Fertility Intentions and Interest in Integrated Family Planning Services among Women Living with HIV in Nyanza Province, Kenya: A Qualitative Study

Harrington, Elizabeth K.; Newmann, Sara J.; Onono, Maricianah; Schwartz, Katie; Bukusi, Elizabeth A.; Cohen, Craig R.; Grossman, Daniel

doi:10.1155/2012/809682

Cited by 44 publications

(61 citation statements)

References 23 publications

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“…Efforts toward integrating FP counselling and services into HIV clinical care have improved uptake of dual method use, 283242 but there are substantial barriers to FP/HIV integration such as different funding streams resulting in vertical programming both at the policy and clinic level, inadequate training of HIV providers in reproductive health and contraceptive method choice counselling, and restricted availability of contraceptives at HIV clinics. 3443 Because condom use was lower among men and women using highly effective contraception, programmes should also ensure that appropriate messages and access to condoms continue to be reinforced.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania

Antelman

Medley

Mbatia³

et al. 2014

J Fam Plann Reprod Health Care

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Aim To describe factors associated with pregnancy desire and dual method use among people living with HIV in clinical care in sub-Saharan Africa. Design Sexually active HIV-positive adults were enrolled in 18 HIV clinics in Kenya, Namibia and Tanzania. Demographic, clinical and reproductive health data were captured by interview and medical record abstraction. Correlates of desiring a pregnancy within the next 6 months, and dual method use [defined as consistent condom use together with a highly effective method of contraception (hormonal, intrauterine device (IUD), permanent)], among those not desiring pregnancy, were identified using logistic regression. Results Among 3375 participants (median age 37 years, 42% male, 64% on antiretroviral treatment), 565 (17%) desired a pregnancy within the next 6 months. Of those with no short-term fertility desire (n=2542), 686 (27%) reported dual method use, 250 (10%) highly effective contraceptive use only, 1332 (52%) condom use only, and 274 (11%) no protection. Respondents were more likely to desire a pregnancy if they were from Namibia and Tanzania, male, had a primary education, were married/cohabitating, and had fewer children. Factors associated with increased likelihood of dual method use included being female, being comfortable asking a partner to use a condom, and communication with a health care provider about family planning. Participants who perceived that their partner wanted a pregnancy were less likely to report dual method use. Conclusions There was low dual method use and low use of highly effective contraception. Contraceptive protection was predominantly through condom-only use. These findings demonstrate the importance of integrating reproductive health services into routine HIV care.

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Section: Discussionmentioning

confidence: 99%

Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania

Antelman

Medley

Mbatia³

et al. 2014

J Fam Plann Reprod Health Care

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“…The present study emerged out of previous qualitative work during the cluster-randomised trial among HIV care providers and women and men living with HIV. Our previous studies raised many questions about relationship power dynamics and socio-cultural gender norms as factors in contraceptive access—factors that could not be addressed with interventions to improve health systems such as in the integration trial (Harrington et al 2012; Newmann, Mishra et al 2013). We sought to gain greater insight into couple decision-making and relationship power concerning fertility and family planning, in order to inform interventions targeting men and couples in the setting of high HIV prevalence.…”

Section: Methodsmentioning

confidence: 99%

Gendered power dynamics and women’s negotiation of family planning in a high HIV prevalence setting: a qualitative study of couples in western Kenya

Harrington

Dworkin

Withers

et al. 2015

Culture, Health & Sexuality

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111

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In sub-Saharan Africa, high burdens of HIV and unmet need for contraception often coexist. Research emphasises the need to engage men and couples in reproductive health, yet couples’ negotiations around fertility and family planning in the context of HIV have been sparsely studied. This study examined the gendered power dynamics that frame women’s and couples’ negotiations of contraceptive use in western Kenya. We conducted 76 in-depth interviews with 38 couples, of whom 22 couples were concordant HIV-positive. Qualitative data were analysed using a grounded theory approach. Direct communication around contraception with men was often challenging due to perceived or expressed male resistance. A substantial minority of women avoided male reproductive decision-making authority through covert contraceptive use, with concern for severe consequences when contraceptive use was discovered. Many men assumed that family planning use signified female promiscuity and that infidelity motivated covert use. Men were more willing to use condoms to avoid HIV re-infection or at the recommendation of HIV care providers, which allowed some women leverage to insist on condom use. Our findings highlight the tension between male-dominated reproductive decision-making and women’s agency and point to the need for gender transformative approaches seeking to challenge masculinities that negatively impact health.

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“…A qualitative study among HIV-infected women in Nyanza showed that perceptions about side effects of contraceptive methods strongly influenced HIV-infected women’s choices along with access to FP and partners’ resistance to contraceptive use. 9 …”

Section: Introductionmentioning

confidence: 99%

Contraceptive Practices and Fertility Desires Among HIV-Infected and Uninfected Women in Kenya

Ngugi

Kim

Nyoka

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Prevention of unplanned pregnancies is a critical element in the prevention of mother-to-child transmission of HIV infection, but its potential has not been fully realized. We assessed the utilization of family planning (FP) and fertility desires among women of reproductive age by HIV status. Methods We selected a nationally representative sample of households using a stratified 2-stage cluster design and surveyed women aged 15–49 years. We administered questionnaires and examined predictors of current use of FP and desire for children among sexually active women with known HIV infection and women who were HIV uninfected. Results Of 3583 respondents, 68.2% were currently using FP, and 57.7% did not desire children in the future. Among women who did not desire children in the future, 70.9% reported that they were using FP, including 68.7% of women with known HIV infection and 71.0% of women who were HIV uninfected. Women with known HIV infection had similar odds of using FP as women with no HIV infection (odds ratio, 1.12; 95% confidence interval: 0.81 to 1.54). Women with no HIV infection had significantly higher adjusted odds of desiring future children (adjusted OR, 2.27; 95% confidence interval: 1.31 to 3.93) than women with known HIV infection. Conclusions There is unmet need for FP for HIV-infected women, underscoring a gap in the national prevention of mother-to-child transmission of HIV strategy. Efforts to empower HIV-infected women to prevent unintended pregnancies should lead to expanded access to contraceptive methods and take into account women’s reproductive intentions.

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Fertility Intentions and Interest in Integrated Family Planning Services among Women Living with HIV in Nyanza Province, Kenya: A Qualitative Study

Cited by 44 publications

References 23 publications

Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania

Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania

Gendered power dynamics and women’s negotiation of family planning in a high HIV prevalence setting: a qualitative study of couples in western Kenya

Contraceptive Practices and Fertility Desires Among HIV-Infected and Uninfected Women in Kenya

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