Integration and utilization of family planning services in a HIV clinic in Nairobi, Kenya

Abstract

Background: Women’s knowledge and access to reproductive health services improves their ability to safely achieve their required fertility, thus reducing maternal and infant morbidity and mortality. In HIV infected women the levels of unintended pregnancies range from 51-90%, with 90% of all HIV transmission among children less than 15 years being attributed to Mother to Child Transmission. Integrated Family Planning (FP) services and HIV services have been recommended as a cost effective strategy to prevent mother to child transmission. We aimed to determine the utilization of FP services among HIV Infected women visiting the HIV clinic. Methods: A cross-sectional quantitative study involving randomly selected HIV positive females was conducted in Kenyatta National Hospital, Nairobi, Kenya. The outcome variable was the utilization of family planning services. Data were acquired by one to one interviewer administered structured questionnaires and entered into Access data base. Analysis was done using Stata version 11.1. Results: We enrolled a total of 387 patients, median age (IQ range) 40 years (36-44). The contraceptive prevalence was 53% with an unmet need of family planning of 38.5%. Patients were more likely to use family planning if they were married, (OR 12.9, 95% CI 6.5-25.7, pvalue <0.01), if condoms were offered at the clinic (OR 3.2, 95% CI 1.9-5.4, p-value <0.001), if they discussed contraception with the clinic staff (OR 3.4, 95%CI 2.2-5.4, p-value <0.001) and their partners (OR 2.6, 95%CI 1.7-4.0, p<0.001). They were less likely to use FP if they had expressed fertility desire (OR 3.0, 95%CI 1.8-4.8, p-value < 0.001). Widows were less likely to use any form of FP than married couples despite having sexual partners (OR 0.1, 95% CI 0.04-0.2, p-value <0.001). Similarly, single and divorced women were less likely to use FP than married women (OR 0.1, 95% CI 0.03-0.3, p-value <0.001) and (OR 0.4, 95% CI 0.02-0.1, p-value <0.001) respectively....