Attitudes toward Family Planning among HIV-Positive Pregnant Women Enrolled in a Prevention of Mother-To-Child Transmission Study in Kisumu, Kenya

Victor Akelo,Kevin Achola,Craig B. Borkowf,Lisa A. Mills,Shirley Lee Lecher,Frank Angira,Sonali Girde,Richard Lando,Timothy K. Thomas,Claire Thorne

doi:10.1371/journal.pone.0066593

Abstract

BackgroundPreventing unintended pregnancies among HIV-positive women through family planning (FP) reduces pregnancy-related morbidity and mortality, decreases the number of pediatric HIV infections, and has also proven to be a cost-effective way to prevent mother-to-child HIV transmission. A key element of a comprehensive HIV prevention agenda, aimed at avoiding unintended pregnancies, is recognizing the attitudes towards FP among HIV-positive women and their spouse or partner. In this study, we analyze FP attitudes among HIV-infected pregnant women enrolled in a PMTCT clinical trial in Western Kenya.Methods and FindingsBaseline data were collected on 522 HIV-positive pregnant women using structured questionnaires. Associations between demographic variables and the future intention to use FP were examined using Fisher's exact tests and permutation tests. Most participants (87%) indicated that they intended to use FP. However, only 8% indicated condoms as a preferred FP method, and 59% of current pregnancies were unintended. Factors associated with positive intentions to use FP were: marital status (p = 0.04), having talked to their spouse or partner about FP (p<0.001), perceived spouse or partner approval of FP (p<0.001), previous use of a FP method (p = 0.006), attitude toward the current pregnancy (p = 0.02), disclosure of a sexually transmitted infection (STI) diagnosis (p = 0.03) and ethnic group (p = 0.03).ConclusionA significant gap exists between future FP intentions and current FP practices. Support and approval by the spouse or partner are key elements of FP intentions. Counseling services should be offered to both members of a couple to increase FP use, especially given the high number of unplanned pregnancies among HIV-positive women. Condoms should be promoted as part of a dual use method for HIV and STI prevention and for contraception. Integration of individual and couple FP services into routine HIV care, treatment and support services is needed in order to avoid unintended pregnancies and to prevent mother-to-child HIV transmission.

Highlights

A significant gap exists between future family planning (FP) intentions and current FP practices
Counseling services should be offered to both members of a couple to increase FP use, especially given the high number of unplanned pregnancies among HIV-positive women
Integration of individual and couple FP services into routine HIV care, treatment and support services is needed in order to avoid unintended pregnancies and to prevent mother-to-child HIV transmission

Summary

Introduction

Women remain disproportionately affected by the HIV epidemic in sub-Saharan Africa, where women comprise 58% of the adults living with HIV, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS), 2012. 3.4 million HIV-infected children globally [1] These unfavorable statistics, coupled with the high prevalence of HIV-infected pregnant women in sub-Saharan Africa, underscore the need for HIV interventions focused on prevention of mother-to-child transmission (PMTCT) and family planning (FP) to avoid unintended pregnancies [1]. It is estimated from data collected from 42 countries in sub-Saharan Africa that 14 million unintended pregnancies occur each year [2]. Preventing unintended pregnancies among HIV-positive women through family planning (FP) reduces pregnancy-related morbidity and mortality, decreases the number of pediatric HIV infections, and has proven to be a cost-effective way to prevent mother-to-child HIV transmission.

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