Effect of HIV status on fertility desire and knowledge of long-acting reversible contraception of postpartum Malawian women

Abstract

The objectives of this study were to describe the most recent pregnancy intentions and family planning preferences of HIV-infected and HIV-uninfected postpartum Malawian women, and to assess whether HIV status is associated with fertility desire and knowledge of intrauterine contraception (IUC) and the subdermal contraceptive implant. We conducted a cross-sectional analysis of the baseline characteristics of Malawian women enrolled in a prospective cohort study assessing postpartum contraceptive uptake and continuation. Women at a government hospital completed a baseline survey assessing reproductive history, family planning preferences, and knowledge of IUC and the implant. We used Pearson's chi-square tests to compare these parameters between HIV-infected and HIV-uninfected women. Modified Poisson regression was performed to assess the association between HIV status and fertility desire and knowledge about IUC and the implant. Of 634 postpartum women surveyed, HIV-infected women were more likely to report their most recent pregnancy was unintended (49% vs. 37%, p = 0.004). Nearly all women (97%) did not want a child in the next 2 years, but HIV-infected women were more likely to desire no more children (adjusted prevalence ratio [PR]: 1.59; 95% confidence interval [CI]: 1.33, 1.89). HIV-infected women were also less likely to know that IUC (adjusted PR: 0.72; 95% CI: 0.61, 0.84) and the implant (adjusted PR: 0.83; 95% CI: 0.75, 0.92) are safe during breast-feeding. Postpartum women strongly desire family spacing and many HIV-infected postpartum women desire no more children, suggesting an important role for these long-acting methods. Education about the efficacy and safety of IUC and the implant particularly during breast-feeding may facilitate postpartum use.

Keywords:

• HIV
• family planning
• postpartum
• contraception
• Malawi

Acknowledgment

The authors would like to thank the study participants, Tadala Kumpumula, Davious Chimwaza, Jacob Chiumia, the postpartum ward of Bwaila Hospital, and the Lilongwe District Management Team for their assistance and support of this study.

Supplementary material

Supplementary content is available via the “Supplementary” tab on the article's online page (http://dx.doi.org/10.1080/09540121.2014.972323).

Additional information

Funding

Jennifer Tang, Nora Rosenberg, and this study were funded by the UNC-CH, Johns Hopkins, Morehouse School of Medicine, and Tulane University Fogarty Global Health Fellowship (NIH [grant number 5R25TW009340-01]; PI: Charles van der Horst); the Office for Research on Women's Health, the UNC Center for AIDS Research (NIH [grant number P30-AI50410-14]; PI: Ronald Swanstrom); and Michele O'Shea was funded by the Fulbright-Fogarty Fellowship in Public Health. Support for use of the REDCap database was funded by grant [grant number 1UL1TR001111] from the North Carolina Clinical and Translational Science Award program of the Division of Research Resources.