Societal Influences on the Utilization of Contraception Amongst Women in South Africa

Abstract

The strong desire to experience motherhood, mediated by prevailing social and cultural norms encourage childbearing in society. Contraceptive use and pregnancy among HIV positive women in South Africa is of growing concern as it may be associated with various adverse factors having socio-economic and health impacts. The timeous initiation and optimal utilisation of antenatal care services is imperative to ensure positive pregnancy outcomes and good maternal health; not always possible due to various challenges in developing countries. Motherhood is a component of a women’s identity in cultural societies and important for female social status. Major challenges are gender-based violence and gender inequality as well as physiological factors that place women at risk like cultural and behavioural practices requiring parental consent for access to reproductive and sexual health services tend to discourage girls and women in their pursuit for decision making in reproductive health. This study examines the societal influences on contraceptive usage amongst women attending an antenatal clinic, their contraceptive use and HIV status in the city of Durban, province KwaZulu-Natal, South Africa. A cross-sectional study was conducted at a Primary Health Care (PHC) facility with a total of 283 pregnant women in trimester one visiting the antenatal clinic for the first time who completed a self-administered questionnaire. Results evidenced that almost 70% of the study population are aware of their HIV status prior to conceiving. Contraceptive usage in HIV positive participants was similar 82 (81%) to 97 (75%) in HIV negative participants. The HIV positive participants were aware of the consequences of non-contraceptive use. HIV positive women were not deterred by the desire to use contraception nor conceive (OR: 1.04, CI: 0.61 - 1.79). The study reports a high number of the women are single (>75%), low level of education (90%), unemployed (>70%). HIV status has no impact on contraceptive use and the prevalence of pregnancy among HIV positive women. The number of miscarriages (11%) and early neonatal deaths (6%) reported appeared higher in HIV positive women. Smoking (>50%) and alcohol consumption (>50%) were equally high amongst the pregnant women. Comprehensive programs for planned pregnancies in HIV positive women is necessary for a paradigm shift in the prevailing social and cultural norms worldwide. Reproductive health education extending to embrace the boys and men in the population will increase the importance and acceptance of contraception usage for both HIV positive and negative women in reproductive health care.