Reproductive aspirations, contraception use and dual protection among adolescent girls and young women: the effect of motherhood and HIV status.

Elona Toska,Camille Wittesaele,Nontokozo Langwenya,Lucie Cluver,Siyanai Zhou,Lorraine Sherr,Christina A Laurenzi

doi:10.1002/jia2.25558

Abstract

IntroductionThere is a growing interest in adolescent motherhood and HIV among policymakers and programme implementers. To better shape services and health outcomes, we need evidence on reproductive aspirations and contraception use in this high‐risk group, including the effect of motherhood and HIV status. We report data from a large survey of adolescent girls and young women conducted in a mixed rural‐urban district in South Africa.MethodsQuantitative interviews were conducted with 1712 adolescent girls and young women (ages 10 to 24): 336 adolescent mothers living with HIV (AMLHIV), 454 nulliparous adolescent girls living with HIV (ALHIV), 744 HIV‐negative adolescent mothers (control adolescent mothers) and 178 HIV‐negative nulliparous adolescent girls (nulliparous controls) in 2018 to 2019. Standardized questionnaires included socio‐demographic measures, reproductive health and contraception experiences. Reproductive aspirations were measured as the number of children participants wanted to have. Dual protection was computed as use of both hormonal and barrier contraception or abstinence. Multivariate logistic regression and marginal effects models in STATA 15 were used to test associations between HIV status, adolescent motherhood and outcomes of reproductive aspirations, contraception use and dual protection, controlling for covariates.Results and discussionNearly 95% of first pregnancies were unintended. Over two‐thirds of all participants wanted two or more children. Hormonal contraception, condom use and dual protection were low across all groups. In multivariate regression modelling, ALHIV were less likely to report hormonal contraception use (aOR 0.55 95% CI 0.43 to 0.70 p ≤ 0.001). In marginal effects modelling, adolescent mothers – independent of HIV status – were least likely to report condom use at last sex. Despite higher probabilities of using hormonal contraception, rates of dual protection were low: 17.1% among control adolescent mothers and 12.4% among AMLHIV. Adolescent mothers had the highest probabilities of not using any contraceptive method: 29.0% among control mothers and 23.5% among AMLHIV.ConclusionsAmong adolescent girls and young women in HIV‐endemic communities, reproductive aspirations and contraceptive practices affect HIV risk and infection. Tailored adolescent‐responsive health services could help young women plan their pregnancies for when they are healthy and well‐supported, and help interrupt the cycle of HIV transmission by supporting them to practice dual protection.

Highlights

There is a growing interest in adolescent motherhood and human immunodeficiency virus (HIV) among policymakers and programme implementers
This study addresses two important questions: First, how do reproductive aspirations, contraception use and dual protection practices of adolescent girls and young women vary by motherhood? Second, do experiences differ by adolescent mothers’ HIV status?
Sociodemographic characteristics, reproductive aspirations, contraception and dual protection frequencies were computed for the full sample and for four sub-groups by HIV status and motherhood: (1) adolescent mothers living with HIV (AMLHIV), (2) adolescent girls and young women living with HIV who have not initiated childbearing, (3) HIV-negative adolescent mothers, and (4) HIV-negative adolescent girls and young women who have not initiated childbearing

Summary

Introduction

There is a growing interest in adolescent motherhood and HIV among policymakers and programme implementers. Multivariate logistic regression and marginal effects models in STATA 15 were used to test associations between HIV status, adolescent motherhood and outcomes of reproductive aspirations, contraception use and dual protection, controlling for covariates. Despite higher probabilities of using hormonal contraception, rates of dual protection were low: 17.1% among control adolescent mothers and 12.4% among AMLHIV. By 2030, there will be nearly 1.5 million adolescent and young mothers living with HIV worldwide [2] The majority of these pregnancies are unintended, and may result from violent and inequitable relationships [36]. Despite these difficult first pregnancies, qualitative research from sub-Saharan Africa suggests that adolescent girls and young women have strong reproductive aspirations, regardless of their HIV status. Half of all unintended pregnancies among adolescent mothers end with

Methods

Results

Conclusion