HIV status, fertility intentions, and contraception in the era of expanded access to antiretroviral therapy: A case study of rural Mozambique

ABSTRACT

Provision of effective contraception to HIV-positive women of reproductive age is critical to effective management of HIV infection and prevention of both vertical and horizontal HIV transmission in developing countries. This exploratory retrospective study examines contraceptive use during the prolonged post-partum period in a sample of 285 HIV-positive and HIV-negative women who gave birth at four rural maternity clinics in a high HIV-prevalence region in Mozambique. Multivariate analyses show no significant variations by HIV status in contraceptive timing (mean time to first contraceptive use of 7.1 months) or prevalence (31% at time of survey) but detect a moderating effect of fertility intentions: while HIV status makes no difference for women wishing to stop childbearing, among women who want to continue having children, or are unsure about their reproductive plans, HIV-positive status is associated with higher likelihood of contraceptive use. Regardless of HIV status, virtually no condom use is reported. These results are situated within the context of a rapidly widening access to post-partum antiretroviral therapy in the study site and similar sub-Saharan settings.

KEYWORDS:

• HIV
• fertility
• contraception
• reproductive intentions
• sub-Saharan Africa

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Corrigendum

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Notably, the median reported period of postpartum abstinence was about six months, and 15% of women in the sample reported not having sex for at least one year after the pregnancy. The median duration of postpartum amenorrhea was even longer, at nine months. Along with the data on timing of first postpartum contraceptive use, these figures suggest that postpartum abstinence and amenorrhea do not necessarily deter use of contraception. In fact, substantial proportions of eventual users began use before resuming sex (31%) or before having a first post-partum menstruation (47%) (these statistics are not shown in Table 2 but are available from the authors upon request).

2. Only four respondents reported ever trying a male condom since the birth of the focal child and only two respondents were using condoms at the time of survey. It is possible that condom use was underreported in the survey, although our field observations and interviews with providers suggest that despite the vigorous promotion of condoms by health authorities, condom use in stable partnerships remains infrequent and sporadic.

Additional information

Funding

Data collection for this study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development [grant number R01HD058365]; This research was further supported by Ohio State University's Institute for Population Research [NICHD, grant number P2C-HD058484].