providers is needed to reduce risk of transmission to partners and infants, which can have major health implications.…”

Children of the (gender) revolution: A theoretical and empirical synthesis of how gendered division of labour influences fertility

“…An alternative socio-psychological model developed independently of the TPB, by Miller and colleagues (Miller 1994(Miller , 2004, incorporates these non-conscious processes by linking fertility intentions to behaviour through a pathway (e.g. Wagner et al 2014;Mynarska and Rytel 2018). The model is thus commonly known as the TDIB framework (Traits-Desires-Intentions-Behaviour).…”

Understanding the Fertility Desires and Intentions among HIV-Positive Men Living in Ontario: Survey Instrument Development and Validation

“…While many variables influencing the desires and intentions of men living with HIV to pursue having children have been identified, many other variables or traits are equally important and also need to be considered. 9 Each of these traits may influence whether men would contemplate parenting and warrant examination to determine how collectively and independently each factor might be associated with planning to raise children and to become a parent. Moreover, current instruments do not investigate the ultimate end point of a model: the actual behavior undertaken to achieve a pregnancy.…”