Identifying factors that influence pregnancy intentions: evidence from South Africa and Malawi

Abstract

In developing-country settings, pregnancy intentions are often assessed using a series of questions from the Demographic and Health Surveys, yet research conducted in several countries yields conflicting results regarding these questions' ability to predict pregnancy. Conducted in Malawi and South Africa, this study identified individual, partner and societal factors that influence desire for pregnancy, and women's ability to achieve their intentions. Data come from interviews and focus-group discussions conducted prior to the FEM-PrEP HIV-prevention trial with women from communities at high risk of HIV infection. Cultural norms regarding contraceptive use and childbearing influenced both women's desire for pregnancy and ability to achieve those goals. Partner's expectations for pregnancy, financial concerns, family composition and contraceptive experiences were additional influences. Actively planning for pregnancy was not a salient concept to the majority of participants. Results support the call for a multidimensional measure of pregnancy intention that reflects the variety of factors that influence intentions, highlight the fluid nature of many women's reproductive health decision making and challenge the notion that all fertility decisions are the result of conscious action. Additional work on how women's plans for pregnancy are achieved would be programmatically more useful than current measures of intention.

Factors associated with desired fertility among HIV-positive women and men attending two urban clinics in Lilongwe, Malawi

“…Similar to other studies in Malawi and other sub-Saharan countries, we found that having fewer children and partner’s desired fertility were associated with HIV-positive men and women desiring fertility [ 2 , 4 , 10 – 13 , 19 , 20 , 32 ]. Interestingly, age—which is inconsistently reported as associated with fertility intentions—was not associated with the desire for future children in our study.…”

“…Our findings may therefore not be generalizable outside of this group. The homogeneity of our participants in regards to ART use, being in committed relationships, and disclosing their status to partners also limited our ability to study these factors previously found to be related to desired fertility [ 2 , 10 , 11 , 18 , 19 , 32 ]. However, the two clinics provide HIV management for a large portion of HIV-positive people in Malawi’s capital.…”

Contraception coverage and methods used among women in South Africa: A national household survey

“…[73] Finally, while the study provides some measure of unmet need for contraception, this indicator is hard to measure, and the variable used (unintended pregnancy) only provides limited information. [74,75]…”

Reproduction and Fertility Beliefs, Perceptions, and Attitudes in People Living with HIV

“…A study on pregnancy intentions in South Africa and Malawi among HIV-positive women and their partners, seroconcordant and serodiscordant, found that a partner's expectations for pregnancy, finances, and family composition were key factors in negotiating pregnancy desires. The majority of participants did not actively plan for a pregnancy and challenged the notion that reproductive decisions are always conscious actions [ 64 ]. Women's conscious decisions, cited in another study, were based on their judgment of the positive aspects of motherhood versus the negative pressures of social stigma [ 65 ].…”