Reproductive intentions and family planning practices of pregnant HIV-infected Malawian women on antiretroviral therapy

ABSTRACT

The objective of this study was to describe the pregnancy intentions of pregnant HIV-infected Malawian women on antiretroviral therapy (ART) for at least 6 months prior to the current pregnancy, and to assess whether time on ART was associated with pregnancy intention. We conducted a cross-sectional analysis of HIV-infected Malawian women receiving antenatal care at a government hospital with a survey assessing ART history, reproductive history, and family planning use at conception. We used Pearson's chi-square tests and Fisher's exact tests to compare these parameters between women on ART greater than 24 months with those on ART less than 24 months. Modified Poisson regression was performed to assess the association between time on ART and pregnancy intention. Most women (75%) reported that their current pregnancy was unintended, defined as either Mistimed (21%) or Unwanted (79%). Women on ART for longer than 2 years were more likely to report an unintended pregnancy (79% versus 65%, p = .03), though there was no significant association between time on ART and pregnancy intention in multivariate analysis. Most women (79%) were using contraception at the time of conception, with condoms being most popular (91%), followed by injectables (9%) and the implant (9%). HIV-infected women on ART continue to experience high rates of unintended pregnancy in the Option B+ era. As Option B+ continues to be implemented in Malawi and increasing numbers of HIV-infected women initiate lifelong ART, ensuring that the most effective forms of contraception are accessible is necessary to decrease unintended pregnancy.

KEYWORDS:

• HIV
• family planning
• Malawi
• antiretroviral therapy

Acknowledgements

The authors would like to thank the study participants, Limbikani Chimndozi, the antenatal unit of Bwaila Hospital, and the Lilongwe District Management Team for their assistance and support of this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the UNC-CH, Johns Hopkins, Morehouse School of Medicine, and Tulane University Fogarty Global Health Fellowship [NIH 5R25TW09340-01; PI: Charles van der Horst], the Office for Research on Women's Health, the UNC Center for AIDS Research [NIH P30-AI50410-14; PI: Ronald Swanstrom] and Eunice Kennedy Shriver National Institute of Child Health and Human Development [R01HD080485; PI: Hosseinipour]. Michele O'Shea was funded by the Fulbright-Fogarty Fellowship in Public Health. Dr Tang is supported by the Fogarty International Center at the National Institutes of Health [1K01TW009657-01]. Dr Hosseinipour is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development [R01HD080485; PI: Hosseinipour]. Dr Rosenberg is supported by the National Institute of Mental Health [K99MH104154-01A1].