High levels of unmet contraceptive needs among women living with HIV in Malawi

Pregnancy prevention and condom use practices among HIV-infected women on antiretroviral therapy seeking family planning in Lilongwe, Malawi.

Haddad LB, Feldacker C, Jamieson DJ, Tweya H, Cwiak C, Chaweza T, Mlundira L, Chiwoko J, Samala B, Kachale F, Bryant AG, Hosseinipour MC, Stuart GS, Hoffman I, Phiri S. PLoS One. 2015 Mar 26;10(3):e0121039. doi: 10.1371/journal.pone.0121039. eCollection 2015.

Background: Programs for integration of family planning into HIV care must recognize current practices and desires among clients to appropriately target and tailor interventions. We sought to evaluate fertility intentions, unintended pregnancy, contraceptive and condom use among a cohort of HIV-infected women seeking family planning services within an antiretroviral therapy (ART) clinic.

Methods: 200 women completed an interviewer-administered questionnaire during enrollment into a prospective contraceptive study at the Lighthouse Clinic, an HIV/ART clinic in Lilongwe, Malawi, between August and December 2010.

Results: Most women (95%) did not desire future pregnancy. Prior reported unintended pregnancy rates were high (69% unplanned and 61% unhappy with timing of last pregnancy). Condom use was inconsistent, even among couples with discordant HIV status, with lack of use often attributed to partner's refusal. Higher education, older age, lower parity and having an HIV negative partner were factors associated with consistent condom usage.

Discussion: High rates of unintended pregnancy among these women underscore the need for integrating family planning, sexually transmitted infection (STI) prevention, and HIV services. Contraceptive access and use, including condoms, must be improved with specific efforts to enlist partner support. Messages regarding the importance of condom usage in conjunction with more effective modern contraceptive methods for both infection and pregnancy prevention must continue to be reinforced over the course of ongoing ART treatment.

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Editor’s notes: This paper highlights the high rate of unmet contraceptive need in sub-Saharan Africa. Almost all of the women living with HIV included in this study in Malawi reported that they did not desire future fertility. Most stated that their partners also did not desire more children.  Despite this, levels of consistent condom use were low. To ensure appropriate delivery of HIV and family planning services, it is important to understand the specific needs of women living with HIV. The study has a number of limitations, such as subjective retrospective reporting by the participants. However, the high rate of unintended pregnancies highlights the continued need to integrate family planning into HIV care. Despite the biases associated with self-reported condom use, the inconsistent condom use reported by women in this study emphasises the need for additional efforts to increase access to and uptake of effective contraceptive services to couples living with HIV, in addition to other HIV prevention and treatment services.

Africa
Malawi
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