Fertility intentions of HIV-infected women in the United Kingdom

Abstract

In the United Kingdom (UK), the number of pregnancies in HIV-infected women has increased dramatically over the last decade, but attitudes towards childbearing among infected women have not been previously described. The aim of this survey was to explore fertility intentions among HIV-infected women and to assess the effect of HIV treatment and interventions for prevention of mother-to-child transmission (PMTCT) on these intentions. HIV-infected women, aged between 16 and 49 years, attending one of seven HIV clinics in the UK between July 2003 and January 2004 were asked to complete a questionnaire. Information on demographic factors, HIV test history, pregnancy history and fertility intentions (i.e., desire for children) was collected. Eighty-six per cent of eligible women (450/521) completed the questionnaire. Three quarters of women (336/450) reported that they wanted (more) children. Forty-five per cent (201/450) reported that HIV diagnosis did not affect their fertility intentions, 11% (50/450) that it made them want children sooner, and 10% (44/450) did not know or reported other views. About one third of women (155/450) decided they no longer wanted children after their HIV diagnosis, but 41% of these (59/144) had changed their mind following advances in HIV management and treatment. Factors associated with an increase in fertility intentions after advances in HIV management and treatment were being in a partnership and having fewer than two children. In this survey of HIV-infected women, the majority wanted children and women were more likely to want children after improvements in HIV management and treatment. These findings highlight the need for specialised family planning and reproductive health services targeting this population.

Keywords:

• HIV infections
• fertility intention
• pregnancy
• United Kingdom

Acknowledgements

We would like to thank the clinicians who were involved with the seven participating centres. The lead clinicians were: Dr Graham Taylor (St Mary's Hospital, London), Dr Mary Poulton (Newham General Hospital, London), Dr Simon Barton (Chelsea & Westminster Hospital, London), Dr Jyoti Dhar (Leicester Royal Infirmary), Dr Elizabeth Carlin (Nottingham City Hospital), Dr David Wilks (Western General Hospital, Edinburgh) and Dr Javier Vilar (North Manchester General Hospital). We are also sincerely grateful to all the women who kindly participated in the research survey.

Susan Cliffe and Claire Townsend were funded by the UK Medical Research Council (MRC; grant numbers G1061006 and G0501895, respectively). This work was undertaken at the Centre for Paediatric Epidemiology and Biostatistics, which benefits from funding support from the MRC in its capacity as the MRC Centre of Epidemiology for Child Health. The University College London (UCL) Institute of Child Health receives a proportion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme.

SC developed the project, implemented the survey, performed the statistical analyses and drafted the initial manuscript. CT contributed to the interpretation of analyses and critically revised the manuscript. MCB and MLN contributed to study design, supervision of the statistical analyses, interpretation of analyses and writing of the manuscript. MLN was responsible for the supervision of this study.

Additional information

Notes on contributors

Claire L. Townsend

Joint first authors