Background
Little is known about the impact of
knowledge of HIV serostatus on pregnancy intention and contraceptive use in
high-HIV-burden southern African settings in the era of widespread
antiretroviral treatment availability.
Methods
We analyzed interview data collected
among 473 HIV-uninfected and 468 HIV-infected pregnant and recently postpartum
women at two sites in southern Botswana. Participants were interviewed about
their knowledge of their HIV status prior to pregnancy, intendedness of the
pregnancy, contraceptive use, and future childbearing desires.
Results
The median age of the 941 women was
27 years, median lifetime pregnancies was 2, and 416 (44 %) of
pregnancies were unintended. Among women reporting unintended pregnancy, 36 %
were not using a contraceptive method prior to conception. Among contraception
users, 81 % used condoms, 13 % oral contraceptives and 5 % an
injectable contraceptive. In univariable analysis, women with unintended
pregnancy had a higher number of previous pregnancies (P = <0.0001), were
less educated (P = 0.0002), and less likely to be married or living
with a partner (P < 0.0001). Thirty-percent reported knowing that
they were HIV-infected, 48 % reported knowing they were HIV-uninfected,
and 22 % reported not knowing their HIV status prior to conception. In
multivariable analysis, women who did not know their HIV status pre-conception
were more likely to report their pregnancy as unintended compared to women who
knew that they were HIV-uninfected (aOR = 1.7; 95%CI: 1.2-2.5). After
controlling for other factors, unintended pregnancy was not associated with
knowing one’s HIV positive status prior to conception (compared with knowing
one’s negative HIV status prior to conception). Among women with unintended
pregnancy, there was no association between knowing their HIV status and
contraceptive use prior to pregnancy in adjusted analyses. Sixty-one percent of
women reported not wanting any more children after this pregnancy, with
HIV-infected women significantly more likely to report not wanting any more
children compared to HIV-uninfected women (aOR = 3.9; 95%CI: 2.6-5.8).
Conclusions
The high rates of reported unintended
pregnancy and contraceptive failure/misuse underscore an urgent need for better
access to effective contraceptive methods for HIV-uninfected and HIV -infected
women in Botswana. Lower socioeconomic status and lack of pre-conception HIV
testing may indicate higher risk for unintended pregnancy in this setting.
Full article at: http://goo.gl/kSzvbg
By:
- 1Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. gmayondi@bhp.org.bw.
- 2Harvard School of Public Health (http://www.hsph.harvard.edu/), Boston, MA, USA. kwirth@hsph.harvard.edu.
- 3EGA Institute for Women's Health/Institute for Global Health, University College London, 74 Huntley Street, WC1E 6AU, London, UK. chelseaamorroni@gmail.com.
- 4University of Botswana, Department of Public Health Medicine, University of Botswana Main Campus, Block 246, Gaborone, Botswana. chelseaamorroni@gmail.com.
- 5Botswana-UPenn Partnership, University of Botswana Main Campus, 244G, Gaborone, Botswana. chelseaamorroni@gmail.com.
- 6Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. smoyo@bhp.org.bw.
- 7Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. gajibola@bhp.org.bw.
- 8Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. mdiseko@bhp.org.bw.
- 9Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. msakoi@bhp.org.bw.
- 10Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. jmagetse@bhp.org.bw.
- 11Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. kmoabi@bhp.org.bw.
- 12Goodtables Data Consulting, 3101 Tisbury Rd., Norman, 73071, OK, USA. jeanleid@gmail.com.
- 13Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. jmakhema@bhp.org.bw.
- 14Harvard School of Public Health, Boston, MA, USA. jmakhema@bhp.org.bw.
- 15Boston Children's Hospital, Boston, MA, USA. Betsy.Kammerer@childrens.harvard.edu.
- 16Harvard Medical School, Boston, MA, USA. Betsy.Kammerer@childrens.harvard.edu.
- 17Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. slockman@hsph.harvard.edu.
- 18Harvard School of Public Health, Boston, MA, USA. slockman@hsph.harvard.edu.
- 19Brigham and Women's Hospital, 15 Francis Street, PBB 4A, Boston, 02115, MA, USA. slockman@hsph.harvard.edu.
- BMC Public Health. 2016 Jan 16;16(1):44. doi: 10.1186/s12889-015-2498-3.
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