Impact of HIV infection on fertility intention and modern contraceptives methods use among women attending kiambu county referral hospital comprehensive care center
Background HIV has a profound effect on morbidity and mortality particularly among the affected individuals from sub-Saharan Africa. Of the 75 % individuals now living with HIV in the region more than half of them are female. Besides, women carry a higher burden from the disease as it affects their reproductive health choices and plans. However modern contraceptive methods if used effectively can prevent Mother to Child HIV transmission, unintended pregnancies and maternal mortality Objective The aim of this study was to evaluate the impact of HIV infection on fertility intention and modern contraceptive use amongst women living with HIV. The reproductive age group was (15 – 49 years). Methodology A survey was conducted at Comprehensive Care Centre (C.C.C.) Kiambu County Referral Hospital and ethical approval was obtained as required. Participants meeting the inclusion criteria were approached briefed about the study and those willing signed the informed consent. Data collection involved interviews using structured questionnaires, focus group discussions and Key informants interviews with selected service providers. Information gathered included sociodemographic, how HIV infection and woman’s parity influences fertility intention ,the role of partners to these HIV infected women in their decision making process to use or not use modern contraceptives methods and the role of counseling on the decisions made by women living with HIV/AIDS(LWHA) concerning fertility intention. [DR. Muthoni Karanja] Page vi Results A total of 275 participants were enrolled into the study. The median age group of the participants was (30 – 34) years with range of 15 – 49 years. 123(45%) of the participants were single while 114 (41%) of the respondents had primary level as the highest level education. 250(91%) were pregnant at the time of data collection. Most of the respondents, 153 (56%) wanted to have more children. 122(44%) did not want to have more children due to assorted reasons. Of the respondents who did not want to have more children, 70(57%) stated that they were satisfied with the number of children, 26(21%) agreed that they would not risk due to HIV, 12(10%) stated that their spouse disapproved, 10(8%) of the respondents had no spouses while 4(3%) stated that their age would not allow them to have more children. Most of the participants, 193(71%) were using a family planning method while 82 (29%) did not. Out of those who used contraception, 70(36%) used condoms. Most of the respondents 196(71%) used condoms and other contraceptive methods. Only 113 (62%) reported that their partners supported them in using contraceptives. 66% made self-decisions on the mode of family planning that they use. From the 25 respondents who were pregnant, 24(95%) were on ART while 1(4%) was not on further inquiry it was reported that the patient was not compliant with ARV’s. Majority of the respondents from the focussed groups agreed that condoms were the safest mode of contraception. In the focus groups, it was also agreed that proper advice was given on family planning methods by medical attendants at the CCC and emphasis of using condoms alongside other methods of family planning were given. 48% agreed that they received family planning services during HIV support. There was a significant association between being a member of the HIV support groups and contraceptive use. Most of the respondents got more information through support groups. [DR. Muthoni Karanja] Page vii From the interviews given to Key informants reported that contraceptives; short and long-term were available, and free to the women attending CCC. Conclusion This study has been useful in determining the impact of HIV Infection on fertility intention and modern contraceptives use among women LWHA. Socio-demographic factors like age and marital status were found to influence the use of contraceptive methods among women LWHA. Most of them are in the peak reproductive age and they are single hence the necessity of contraception. Moreover, women’s parity was crucial since most women are not afraid of bearing children due to the availability of ART to all affected women. Partners’ role is minimal in decision making on contraception since most of the women make self-decisions. Recommendation The county health management team should emphasize on community outreach activities at the household level on HIV and family planning education to fill out the gap of those not on contraception and promotion of more HIV support groups.