Improved access increases postpartum uptake of contraceptive implants among HIV-positive women in Rwanda.
BACKGROUND
Long-acting reversible contraceptives (LARCs) and sterilisation are the most cost-effective methods of contraception but are rarely used in sub-Saharan Africa partly due to limited access.


METHODS
HIV-positive pregnant women attending two urban clinics in Rwanda were followed prospectively in a perinatal HIV transmission cohort study. Women attending one clinic were referred to public family planning (FP) services for all contraceptive methods (Site A) and women attending the other clinic (Site B) were offered implants and intrauterine devices (IUDs) on-site.


RESULTS
Fifty three percent of the pregnant women reported an intention to use a LARC or to be sterilised after delivery. The uptake of implants was significantly higher at Site B (38%) than at Site A (6%). The IUD uptake was extremely low at both sites (2%). Twenty-eight of the 39 women at Site B who had intended to start using a LARC actually did so as compared to only one of 23 at Site A.


CONCLUSIONS
When access to LARC was provided, a substantial number of HIV-positive women started using hormonal implants, but not IUDs, in the postpartum period. HIV and FP services should consider improving access to implants to reduce the number of unintended pregnancies.
Dhont
Nathalie
N
International Centre for Reproductive Health, Ghent University, Ghent, Belgium. dhontnathalie@gmail.com
Ndayisaba
Gilles François
GF
Peltier
Cécile Alexandra
CA
Nzabonimpa
Aniceth
A
Temmerman
Marleen
M
van de Wijgert
Janneke
J
D000328:Adult; D015331:Cohort Studies; D003268:Contraception Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data*; D003657:Decision Making; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D012432:Rwanda; D013245:Sterilization, Reproductive / Q000523:psychology / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data; D016387:Women's Health; D055815:Young Adult