Enabling women living with HIV to effectively plan whether
and when to become pregnant is an essential right; effective prevention of
unintended pregnancies is also critical to reduce maternal morbidity and
mortality as well as vertical transmission of HIV. The objective of this study
is to examine the use of family planning (FP) services by HIV-positive and
HIV-negative women in Kenya and their ability to achieve their fertility
desires.
Data are derived from a random sample of women seeking
family planning services in public health facilities in Kenya who had declared
their HIV status (1887 at baseline and 1224 at endline) and who participated in
a longitudinal study (the INTEGRA Initiative) that measured the benefits/costs
of integrating HIV and sexual/reproductive health services in public health
facilities. The dependent variables were FP use in the last 12 months and
fertility desires (whether a woman wants more children or not). The key
independent variable was HIV status (positive and negative). Descriptive
statistics and multivariate logistic regression analysis were used to describe
the women’s characteristics and to examine the relationship between FP use,
fertility desires and HIV status.
At baseline, 13 % of the women sampled were
HIV-positive. A slightly higher proportion of HIV-positive women were
significantly associated with the use of FP in the last 12 months and dual
use of FP compared to HIV-negative women. Regardless of HIV status,
short-acting contraceptives were the most commonly used FP methods. A higher
proportion of HIV-positive women were more likely to be associated with
unintended (both mistimed and unwanted) pregnancies and a desire not to have
more children. After adjusting for confounding factors, the multivariate
results showed that HIV-positive women were significantly more likely to be
associated with dual use of FP (OR = 3.2; p < 0.05). Type of health facility, marital status and
household wealth status were factors associated with FP use. Factors associated
with fertility desires were age, education level and household wealth status.
The findings highlight important gaps related to utilization
of FP among WLHIV. Despite having a greater likelihood of reported use of FP,
HIV-positive women were more likely to have had an unintended pregnancy
compared to HIV-negative women. This calls for need to strengthen family
planning services for WLHIV to ensure they have better access to a wide range
of FP methods. There is need to encourage the use of long-acting reversible
contraceptive (LARC) to reduce the risk of unintended pregnancy and prevention
of vertical transmission of HIV. However, such policies should be based on
respect for women’s right to informed reproductive choice in the context of
HIV/AIDS.
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