Family planning behaviours among South African HIV-infected and HIV-negative women during the post partum period

Abstract

There has been growing research on the impact of HIV on family planning and fertility behaviours with studies showing conflicting results. However, these relationships have been understudied in sub-Saharan Africa, especially during the postpartum period. Based on the differences reported in different studies as well as the lack of studies performed in South Africa during the postpartum period, further research is required to investigate differences in fertility desire and use and need for family planning among and between HIV-infected and HIV-uninfected women. The aim of this study was to compare family planning use, fertility desires and unmet family planning need at 12 months postpartum in a population of HIV-infected and HIV-uninfected women from Gugulethu, Cape Town. The thesis components include a study protocol, a literature review investigating previous work on family planning uptake, fertility desire and unmet family planning need in sub-Saharan Africa, and an analysis of secondary data from three contributing studies performed in Gugulethu, Cape Town of HIV-infected and HIV-uninfected women who participated at 12 months postpartum. Logistic regression was used to model associations between HIV status and family planning use, fertility desires and unmet family planning need. Of the 854 women included in this analysis, 497 (58.0%) were HIV-infected and 357 (42.0%) were HIV-uninfected. Family planning prevalence was 62.3%, injectable contraceptives were the most common FP methods used among participants (>90.0%) and 37.2% of participants had an unmet family planning need. Only 8 participants (0.9%) had an immediate fertility desire (wanted to have a child within the next 12 months) and 20.9% wanted to have a child sometime in the future. Family planning use and unmet family planning need did not differ by HIV status however, fertility desires significantly differed by HIV status. In multivariable analysis, HIV status was not associated with family planning use or unmet family planning need. HIV status was significantly associated with future fertility desire. HIV-infected women were significantly less likely to have a future fertility desire than HIV-uninfected women (OR=0.3, 95% CI=0.2 to 0.4, p<0.001). Age, parity, intended pregnancy and discussed family planning/ pregnancy with partner were also significantly associated with future fertility desire. HIV status appears to be associated with fertility desires in this population. No significant association was found between family planning use and unmet family planning need in this population by HIV status. Family planning services need to be strengthened for all women in this population and access to a larger variety of family planning methods is needed.