Repeated pregnancy among women with known HIV status in Pune, India

Abstract

HIV-positive women of reproductive age face challenges in decision making related to pregnancy. Understanding factors influencing repeat pregnancies in women with known HIV status are necessary to guide interventions and counseling strategies to better inform and support them. We compared three groups of women attending a large antenatal clinic in Pune, India. They include: Group A – 63 HIV-positive women comingfor care for a repeat pregnancy after being diagnosed in a previous pregnancy; Group B – 64 HIV-negative (repeat) pregnant women attendingthis antenatal clinic; and Group C – 63 HIV-positive non-pregnant women currently enrolled in an ongoing clinical trial. Comparisons of Group A and B indicate that the likelihood of unplanned repeat pregnancies was significantly higher in HIV-positive (70%) than HIV-negative (36%) women (OR=4.1, CI: 2.0–8.7). Inability to terminate the pregnancy (31%) and familial obligations (40%) appear to be important for continuing the unplanned repeat pregnancy. Despite high reported contraceptive use by HIV-positive women, pregnancies still occurred. Death of their youngest child is an important factor as 21% of HIV-positive pregnant women lost their youngest child compared with 3% of HIV-negative women and 3% of HIV-positive non-pregnant women (p<0.001). Repeat pregnancies were more likely to occur for women who did not disclose their HIV status to their spouse. Thus the majority of the repeat pregnancies for HIV-positive women were both unplanned and unwanted.

Keywords:

• HIV
• contraception
• pregnancy
• decision making
• India

Acknowledgements

This study was supported by a grant from the US National Institutes of Health (NIH, NIAID) (R01 AI45 462) and undertaken in collaboration with BJ Medical College in India. These data have been presented in part in the following oral presentation: ‘Repeat Pregnancy in HIV-positive women in India’ at the XVI International AIDS Conference 2006 at Toronto. This presentation was supported by a grant from Fogarty AITRP.