Abstract
Previous studies indicate that parenthood is a central life goal in most societies. Child bearing among HIV infected women poses danger of vertical HIV transmission. The study sought to investigate factors accounting for the differences in levels of fertility desires and intentions for HIV-infected and uninfected women of reproductive age from six hospitals in Nyanza and Central regions of Kenya. Intention connotes commitment to a course which usually leads to instrumental behaviors whereas desires are, however, wishes, which may be based more on emotions than on reality. A combination of quantitative and qualitative methods was used. Both HIV-infected and uninfected women desired and intended to have a median of three children. Women from Nyanza were 10.1 times more likely to desire more children than those from Central region (p<0.001). There was significant greater intention to have children among women aged 40-44 years or older with lower levels of education and living in rural areas. Cultural factors were found to influence fertility desires and intentions among women. To eliminate mother-to-child transmission of HIV, reproductive health interventions should take into consideration the special needs of HIV-infected women to avoid unintended pregnancies, and eliminate the risk of vertical transmission. Additional tailored sexual and reproductive care and counselling support should be provided to HIV- infected women; couples and men to assist them make decisions on issues such as number, spacing and timing of pregnancy and use of contraceptives. Fertility and family planning education should be part of each clinic visit for both female and male HIV- infected clients. More effort should be put on educating male HIV infected clients since male partners have greater influence on fertility intentions in the family in Kenyan society.
Highlights
Kenya is one of the four HIV high burden countries in Africa [1]
Factors including; region of residence, place of residence, age, education and employment status were significant in assessing the desires and intentions for children among HIV-infected and uninfected women while marital status was a significant factor for fertility intentions regardless of HIV status
This is consistent with qualitative findings of this study in both regions which indicated that women are driven by cultural norms and cultural expectations of women’s role in the society, as in the quote from HIV-infected woman focused group discussion (FGD) participant from Central region; “Women without children are not respected
Summary
Kenya is one of the four HIV high burden countries in Africa [1]. Kenya’s HIV prevalence was estimated at 5.9 percent in 2015 with more women (6.5 percent) compared to men (4.7 percent) living with HIV [2, 3]. HIV prevalence among women is 16% and 6.2% in Nyanza and Central regions respectively [4]. Coding category 35-39 40-44 45-49 Central Nyanza Urban Rural Kikuyu Luhya Luo Others Christian Others No formal education Primary Secondary Post-secondary Formally employed Self employed Housewife Married Not married. Characteristics 35-39 40-44 45-49 Residence: Nyanza vs Central (ref.) Place: Urban vs Rural (ref.) Level of Education: ref.=No Education Primary Secondary Post-Secondary Employment Status: ref.=Formally employed Self employed House wife Marital Status: ref.=Married Single Divorced Separated Widowed HIV Status: Negative vs Positive (ref.). Characteristics Age: ref.=20-24 years 15-19 [no data] 25-29 30-34 35-39 40-44 45-49 Residence: Nyanza vs Central (ref.) Place: Urban vs Rural (ref.) Level of Education: ref.=No Education Primary Secondary Post-Secondary Employment: ref.=Formally employed Self employed House wife Marital Status: ref.=Married Single Divorced Widowed HIV Status: Negative vs Positive (ref.) crude OR (95%CI).
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